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UGS Microbiology

Microbiology of the Urogenital System Final Material

What is characteristic about Parvovirus B19? ONLY Single stranded linear DNA virus Smallest icosahedral virus Replicates in the nucleus
What disease does parvovirus cause? A childhood disease called Erythema or fetiosum(fifth disease)
How does the erythema manifest clinically? By a fever and slapped face rash on the cheeks Malaise, headache, myalgia, itching, and enlarged liver and spleen
What percentage of women of child-bearing age are immune to congenital parvovirus? 50%
If congenital parvovirus is acquired by a non-immune pregnant women what is the transmission rate? 33%
What effects can congenital parvovirus have on a non-immune pregnant woman? Fetal loss through hydrops fetalis, severe anemia, congestive heart failure, and edema
Risk of fetal death to congenital parvovirus is highest in: The second trimester
How is congenital parvovirus diagnosed? IgM-sepcific Ab
How is congenital parvovirus treated? Intrauterine infusions in case of hydrops fetalis and administration of digoxin to the fetus
What are the characteristics of Herpesviruses? Double stranded linear DNA Enveloped and Icosahedral
What are the three subfamilies of Herpesviruses? Alpha, beta and gamma viruses Alpha --> HSV1,2, and VZV Beta --> CMV, HHV-6, and 7 Gamma --> EBV, and HHV8
What are the clinical manifestations of a herpes infection? Ulcers, chickenpox, encephalitis
What is the herpes virus capable of? Latency and reactivation
What are the types of proteins in Herpesviruses? IE --> transcription E --> non-structual proteins L--> Major structural proteins
How is the neonate infected with herpes? During passage through the birth canal, especially in case of premature membrane rupturing May also be infected transplacental or oral
What makes it difficult to diagnose herpes prenatally? It may be confined to the cervix
How long does it take for Herpes to manifest in the neonate and how does it manifest? 1-2 weeks --> 4 weeks max Skin vesicles in 55% or localized CNS disease (encephalitis, pleocytosis) Disseminated disease --> hepatitis, pneumonoa, DIC
How is Herpes in the neonate diagnoses? Samples from skin vesciles tested with culture, PCR, IF, or Electron microscope Tzanck test may show multinucleated giant cells and intranuclear inclusions
How is herpes treated? Acyclovir/Zovirax or supportice therapy Herpetic keratoconjunctivitis requires topical trifluridine or vidarabine
What is the mortality rate of untreated disseminated disease and encephaltis? 85% 50% Brain involvement --> Almost 100% mortality
How can herpes transmission to the child be prevented? C-section
What are the characteristics of the VZV? Alpha herpes virus
How is VZV transmitted? Respiratory or contact with lesion
How does VZV manifest? URTI, Lymph node enlargement, respiratory disease, viremia, skin lesions Scarring, limb hypolasia, CNS defects, death in infancy
What percentage of pregnant women are immune to VZV? 90%
How can VZV spread to the fetus? It can cross the placenta in late stages of the virus
Which form of hepatitis is a major cause of neonatal hepatitis? HBV
What is the mode and risk of transmission from the mother tot he fetus? During delivery and the risk is from 70-90% Postpartum transmission and transplacental transmission is RARE
What are the clinical manifestations of neonatal hepatitis? Mostly asymptomatic Can have low birth weight, jaundice, failure to thrive, abdominal distension, red-ish stool, heptamegaly, ascites, and hyperbilirubinemia
How is HBV diagnosed? Measure HBsAg, HBeAg, anti-HBe, and HBV DNA in blood
Which markers are positive in acute HBV infection? HBsAg, IgM anti-HBc, HBeAg, and HBV-DNA
What markers are positive in chronic HBV infection? HbSAg, IgG, HBeAg, Anti-HBe, and HBV-DNA
What markers are positive in prior HBV infection? Anti-HBs, IgG, and Anti-HBe
What is the treatment for HBV infection? Symptomatic care and nutrition Immunization for other forms of Hepatitis Antiviral infection like IF-alpha
How can we prevent HBV? Testing pregnant women Treating pregnant women with lamivudine or Telbivudine Immunize children with HBIG IM after birth
What is the prognosis of HBV infection in neonates? Carrier state after vertical transmission --> 20x liver disease 86x hepatoma
What is the chance of spontaneous transmission in case of HCV infection? 25-50%
What are the clinical manifestations of HCV infection? Commonly asymptomatic Cirrhosis with liver failure and hepatocellular carcinoma may occur in childhood
How id HCV treated? Interferon, ribavirin, and Sofosbuvir
What are the risk factors of children being affected with HIV? High viremia in the mother Low maternal CD4 count Primary HIV infection during pregnancy Other STDs Rupture of membranes more than 4 hours before delivery Vaginal delivery, older age, and preterm births
How often is HIV vertically transmitted? 15-25%
How can transmission of HIV be drastically reduced? By administration of retroviral to the mother IV in labor and to the infant during the first 4 weeks of life This can decrease risk by 66% or more
How can HIV be identified? By antenatal testing in 25-50% of cases (MANDATORY)
How many cases of pediatric HIV are due to vertical transmission? More than 90% of cases
How can congenital and perinatal infection be reduced? Serological screening of rubella, syphilis, HBV, and HIV in pregnancy By washing hands: prevent CMV and toxoplasmosis Modify behavior: to prevent STDs and blood borne viruses Avoid undercooked food Avoid vaginal delivery in active herpes
Which organisms are retroviruses found in? All vertebrae
Which classes are included in the retroviridae? HIV, FIV, and FeLV
What is a characteristic feature of Retroviruses? Their nucleic acids are RNA in the virus, and DNA in infected cells
How are retroviruses transmitted? Either by exogenous viruses of vertically by endogenous viruses
What are the general characteristics of retroviruses? Enveloped with a lipid bilayer and viral spike glycoproteins Outer matrix and inner capsid Single stranded positive RNA
How are retroviruses classified? Alpha, beta, and gamma --> simple genome Delta, epsilon, lenti, spuma, meta, and errant --> Complex genome
What are the proteins of the HIV? gag core proteins--> p17 (Matrix) and p24 (Capsid) pol --> p16 (protease), p31 (integrase/endonuclease), RT, and RNaseH env--> gp160 (gp:120 outer membrane part, and gp41: transmembrane part)
How does the HIV replicate? 1) Viruses attaches to CD4 2) binding of gp120 to CD4 3) Penetration and uncoating 4) RNA reverse transcribed into a DNA provirus 5) Latency or active transcription --> synthesis and maturation of virus progeny
Which type of HIV is the main cause of infection? HIV1
How many people are living with HIV in the world and how many new cases are there each year? 34 million 2.5 million
What are the modes of transmission and risk factors of HIV infection? 1) Sexual transmission 2) Blood products 3) Vertical transmission 4)Other: Contact with non-intact skin and accidental needle sticks
How is HIV staged? 1) Stage 1--> HIV+ blood with no other HIV symptoms 2) Stage 2 --> CD4 count between 200-499 cells/microL 3) Stage 3 --> AIDS, most severe stage CD4 <200
What conditions are AIDS defining? Candidiasis of the bronchi, trachea, lungs, or esophagus Cervical cancer Disseminated coccidiomycosis/Cryptococcus CMV disease in unusual sites Herpes does not heal Kaposis sarcoma Burkitt's lymphoma Mycobacterium infections Recc pneumonia
What are the clinical manifestations of the acute HIV infection? 2-4 weeks up to 3 months after infection comes a SEVERE flu with fatigue, sore throat, enlarged lymph nodes, loss of apetite, mouth sores, neck stiffness, headache, and rash
What are the clinical manifestations of HIV when it is latent? Patients are contagious but others no specific symptoms
Which oppurtunistic infections occur with AIDS? Pneuocystis jirovecii Toxoplasmosis, cyrptospoidosis Candidiasis, crytococcosis, histoplasmosis Mycobacterim avium, salmonella septicaemia, reccurent pyogenic infection CMV, HSV, VZV, JCV
What is the most common neurological disorder observed in AIDS patients? Encephalopathy in almost 2/3rds of patients
How is HIV diagnosed? Serology-Most likely ELISA or Western blot Viral detection is done by testing for p24 antigens ELISA can detect it 4-6 weeks after exposure Western blot detects gp120, gp160, and gp41 Clearview/ Rapid tests are also available
How can we decide what the prognosis of a patient with HIV is? By measuring the HIV viral load with antiviral therapy By measuring HIV Antigens
How do we treat HIV? HAART Nucleoside analogue RTI --> Lamivudine, Zidovudine Non-nucleoside RTI --> Nevirapine Protease I -->Indinavir, Ritonavir Fusion I--> Fuzeon (IM)
What does HAART consist of? 2 nucleoside reverse TI and a protease inhibitor
What is the general prognosis of HIV? Progression to AIDS within 10 years, death within 3 years of AIDS onset With tx --> Almost normal life span
How can you prevent HIV infection? Use of condoms and less sexual partners Blood donor screening AZT in HIV+ mother and child Inoculate health care workers (controversial) Do not share razors or toothbrushes
What are the 4 types of Schistosomas likely to infect humans? 1) S. Mansoni 2) S. Haematobium 3) S. Japonicum 4) S. Mekongi
After mating in the portal vein, adult Schistosomas ascend which vessels? The mesenteric vessels Japonicum and Mekongi enter the superior mesenteric Mansoni and Haematobium enter the inferior mesenteric
Which Schistosoma reaches the venous plexus of the bladder and other pelvic organs? Haematobium
Once reaching the submucosal venules, what do the worms perform? Oviposition--> deposition of 300 eggs per day for 4-35 ears
Where do the ova laid by the schistosomas rupture? Into the lumen of the bladder and are passed into the urine
What are the sizes of the eggs laid by schistosomas? 60-140 microns
What is characteristics of the eggs laid by the schistosomas? They have a terminal spine
What are the hosts of the schistosomas? 1) First intermediate host -Snail host after the hatch in the water (Miracidia) 2) Infectious stage (Cercariae) 3) Come in contact with human skin (Second intermediate host)
What are the methods of prevention of schistosomiasis? Modern waste disposal Water purification Den snail access to newly irrigated lands
What severe outcome can result from developing heavy loads? Possible live cirrhosis, cancer, and subsequent death
What are the clinical stages of Schistosomiasis? 1) Penetration and migration of the schistosomula 2) Oviposition and clinical manifestation 3) Chronic stage --> granuloma formation and scarring around eggs
What are the characteristics of the 2nd/intermediate stage? 1-2 months after exposure Acute febrile illness like serum sickness Formation of immune complexes Fever, chills, cough, urticaria, athralgia, lymphadenopathy, splenomegaly, abdominal pain, and diarrhea
What are the clinical symptoms of a chronic S. Haematobium infection? Bladder mucosa becomes thickened, papillated, and ulcerated Hematuria, dysuria, anemia due to hemorrhage, and severe muscular bladder infection Possible renal failure, uremia, and bladder carcinoma
How is schistosomiasis diagnosed? Recovery of eggs in urine and biopsy Painless hematuria Cytoscopy with biopsy of the bladder Conventional serology --> Antibodies over 90$
How is schistosomiasis treated? Antihistamine and corticosteroids for dermatitis Praziquantel --> Effective against all times
Candida albicans is able to form hyphae in changes in: pH, temperature, and available nutrients
What are the types of Candidiasis? Localized and Disseminated
What are the clinical manifestations of Localized Candidiasis? Erythema, white plaques (diaper rash), oral thrush in the immunocompromised Itching and thick white discharge of vulvovaginits
What are the clinical manifestations of disseminated Candidiasis? Limited almost exclusively to the immunocompromised Diffuse pneumonia and urinary tract involvement (Ascending or hematogenous cystitis. pyelonephritis, renal pelvis infections or abscesses) Endophthalmitis
Candida albicans is a member of which flora? Oropharyngeal, GI, and female genital flora
What are the causes of Candida infection? Infections are usually endogenous except in directmucosal contact with lesions (sexual contact) Nosocomial infections
What determines the severity of infection? Neutrophil function and count
How can we diagnose Candida? Potassium hydroxide Gram smears of superficial lesions ==> yeat/hyphae Direct aspirate, biopsy, or lavage in lung involvement
How is Candida treated? Nystatin, Amphociterin B, Flucytosine, and Azoles Superficial lesions --> Topical Nystatin and Azoles
What are the general characteristics of Chlamydia trachomatis? Round cells between 0.3-1 microns in diameter Enveloped with a trilaminar outer membrane which contains LPS and proteins similiar to gram -ve bacteria but without peptidoglycan
What are the two forms of Chlamydia in the replicative cycle? 1) Elementary body -small and infectious 2) Reticulate body - larger and IC replicative
What happens as the reticulate bodies increase in number? The membrane expands by fusing with the golgi apparatus forming the inclusion body After 24-72 hours, the process reverses and multiple EBs are formed and released from the disintegrated host cell membrane
What characteristic does C. trachomatis have which enables it to complete its replication? It inhibits apoptosis of epithelial cells
Where does C. trachomatis cause disease? Conjunctiva and genital tract (MOST COMMON STD) Tropism for epithelium of the endocervix, upper genital tract, urethra, rectum, and conjunctiva
What is the sole reservoir of Chlamydia? Humans
Non-gonococcal urethritis is most commonly caused by : C. trachomatis
Where does LymphoGranuloma Venereum enter through Skin or mucosa that is not intact
What are the characteristics of the early stage of C. Trachomatis? Release of proinflammatory cytokines such as interleukin-8
What are the characteristics of the late stage of C. Trachomatis? Aggregates of lymphocytes and macrophages may form in the submucosa; can progress to necrosis, fibrosis and scarring.
What diseases can C. Trachomatis cause? Urethritis, epididymitis in men Cervicitis, salpingitis, and a urethral syndrome in women
What are the clinical manifestation of C. trachomatis infection? Urethritis --> Dysuria and urethral discharge Uterine cervix -->Asymptomatic vaginal discharge
The scarring produced by chronic or repeated infection is an important cause of Sterility and ectopic pregnancy
More than 50% of infants born to mothers with C.trachomatis show: Infection during first year Inclusion conjunctivits Infant pneumoni syndrome
What is LymphoGranuloma Venereum characterized by? Primary genital lesion, painless and heals Abscess and fistulas--> chronic Suppurative involvement of the inguinal lymph nodes
How is Chlamydia diagnosed? Epithelial cells from the site of infection Cervical or urethral speciments Acheieved in cell culture of McCoy cells Ligase chain reaction or PCR--> most sensitive
How is Chlamydia treated? Tetracycline, macrolides, and floroquiolones Azithromycin --> Single dose Erythromycin --> Pregnancy Doxycycline --> DOC for LGV
What are the characteristics of Ureaplasma urealyticum? Diameter of 0.2-0.3 mm Highly pleomorphic May appear coccoid, filamentous or multinucleoid No cell wall but membrane containing STEROLS
What diseases does it cause? One half of cases of nongonococcal, nonchlamydial urethritis Chorioamnionitis and postpartum fever (10%)
How is Ureaplasma infection treated? Tetracycline Spectinomycin or quinolone
What are the characteristics of Gardnerella vaginalis? Facultative anaerobe
Gardnerella vaginalis most commonly cause: Bacterial vaginosis
Gardnerella vaginalis grows on what media? Small, circular, convex, gray colonies on Chocolate agar
What areas can Gardnerella vaginalis be isolated from? Genitalia, blood, urine, and pharynx
Gardnerella vaginalis is associated microscopically with: Clue cells
What are the clinication manifestations of infection with Gardnerella vaginalis? Gray, thin, and homogenous vaginal discharge Musty odor
How is Gardnerella vaginalis diagnosed? A wet mount of saline with vaginal secretions examined under microscope WBCs, lactobacilli, and clue cells
How is Gardnerella vaginalis treated? Oral metronidazole --> contraindicated in pregnancy and lactation Cephradine
Created by: Ulaisl