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116 Cards in this Set
- Front
- Back
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what are some clinical features of uncomplciated urethritis or cystitis? what about pyelonephritis
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dysuria = uncomplicated urethritis or cystitis
fever, sepsis, decreased kidney function = pyelonephritis |
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what is the cause of 90% of UTI
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e. coli
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what are high risk groups of UTI
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general pop and sexually active women esp ones that use diaphragm with spermicide
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why are spermicides a RF for UTI
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they increase colonization of vagina with uropathogens and increase adherence of E. Coli to vaginal epithelial cells
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what sx accompany cystitis and what location does it occur in
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FUD
frequency, urgency, and dysuria occurs in suprapubic area |
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what will you find in the urine of pts with cystitis
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bacteria, WBC, sometimes hematuria
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what does the urine look and smell like for a pt with cystitis
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malodorous
bloody |
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how does urine from acute pyelonephritis differ from cystitis
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WBC, CELLULAR CASTS*, bacteria, and *PROTEIN
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if you don't treat pyelonephritis, what can it lead to
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nephron loss and renal failure
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what is the MC of urethritis
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bacterial inflammation of urethra
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if you have glomerulonephritis, what will you see in the urine
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plasma protein and blood cells
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what are the MCC of cystitis
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E. Coli
Klebsiella, Proteus, staph saprophyticus, serratia marcescens, pseudomonas aeruginosa, enterococcus faecalis |
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cystitis is more common in women why?
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short urethra and location is near anal opening allowing for fecal contamination
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what usu precipitates prostatitis
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bladder or urethral infection and often dt catheterization
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what are some virulence factors for UTIs
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adherence to vaginal and uroepithelial cells
cytotoxic, necrotizing factors hemolysin |
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the genes for the virulence factors are linked together and called what
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pathogenicity islands
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t or f pathogenicity a pt w/o FUD sx still has pathogenicity islands
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false. they are absent in normal, fecal coliforms
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what makes up pathogenicity islands
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mobile genetic elements ( in addition to virulence plasmids)
genes that encode secreted virulence proteins virulence proteins which are made of fimbriae, pili, OMP, which are needed for colonization and attachment |
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what determines the anatomical location of infections in UTIs
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adhesive properties
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which adheres better, pyelonrphitis or cystitis isolates
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e. coli pyelonephritis isolates
urinary isolates > fecal isolates |
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what cytokines are mediators of UTIs
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IL-6, IL-8
these help bring in the e. coli and exfoliate the skin |
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what are the main things to know about e. coli
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G-
facultative anaerobes virulence factors= pili and LPS endotoxin (inflammation) MC cause of UTI |
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what is the tx for e. coli
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PCN, ciprofloxacin
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what are the virulence factors of e. coli from extraintestinal infections
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col V plasmid- codes for sidorophore for fe chelation
hemolysin- damages host cells, releases fe from RBC enterochelin - chelates fe for bacterial uptake k1 antigen - impedes phagocytosis p pili - prevents binding of bac to p blood group Ag type 1 pili - prevents binding to bladder epithelium |
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what are the main things to know about proteus vulgaris/mirabilis
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G-
facultative anaerobes opportunistic, transmitted via catheters enteric bacteria urease positive **- raises pH via urea --> ammonia HIGHLY MOTILE ** |
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it is the 2nd MC cause of UTI. however, unlike e. coli, it will infect _________ more commonly than e. coli
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kidneys
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what is the demographic of pts infected with proteus mirabilis
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structural abnormalities of the urinary tract
elderly pts undergoing long term catheterization |
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what are some things proteus mirabilis produces to invade and attach to host
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pore forming hemolysins
endotoxin urease adhesins pili, fimbriae, flagella, biofilm formation |
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because of its ability to hydrolyze urea --> ammonia, what are pts with proteus mirabilis at risk for
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with the pH rising dt increased ammonia, pts are at increased risk for struvite (magnesium ammonium phosphate) stones and calcium phosphate stones
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what characteristic of proteus mirabilis is critical to its virulence
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swarming ability
protease and hemolysin is specific to swarmer bacteria |
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what is paranitrophenyl glycerol (PNPG)
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it is a tx for proteus mirabilis undergoing research right now.
it is an anti swarming agent which inhibits expression of hemolysins, proteases, flagella inhibits invasion of urothelial cells |
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what is the tx for proteus mirabilis
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PCN and cephalosporins
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what is not susceptible to
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nitrofurantoin and tetracycline
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there is an increasing resistance for proteus mirabilis to what drugs
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cat
ciprofloxacin ampicillin trimethoprim |
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this organism is coagulase negative, catalase positive, gram + cocci, nitrite negative, resistant to novobiocin, and nonhemolytic dt it being gamma hemolytic
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staph saprophyticus
UTI that occurs in sexually active women, honeymoon cystitis |
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this organism gives a brick red color, is a gram - bacilli, belongs to the enterobactericeae family, and is + for DNAse, gelatinase, lipase, citrate utilization
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serratia marcescens
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back in the day, serratia marcescens was used by the military in biowarefare tesets. they also conducted a secrete experiment where they sprayed serratia marcescens over the SF bay area to gauge a similar bio attack. what was there an increase of in the hospitals
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pneumonia and urinary tract infections
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what microorganism is related to group D streptococci
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strep faecalis
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enterococcus faecalis is a causative agent for what infections
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endocarditis
cystitis wound infections typically found in GI tract |
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T or F enterococcus faeclis is not a group D streptococci
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FALSE. it is a group D strep and its lancefield classification is based on the antigenicity of the c-carbohydrate
human pathogens are A, B, D, and G strep lacking the c carb = viridans strep |
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enterococcus faecalis grown on blood agar will show what kind of hemolysis
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gamma hemolysis
*remmebe rthat staph saprophyticus also does gamma hemolysis |
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what will enterococus faecalis look like on bile esculin agar
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black discolocation
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what other type of medium can enterococcus faecalis grow on that many other microorganisms can't grow on
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6.5 % NaCl
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since staph saprophyticus and enterococcus faecalis can both do gamma hemolysis, what other test is saprophyticus + for that enterococcus is - for
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catalase
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25% of the genome for enterococcus faecalis is acquired how
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exogenously acquired DNA
Lateral gene trasnfer between genus and species |
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pathogenicity islands for enterococcus faecalis have what kind of genes
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genes that produce toxin that forms holes in cell walls and adherence
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what is the virulence factor for entereococcus faecalis
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abx resistance via ability to acquire mobile gene elements and rapid acquisition and dissemination of drug resistance
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what is the tx for enterococcus faecalis
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amoxicillin, ampicillin, vancomycin, resistance to this abx is appearing in e. faecalis
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this is non motile, G-, aerobic, has endotoxin activity , and produces red currant like jelly capsule also called "k antigen"
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klebsiella
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what other microorganism has endotoxin activity, specifically LPS
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e. coli
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what does klebsiella look like on a culture
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large mucoid colonies
has a large mucoid polysaccharide capsule which aids in adherence and protects microorganisms from phagocytosis |
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klebsiella is considered opportunistic. what other microorganism is considered opportunistic
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staph saprophyticus because it is transmitted via catheter or soon after catheterization
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where is klebsiella normally found and what is it a major cause of
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commonly found in mucosal surfaces, passed by hospital personnel --> nosocomial infections
causes UTI and lower resp tract, biliary tract infections |
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if there is a patient in the hospital that develops a lower respiratory tract infection, what will their sputum look like
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thick, bloody, mucoid sputum (red currant jelly)
they will have hemoptysis |
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what can klebsiella sp. cause?
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UTI, primary p nuemonia, wound infections, bacteremia, meningitis, diarrhea
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what is the tx for klebsiella
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cephalosporin
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this is part of the urogenital tract flora. there is an increased risk of this infection with taking broad spectrum abx, pregnancy, diabetes, AIDS, surgery, in-dwelling catheters
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candida sp.
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what is the tx for candida
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nystatin or clotrimazole
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at 37 deg C , candida will form what? this is the first step in what transition
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yeast form to hyphal form and forms germ tubes
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what active component in the serum is an inducer of germ tube formation
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D-glucose
optimum pH for this activity if pH 7-8 |
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what can inhibit germ tube formation
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enzymatic destruction of D-glucose by glucose oxidase
no germ tube= no adherence or colonization germ tube is essentially the virulence factor for candida |
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germ tube is a cofactor for candida sp. in its ability to do what? germ tube formation is triggered by environmental cues like what
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co factor for ability to adhere
formation triggered by environmental cues like pH, temperature, chemical inducers |
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nosocomial UTI usually follow what
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urinary catheterization ~66-86%
usu if catheterization is >4 days |
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pathogens that can cause UTIs include what
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e. coli, klebsiella, proteus, enterococcus, pseudomona cepacia, enterobacter, serratia marcescens, and candida
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what is special about pseudomona cepacia and serratia marcescens
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these 2 don't commonly reside in the GI and therefore implies acquisition from exogenous source
isolation from catheterized patients implies acquisition from an exogenous source |
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what are some ways that microoragnisms can cause CAUTI catheter associated UTIs
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microorganisms which inhabit the meatus or distal urethra can get into the bladder when catheter is inserted
microoragnisms migrate to bladder along outside of catheter in periurethral mucous sheath or along internal lumen of catheter after catheter bag or catheter drainage tube is contaminated |
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how do you get extraluminal infections early on and at a late stage
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early at insertion
late by capillary action |
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how do you get intraluminal infections for CAUTI
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break in closed drainage
contamination of collection bag urine |
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catheters are susceptible to colonization by what microorganism and leads to what
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proteus mirabilis and because of urea --> ammonia the pH increases --> stone formation and precipitation of phosphatic salts leading to blockage
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what can lead to renal failure dt obstructive uropathy, or pyelonephritis, or bladder carcinoma
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urinary tract schistosomiasis (schistosoma haematobium)
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what can schistosoma haematobium cause in femal egenital tract and may facilitate what dt it
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can cause lesions and may facilitate the spread of STDs such as HIV and HPV
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what clinical sx will you get with s. haematobium urinary schistosomiasis
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dysuria
frequency terminal hematuria |
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what will you see on labs of urinary schistosomiasis
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identify and speciate eggs, urinary excvretion of eggs isn't uniform throughout the day, need to quantify eggs via 24 hr urine collection
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how do you dx urinary schistosomiasis
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UA culture for associated infections
UTI dt salmonella sp. is suspicion for urinary schistosomiasis (do blood cx for salmonella) blood chemistries - renal panel CBC - check for eosinophilia and anemia |
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how do you check for effectiveness of treatment or urinary schistosomiasis
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egg viability test- mix urine with room temp distilled water and watch for hatching miracidia
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what is the treatment for schistosomiasis
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praziquantel
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how does praziquantel work
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exposes worm to immune defenses by damaging tegument membrane (covering of worm)
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what do you look for on routine urinalysis
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physical properties - color, clarity, specific gravity
chemical properties- pH, protein, blood, nitrie, leukocyte esterase, glucose, ketones, bilirubin, urobilinogen microscopic- RBC, WBC, casts, epithelial cells, bacteria, parasites, crystals |
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if you detect bacteria in the urine, does that indicate infection?
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highly likely if the urine wasn't contaminated via handling. urine is normally sterile and we assume that any presence of bacteria could be dt sign of infection
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how do we collect a "clean" urine sample
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midstream clean catch - least invasive way in obtaining a clean urine specimen
invasive ways = catheter, suprapubic aspiration |
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what is the window of time you must test the collected urine? if not what should you do
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test within 1 hr of collection. if not, refrigerate immediately
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if a urine is the following colors,what does it indicate :
red brown yellow brown to green black brown dark brown to red |
red brown hemoglobin
yellow brown to green bile black brown melanin dark brown to red porphyrin |
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even thouhg odor is not considered of diagnostic significance, what do these things indicate
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freshly voided urine is aromatic
ammonia is dt breakdown of urea by urease fruity odor= acetone/DM foul odot= UTI, coliform bacteria asparagus |
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what 4 things will be positive in UTI
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proteins, blood, nitrites, leukocytes
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what color will nitrite show up on a urine dipstick
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pink
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what is the point of nitrite
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used to detect bacteriuria
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what kind of bacteria usually converts nitrate to nitrite
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gram negative : pseudomonas, e. coli, citrobacter, salmonella, shigella, klbesiella, proteus
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what color will a positive leukocyte test show up as
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purple
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what does + leukocytes tell you
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dipstick method detects leukocyte esterase activity in WBC (granulocytic cells) detects both lysed and intact WBCs
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what color on a urine dipstick will indicate hemoglobin
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blue
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with what kind of diseases would you see a positive hemoglobin in the urine
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renal dz or trauma and hemolytic anemia
renal dz dt RBC entering the urine and hemolyzed there in hemolytic anemia- hb is filtered into urine via transfusion rxns, severe burns, infections, and strenous exercise |
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what do hyaline casts usually look like
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they have blunt ends and may have scalloped edges
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if you have a positive hyaline cast result, what does that indicate
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capillary membrane damage with proteinuria
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what is tamm-horsfall protein
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mucoprotein that makes up the matrix of hyaline casts
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what is the tx for the majority of UTIs
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trimethoprim-sulfamethoxazole + amoxicillin
fluoroquinolones + levaquin |
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if the UTI are dt chlamydia trachomatis, mycoplasma hominis, what is the tx
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tetracycline or doxycycline
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women who are part of this particular group are at higher risk for recurrent UTI
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nonsecretors for a certain blodo group antigens
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secretors vs nonsecretors. secretors have what kind of antigens in the body fluids and have the same specificity as the antigens on the RBC membrnae
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A, B, H antigens
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what determines your ability to secrete
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presence of secretor gene either in homozygous or heterozygous state
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Se gene is inherited independent or dependent of the ABO and H gene
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independent
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what gene is a necessary precursor for ABO
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H gene
therefore all secretors will secrete the H gene |
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what will you find on lab findings for vaginitis
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rare to find pyruria or hematuria...most dx made off of fishy odor and external dysuria, pruritis dyspaereunia
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what causes vaginitis
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candida, trichonomas vaginalis
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what causes urethritis
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chlamydia, neisseria gonorrhea, HSV
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what will the labs show for urethritis
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pyuria but rare to find hematuria
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what are the causes of cystitis
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e. coli, staph saprophyticus, proteus klebsiella
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what are the lab findings
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pyuria, hematuria
abrupt onset icnreased FUD, suprapubic or low back pain |
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summarize E. coli
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G-
facultative anaerobe LPS endotoxin grows pink on maconkey bc it is lactose fermenting nitrate --> nitrite (pink color) most strains are motile KOH antigens (capsular, somatic cell walls, flagella antigen) ferments glucose, lactose, trehalose, xylose +indole, methyl red tests negative h2s producer negative dnase, urease, phenylalanine can NOT use citrate as sole carbon source negative voges proskauer |
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summarize staph saprophyticus
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catalase +
coagulase - novobiocin resistant a/w UTI in YOUNG SEXUALLY ACTIVE females able to adhere more effecitvely to epithelial cells in urogenital tract honeymoon UTI G+ COCCI |
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summarize klebsiella
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G- rods
red currant jelly mucoid colonies k1 antigen - polysaccharide capsule urease positive uses citrate as sole carbon source nitrate --> nitrite ferments glucose with gas production - also does lactose, sucrose, mannitol, maltose opportunistic dnase negative absence of motility |
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summarize proteus
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g- bacilli
urease + swarming motility produces h2s urease positive methyl red positive DNAse, lipase, gelatinase citrate utilization nitrate --> nitrite |
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summarize enterococcus faecalis
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similar to group D strep
found in intestinal tract e. faecalis is g+ positive for bile esculin growth on 6.5 % nacl PYR+ - ability to hydrolyze PYR and produces red color can be a, b, or y hemolytic |
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summarize enterobacter
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g- bacilli
e. cloacae, e. aerogenes isolated from wounds, urine, blood, csf urease - vogues proskaeuer postive can use citrate as sole carbon source dnase negative ferments glucose with gas production (lactose, sucrose, mannitol) |
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summarize candida albicans
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MCC of yeast infection in the world
normal flora of mucosa, skin, digestive tract c. glabrata is aggressive and hard to treat forms hyphae via D glucose in serum and 37deg C germ tube production + neg for urease neg for k+ nitrate assimilation |
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summarize serratia marcescans
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brick red color
opportunistic +dnase activity lipase positive gelatinase positive gram negative rods a/w nosocomial infections citrate utilization |
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summarize pseudomona cepacia
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not normally found in GI
a/w CF patients G- rods isolated from irrigation fluids, anesthetics, nebulizers, detergents, disinfectants DOES NOT FERMENT - utilizes glucose, maltose, lactose mannitol, oxidase and catalase positive motile- polar tufts of flagella yellow or green pigment |
