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76 Cards in this Set

  • Front
  • Back
How does urine protect the urinary tract?
low pH, Urea, Osmolarity, high force expulsion
Other urinary tract protectors?
sphincter, mucus, tamm-horsfall glycoprotein, Lewis antigen (ABO)
How does Tamm Horsfall work
blocks adherence of organisms
How can someone be predisposed to UTI?
people that don't secrete Lewis Antigen
Are males more likely to get UTI
NO!! Females 14:1
At what ages are males and females equally likely to get UTI?
less than 1 years old
Is the ratio of female to male UTI higher in old age or lower
Much higher 40:1 in over 60yo
Can men get UTI?
yes, especially if they have predisposing problem (prostatitis, congenital malformation)
How can organisms bypass protection?
Sex, Antibiotics kill normal flora, CATHETERS
Nosocomial Infections
10% of catheter patients get UTI; often antibiotic resistant, WASH YOUR HANDS. Staph epidermidis usually cause catheter problems
do UTI usually get 100% identified?
No, just assume it is E. Coli
How does UPEC attach to urinary epithelia?
fimbriae
Pap-->kidney and upper ureter
1-->urethra and bladder
E. Coli UTi cycle
Type 1 fimbriae-->bladder epithelia-->cystitis(inflamm response)-->bladder exfoliates-->some bacteria invade-->pyelonephritis(kidney)
what allows long term e.coli infection
Pods-they are antibiotic resistant too
How does proteus stay in urniary tract
excellent swimmer; swims upstream
Proteus Mirabilis
prolific swimmer, 3% of UTI; has its own urease; precipitates satls-->struvite or apatite stones
Dx Proteus
significant bacteria in urine; dipsticks for leukocyte esterase and nitrate reductase; gram (-), oxidase (-)
Tx Proteus
fluoroquinolones, amoxicillin, trimeth-sulfa, ??FimH immunization to prevent attachment??
How does body keep vaginal organisms out of uterus
cervyx w/ mucus plug
Normal Flora of Urethra and bladder
Nothing-it's sterile
external genitalia and distal urethra flora
small # intestinal flora
Vaginal flora
Lactobacillus, bacteroides, candida, strep and staph, gardnerella vaginalis
Uterine Flora
Nothing or else baby in trouble
Toxic Shock Syndrome
staph aureus grew like crazy in old tampons-->TSST-1 produced-->fever, "sunburn"-->hypotension, desquamations
Rank the STDs on prevalence
Trichomoniasis, Papillomavirus, Chlamydia, HSV-2(genital), Gonorrhea, Hep B, Syphilis, HIV, Bacterial vaginosis
STD epidemiology
1 in 4 has STD in US; $10 billion/yr; blacks much more likely
Is chlamydia higher in men or women?
Gonorrhea
Women
What makes an STD
Human specific; no environment exposure; often asymptomatic; increase HIV transmission
What effect does STD have on HIV spread
Lesions, increased CD4 cells, T cell activation, risky business-->HUGE increase
Neisseria Gonorrhea
Gram (-) diplocoocci
grows on chocolate agar in candle jar
men-->urethra Women-->CERVYX
purulent discharge, PMNs,
can become systemic
Dx Neisseria Gonorrhoeae
classic-gram stain (-)
Modern-Ligase chain reaction
Neisseria Gonorrhoeae virulence
Pili, OPA, LOS Sialic Acid, Serum resistance, invades epithelium, survive in PMNs, sIgA protease, Iron uptake
What is the best animal model for N. Gonorrhoeae
There isn't one- volunteers only
Gene variation in Neisseria Gonorrhoeae
N terminal conserved; pilE switches
Cx of Neisseria Gonorrhoeae
PID;
systemic(1-3%)-->arthritis, endocarditis, meningitis;
Perinatal Infection-->blind
prevent with antibac eye drops
Chlamydia trachomatis
obligate intracellular
human pathogen
no protective imminity
inflamm discharge
gram (-) like w/o peptidoglycan
LPSs and OMPs
Dx Chlamydia trachomatis
classic- PMN w/o diplococi
Ligase Chain Reactions
why isn't Chlamydia trachomatis well-studied
hard to grow
Life cycle of Chlamydia trachomatis
enter-->elementary body in vacuole-->reticulate body-->mature reticular body-->release
Cx of Chlamydia trachomatis
PID
60-70% of perinatal seroconvert
17% pneumonia
33% conjunctivitis (blindness)
lymphogranloma venereun
40% lead to chlamydia
Pelvic Inflammatory Disease (PID)
lead cause of infertility and ectopic
can be caused by normal flora
recurrent in common
infertility risk increases w/ recurrence
chlamyida damages cervyx so block lost between vag and uterus
how do we treat gonorrhea?
chlamydia? why?
gonorrhea-->penicllin

chlamydia--> not penicillin bc it does not have peptidoglycan
Ligase Chain Reaction
just like PCR but extra primers that must be ligated before extension
Treponema Pallidum
spirochete
gram (-) like
too small to see in scope for gram
humans only
enters through small lesions
Who gets more syphilis
Men by a lanslide
1ary syphilis
14-21 d post innoculation
red painless papule at site
can form ulcerated chancre
enlarged lymph node
bacteria present in chancre
3-8 weeks healed
2ary syphilis
4-10 weeks
spread through lymphatics and blood
like low temps
rash soles of feet and palms
flu-like, itch, swollen nodes, mild hepatitis
Latent syphilis
immune gaisn control
2ary symptoms resolved in 3-12 wks
not infectious
1/3 clear infection on own
3ary syphilis
years or decades hidden
granulomas
CNS neurosyphlis
meningitis, optic nerve, deafness
Neurosyphilis and HIV
Rapid transition from 1ary syphilis to CNS damage
What causes syphilis?
Treponema Pallidum
Treponema Pallidum
congenital- crosses placenta
gram (-)
flagella in periplasm
OMPs are immunogenic
LPS not recognized by TLR4
only cultures in rabbit nuts
no capsule or toxins
small inoculum
modulates immune response
Treponema Pallidum Dx
serological for anti-cardiolipin
most successful in 2ary syphilis
good indicator of current infection
Treponema Pallidum Dx
MHATP-microhemagglutinin assay
positive for life
can't tell how long they have had it
Treponema Pallidum Tx
Does NOT become peniccillin resistant
procain penicillin for HIV neurosyph
rapid resistance to azithromycin
What is most common Vaginal flora
Lactobacillus 95%
long gram (+) rods
aerotolerant anaerobes
how does lactobacillus help vagina
ferments glycogen to lactic acid to lower pH
produce H peroxide and antimicrobials
how does vagina help lactobacillus
secretes glycogen
How to avoid harming vaginal flora
Minimize antibiotics
No Douching
Should women Douche?
DON'T EVER DOUCHE

Tell patients not to do it
Vaginosis-overgrowth of resident microflora
gram (-) anaerobe usually;
discomfort, itching, gray discharge; fish smell; high pH
Cx of vaginosis
PID
preterm delivery/ low birthweight
increased HIV susceptibility
Tx of vaginosis
clindamycin or metronidazole
Candida Albicans
Yeast Infection
cutaneous infections, oral thrush, burns, catheter UTI;
intense itch, thick white discharge, no odor
Yeast Infection TX
Miconazole-OTC
Virulence Factors of C. Albicans
adherence factors, mimicry, hydrolytic enzymes, hyphal transition
Trichomonas Vaginalis
7.4 million cases/yr
protozoa-no cyst; trophozoite only
male urethral infxn x 10 days
diagnosing T Vaginalis
wet mount of vag swab
jumpy, twitchy movement
Trichomonas Vaginalis Sx
Yellowish-green frothy discharge
itching/burning
"strawberry" cervix
premature rupture of membrane, PID
Trichomonas Vaginalis Tx
metronidazole

treat partner too to prevent passing back and forth
Normal
Long G+ rods
Ph <4.5
Gonorrhea
PMN, diplococci
pH <4.5
Ligase Chain Rxn
NGU
PMNs
pH <4.5
Ligase Chain Reaction
Bacterial Vaginosis
Short G- rods
Clue Cells-epi cells shed with G- rods
pH >5 Fishy odor
Candida Vaginits
Yeast Infection
Long G+ rods Candida
pH , 4.5
hyphae in wet mount and 10% KOH
very large
Trichomoniasis
Long G+ rods Trichomnad
pH <4.5?
jerky motility in wet mount