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34 Cards in this Set

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Neisseria Gonorrhoeae
Gram - / diplococci/ likes humid atmospheres with CO2 in 35º-37ºC temp.//oxidizes glucose.
Diognosis/TESTING--Gram stain of urethral specimens is accurate for symptomatic males only!
Thyer Martin agar//choclate with antibiotic agar is selective to pathogenic strands of nisseriae
-Nucleic acid amplification assays(best test)
Neisseria Gonorrhoeae
-2 to 5 day incubation/Purulent discharge form involved site.
-95% of men have acute SX
-primary infection is cervix on women
-SX- Vaginal discharge dysuria, abdominal pain, salpingitis, tubovarian abscesses,eptopic pregnancy, and PID...gonococcal opthalmia in newborns.
Gonoccoccemia
Sisseminated infections with septicemia. Infection of skin and joints occur in 1-3% of infected woman (will occur if continuly undetected/untreated)
SX--fever, migratory arthralgias, suppurative arthritis, and a pustular rash on an erythematous base(on extremities)--leading cause of purulent arthritis in adults.
Meningococcemia
N. Meningitidis(gram- diploc)
Septicemia (Meningococcemia)
-Life threatening if untreated
-thrombosis of small blood vessels and multi organ involvment.
-Small petechial skin lesions on trunk and lower extremities
-intervascular coagulation with shcok
-bilateral destruction of adrenal glands(Waterhouse-Friderichsen syndrome)
--also can me mild chronic septicemia where even after days or weeks only symptoms are low fever, arthritis and petechial skin lesions. <good Antibiotic response>
N. Meningitidis
-if seen on gram test as a gram negative diplococci within polymorphonuclear leukocytes then positive result is Reliable. All negative results in woman and asymptamatic men must be comfirmed with a culture.
Hepititis A vacine is called
A vacine = Harvix
A and B vacine = Twinrix

Hep A causes an ACUTE INFECTION after infection body should have immunity.
-Fecal oral transmission
Hepititis B C
Call chronic disease
Hep B and C
Hepatocellular carcinoma
and
cirrosis
Rotovirus
Doubled-stranded RNA, doubled-shelled capsid, no envelope
95% children by 3-5 years of age
ELISA/ latex agglutination
IgA antibodies
-causes viral
--double shelled capsid/no envelope. Resists harsh envioirments.
Urinary Tract Infection
(Perdesposing Factors)
=Most infections are ascending, but some can spread through the blood such as TB or staph aureus
E. Coli is most common cause of urinary infections=

-Obstruction: enlarged prostate, kidney stone, weaker detrusor muscle (causes pooling of urine where bacteria grow)
- post void residual: urine left over after micturition, can be up to 50 cc but only a few cc’s is enough to cause an infection.
-Neurogenic bladder:don’t get sensation that need to urinate or muscles will not contract. May pass urine without realizing it.; MS effects nerves, starts to demyelinate, and cause neurogenic bladder; also with diabetic patients, spina bifida, paraplegic patients, cauda equinism – affects continence.
-Vesicoureteral reflux:common in young girls-urine goes back up into ureter and kidney-hydronephrosis
-Diabetes:if blood glucose over 160 or 200, glucose will get into urine; bacteria can easily grow in the urine if it contains glucose
-Catherization:foreign body fosters growth of bacteria
-Uncircumcised male: Easy for bacteria to hide adn grow
-Sexual Intercourse-non-sterile, friction can make skin more susceptible to infection, spermicides and diaphragms increase risk
UTI Symptoms in woman-
(URETHRA 4CM)
- frequent urination,
- urgency
- burning
- suprapubic pressure
- bladder spasm (doesn’t hurt at first but start having pins and needles sensation at urethra later during flow)
-could also be pelvic inflammatory disease; test cervix by moving it – Chandelier test – will cause pain if inflamed = PID
UTI Symptoms in men
(URETHRA IS 20CM)
-complain of penile discharge
-hesitancy or decreased
urinary flow
-Urgency
-can also get prostatitis – which can be felt during palpation during DRE – digital rectal exam (the posterior portion of prostate) and will cause pain.
-PROTECTIVE FACTOR:Prostate secretes zinc which has an antibiotic effect
Diferential Diagnosis of UTI's
Women- Pelvic Inflamatory Disease/// STD's

Men:
>60: Prostatitis/prostatic hypertrophy
Younger men: STD's//wouldn’t give a urine specimen bc could wash away the bacteria.
Neisseria Gonorrhoeae
Gram - / diplococci/ likes humid atmospheres with CO2 in 35º-37ºC temp.//oxidizes glucose.
Diognosis/TESTING--Gram stain of urethral specimens is accurate for symptomatic males only!
Thyer Martin agar//choclate with antibiotic agar is selective to pathogenic strands of nisseriae
-Nucleic acid amplification assays(best test)
Neisseria Gonorrhoeae
-2 to 5 day incubation/Purulent discharge form involved site.
-95% of men have acute SX
-primary infection is cervix on women
-SX- Vaginal discharge dysuria, abdominal pain, salpingitis, tubovarian abscesses,eptopic pregnancy, and PID...gonococcal opthalmia in newborns.
Gonoccoccemia
Sisseminated infections with septicemia. Infection of skin and joints occur in 1-3% of infected woman (will occur if continuly undetected/untreated)
SX--fever, migratory arthralgias, suppurative arthritis, and a pustular rash on an erythematous base(on extremities)--leading cause of purulent arthritis in adults.
Meningococcemia
N. Meningitidis(gram- diploc)
Septicemia (Meningococcemia)
-Life threatening if untreated
-thrombosis of small blood vessels and multi organ involvment.
-Small petechial skin lesions on trunk and lower extremities
-intervascular coagulation with shcok
-bilateral destruction of adrenal glands(Waterhouse-Friderichsen syndrome)
--also can me mild chronic septicemia where even after days or weeks only symptoms are low fever, arthritis and petechial skin lesions. <good Antibiotic response>
N. Meningitidis
-if seen on gram test as a gram negative diplococci within polymorphonuclear leukocytes then positive result is Reliable. All negative results in woman and asymptamatic men must be comfirmed with a culture.
Hepititis A vacine is called
Harvix
A and B Twinrix

Hep a causes an ACUT INFECTION AND THEN HAVE
Fecal oral transmission
Hepititis B C
Call chronic disease
Hep B and C
Hepatocellular carcinoma
and
cirrosis
Rotovirus
Doubled-stranded RNA, doubled-shelled capsid, no envelope
95% children by 3-5 years of age
ELISA/ latex agglutination
IgA antibodies
-causes viral
--double shelled capsid/no envelope. Resists harsh envioirments.
Urinary Tract Infection
(Perdesposing Factors)
=Most infections are ascending, but some can spread through the blood such as TB or staph aureus
E. Coli is most common cause of urinary infections=

-Obstruction: enlarged prostate, kidney stone, weaker detrusor muscle (causes pooling of urine where bacteria grow) post-void residual – urine left over after micturition, can be up to 50 cc but only a few cc’s is enough to cause an infection

-post-void
residual
-Neurogenic bladder
-Vesicoureteral reflux:common in young girls-urine goes back up into ureter and kidney-hydronephrosis
-Diabetes
-Catherization
-Uncircumcised male
-Sexual Intercourse
UTI Symptoms in woman-
(URETHRA 4CM)
- frequent urination,
- urgency
- burning
- suprapubic pressure
- bladder spasm (doesn’t hurt at first but start having pins and needles sensation at urethra later during flow)
-could also be pelvic inflammatory disease; test cervix by moving it – Chandelier test – will cause pain if inflamed = PID
UTI Symptoms in men
(URETHRA IS 20CM)
-complain of penile discharge
-hesitancy or decreased
urinary flow
-Urgency
-can also get prostatitis – which can be felt during palpation during DRE – digital rectal exam (the posterior portion of prostate) and will cause pain.
-PROTECTIVE FACTOR:Prostate secretes zinc which has an antibiotic effect
Diferential Diagnosis of UTI's
Women- Pelvic Inflamatory Disease/// STD's

Men:
>60: Prostatitis/prostatic hypertrophy
Younger men: STD's//wouldn’t give a urine specimen bc could wash away the bacteria.
Urine Specimen Collection
-First morning vs. random
-clean-catch
-midstream
-straight cath: not out of bag
-indwelling caths,
-suprapubic aspiration- (20cc)long needle through stomach into bladder
-nephrostomy tube collections
Tin- Kol bag- use on toddlers-goes around entire genital region
(boric acid perserves collection)
Urinalysis
Ketones-in diabetics or if pt is dehydrated
-Positive leukocyte, nitrate, and protein indicates specimen needs to be cultered
--UA-dipstick result---spin---in tube—supernutent at top and concentrate sediments at bottom-look at sediment microscopy for cells, bacteria, casts, sperm, mucus, trichomonas and quantitate
Culture of Urine bacteria
Usually on SBA and MAC plates (Mackonkey plate)
Mackonkey –U see E. coli and other gram-negative agents; distinguishes btwn lactose fermentors and nonfermentors
--SBA – can detect swarming Proteus or gram-positive causative agents;
Staph saprophyticus – most common in sexually active females; also grp B strep and diptheroids
!!.01cc Calibrated loop is used to plate – so any colony that grows represents 1000 col/.01cc urine;
-whole plate full means greater than 100,000 colonies per cc.
--3 colonies per .01 means infection
UTI Prevention and Treatment
-Patient needs to be educated on proper hygeine—(to prevent self contamination with wiping)
-urination after sexual intercourse
-Prophylatic antibiotics: bactrim
= trimethiprim/sulfa),
= Macrobid (nitrofurantoin)
= Keflex (cephalexin)
-can be taken to prevent
UTI’s
UTI SIGNS! (NOT SYMPTOMS)
Signs (objective):
- dark, malodorous (with odor) urine;
+ leukocytes
+/- nitrite
+ protein with >50 WBC per field and 3+ bacteria colonies
-Tenderness on palpation
-Nausea/Vomiting/Fever/Chills
with flank pain =
pylonephritis symptoms
-Fever
-increased WBC, tachycardia,
- + CVA (costovertebral)
- tenderness = pylonephritis signs
--Degree of pyuria does NOT necessarily correlate with severity of symptoms
Organisms
(#1 cause = Escherichia coli)

-Enterobacteriacae-Klebsiella, Proteus species (urinary stones),
Pseudomonas, Enterobacter, Serratia
-Enterococcus, Staph epidermidis: Seen in hospital settings more often because normal skin flora gets into cathater.
-Staph saprophyticus-sexually active women

++(Proteus-creates urease which can make some patients more prone to kidney stones
Urethritis
pertainting to(UTI)
Men vs. women
Gonococcal-Neisseria gonorrhoeae
Nongonococcal-Chlamydia trachomatis

(Rare viral and parasitic causes of UTI too)
Rare causes of UTI's
-Adenovirus-hemorrhagic cystitis
-Hantavirus- infects capillary blood vessels in kidney
-Schistosoma haematobium-inflammation of the bladder