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91 Cards in this Set
- Front
- Back
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What defines a significant bacteriuria?
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It is defined by the presence of greater than 10^5 colony forming units
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What are the gram negative rods that are associated with nosocomial UTI
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E.coli (major), Proteus, Klebsiella, Serratia, Pseudomonas
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What are the gram positive organisms that are associated with community-acquired uncomplicated UTI
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Staphylococcus saprophyticus, Enterococcus
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What defines a pyuria?
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The presence of 10 or more neutrophils per high power field of unspun urine
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List the characteristics of the Enterobacteriaceae.
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1. Gram negative rods 2. facultatively anaerobic 3. all ferment glucose (E.coli also ferments lactose) 4. oxidase negative. 5. Grow on blood agar 6. have either two or three antigens- somatic O antigen, H antigen, K antigen
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Common UTI with catheterization
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proteus species
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E coli is oxidase (+ or -)
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oxidase negative
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With UTIs urinalysis shows elevated...
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leukocyte esterase, possible WBCs if it is pyelonephritis
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Which E coli virulence factor is found on the capsule?
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K antigen
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E coli LPS is found with which antigen
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Somatic O antigen
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E coli is grown on what agar?
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blood agar
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What is the role of the fimbriae of E.coli?
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It allows them to adhere to the uroepithelium. They also stimulate local inflammatory responses like the secretion of IL-6 and IL-8 and the induction of both apoptosis and epithelial cell desquamation
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What faciliates the movement of gram negative bacteria to the ureters and kidneys?
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Flagella
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What are the common risk factors of cystitis?
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Urethral stricture; increased residual volume; decreased urinary flow; stasis; decreased urinary acidification/concentration; catherization
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The treatment course for an uncomplicated UTI is _____ but those with risk factors for pyelonephritis, the treatment course is _______.
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3 days; 10 to 14 days
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2 types of E coli fimbriae
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P-fimbriae and type 1
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Kidney stones are more common in E coli UTI due to what enzyme's activity?
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urease; increases the pH = more alkaline = promotes kidney stones
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Kidney damage by E coli is mediated by what enzyme?
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hemolysin
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E coli use what siderophore to sequester iron?
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aerobactin
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How can we clinically differentiate pyelonephritis from uncomplicated UTI?
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WBC in urine indicates pyelonephritis; leukocyte esterase without WBCs is uncomplicated UTI
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Pregnant women are at risk of E coli meningitis due to what antigen?
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K1 capsular antigen
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What stage of syphilis features constitutional symptoms?
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Secondary syphilis
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Describe condylomata lata.
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Flat topped papules, found wherever contiguous folds of skin produce heat and moisture
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When does secondary syphilis typically appear?
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disseminated disease appears within 6 months of primary infection
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What is the cause of the gummatous ulcerations in tertiary syphilis?
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A delayed- type hypersensitivity to T pallidium mediated by sensitized T lympho cytes and macrophages
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What stages of syphilis are considered infectious?
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Primary syphilis; secondary, latent (infected mothers can pass it to newborns)
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Palmar rash and condylomata lata indicate which STD?
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SECONDARY syphilis (treponema palladium)
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Chancre alone indicates which STD
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primary syphilis
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What is a chancre?
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painless ulcer on genitals in primary syphilis
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2 types of tests for syphilis
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RPR, VDRL
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Gummatous ulcers are seen in which type of syphilis?
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tertiary syphilis
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Latent syphilis (is or isn't) passed down to newborns?
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latent can still be passed to newborn; can also progress to tertiary
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Argyll Robertson pupils are seen in which STD?
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tertiary syphilis
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Congenital syphilis is acquired via _____ transmission.
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vertical
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When does the vertical transmission of syphilis occur?
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It occurs after 18 weeks of gestation and with women infected for 2 years or less- may cause abortion or stillbirth
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What is the treatment of primary, secondary, and latent syphilis?
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Benzathine penicillin G
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What is the treatment of neurosyphilis?
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High dose IV PCN G
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What is tabes dorsalis?
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degeneration of dorsal column and dorsal roots in tertiary syphilis = motor ataxia; symptoms are shooting pain, charcot joints, and Argyll Robertson pupils
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Describe the herpesvirus structure.
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Icosahedral nucleocapsid, linear double stranded DNA genome and a lipoprotein envelope
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How can neonatal herpes be prevented?
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Treat for the last 4 weeks of pregnancy using acyclovir can reduce the risk
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The first- episode of HSV-2 infection during pregnancy can result in __.
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spontaneous abortion, prematurity, and congenital and neonatal herpes.
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Describe the structure of HPV.
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Nonenveloped viruses of icosahedral symmetry that surrounds double stranded circular DNA
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How does HPV cause unregulated epithelial growth?
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HPV proteins E6 and E7 of HPV types 16 and 18 inactivate the host's tumor suppressor proteins p53 and RB
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Painful, itchy blisters on penis indicates which STD?
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HSV2 (genital herpes)
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Herpes is seen diagnostically on what type of smear?
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Tzanck smear shows giant multinucleated cells
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Primary herpes lesions are due to ...
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cytolytic effects on mucocutaneous epithelium
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Herpes treatment
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acyclovir 10 days
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Raised lesions on the cervix indicates which STD?
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HPV
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What HPV types cause skin cancers in transplant recipients?
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6,11
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Sexual activity before what age is a major HPV risk factor?
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15
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Which types of HPV are linked to cervical cancer?
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16, 18
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Cytological description of HPV infected cells
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nuclear atypia, koilocytosis, perinuclear clearing (halo) and shrunken nucleus
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HPV E7 protein affects what anti cancer protein?
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RB
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HPV E6 protein affects what anti cancer protein?
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p53
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Yellow penile discharge indicates what STD?
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Gonorrhea
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Neisseria gonorrhea are oxidase (+ or -)
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oxidase positive
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Bean shaped, gram negative diplococci within a neutrophil indicates ...
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neisseria gonorrhea
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Neisseria gonorrhea is grown on which media?
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Thayer Martin
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What are the virulence factors in N. gonorrhoeae?
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pili, cell-wall lipooligosaccharide (LOS), and outer membrane proteins (OMP)
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What components of N. gonorrhoeae undergo phase variation?
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pili, OMPs ( host antibodies do not protect against these)
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What is the cause of the gonococal urethral discharge?
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local invasion through or around epithelial cells allows it to reach the subepithelial matrix --> inflammatory reaction
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Neisseria gonorrhea ferments _____ and is oxidase ____
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glucose; positive
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Neisseria gonorrhea treatment
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ceftriaxone
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How can a gonorrhoeae infection cause infertility in men?
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via untreated epididymitis
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How can a gonorrhoeae infection cause infertility in women?
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via PID with internal abscesses
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What is the treatment for gonococcal conjunctivitis?
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silver nitrate, tetracycline, or erythromycin
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Who is at risk for a disseminated gonococcal infection?
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Absence of bactericidal antibody or terminal components of the complement pathway (C5-C8)
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Lower abdominal pain and red cervix indicates which STD?
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chlamydia
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How does chlamydia infect the mucosal membranes?
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1. through minute abrasions as metabolically inert elementary bodies that stimulate host cellular uptake. 2. they specifically target the columnar epithelia cell receptors on the cervix, the internalized Ebs in the host vacuole differentiate to larger metabolically active reticulate bodies 3. the RBs multiply by binary fission and then they reorganize to EBs and lyse cell --> proinflammatory cytokines
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Which chalmydia serotypes are the worst?
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D to K
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Chlamydia reticulate bodies replicate by ...
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binary fission
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Chlamydia elementary bodies become reticulate bodies where?
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in host vacuoles (cytoplasmic inclusions)
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Sexual intercourse spread chlamydia (elementary or reticulate bodies)
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elementary bodies are spread and become reticulate bodies in the host
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What factors allow for the extension of chlamydiae to the endometrium and endosalpinx
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Estrogen- dominated [thin] cervical mucus, attachment of the organisms to sperm, BV, IUDs
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Chlamydia treatment
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doxycycline
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Chlamydia infection with painful inguinal lymphadenopathy indicates...
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LGV, lymphogranuloma venerum
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What is Chlamydial trachoma?
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caused by chlamydial serotypes A,B and C; chronic infection of the conjunctiva leads to follicles of inflammatory cells; fibrosis of eyelid causes lashes to turn inward and abrade cornea
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What are the chlamydia serotypes that are responsible for lymphogranuloma venereum?
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L1, L2, L2a, and L3
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Neonatal conjunctivitis is seen with which STD?
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chlamydia
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Neonatal pneumonia is seen with which STD?
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chlamydia
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Reiters syndrome is seen with which STD?
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chlamydia
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Triad seen in Reiters syndrome
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cervicitis (urethritis), conjunctivitis, arthritis; seen 6 months after chlamydia infection
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Chlamydia serotypes A, B, C are responsible for blindness due to what syndrome?
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Trachoma
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Yellow vaginal discharge + Strawberry cervix indicates which STD?
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trichomonas
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what is the causative agent in bacterial vaginosis?
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Gardeneralla vaginalis and Mobiluncus
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What is a diagnostic finding in bacterial vaginosis?
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The presence of a vaginal epithelial cell with attached microorganisms --> clue cells
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What would direct examination of a vaginal secretion of T. vaginalis show?
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Pus cells interspersed with the nucleated, flagellated trichomonads with ameboid motility.
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What is the typical vaginal pH in a T. vaginalis infection?
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greater than 4.5
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What are the symptoms seen in men with T.vaginalis infection?
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none; usually asymptomatic
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What is the treatment of trichomonas?
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metronidazole
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Who is at high risk for developing Reiter syndrome?
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those with HLA-B27
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