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Path Micro Final
| Question | Answer |
|---|---|
| Bacteriuria | presence of bacteria in urine |
| T or F: Bacteria in urine means there is an infection | F |
| cystitis | infection of bladder/lower urinary tract |
| pyelonephritis | infection of kidney/upper urinary tract |
| How/where can pyelonephritis occur/spread from | bloodstream or from bladder |
| Acute uncomplicated cystitis (UTI) | cystitis symptoms without fever, flank pain, costovertebral angle tenderness, or other signs of systemic illness |
| Where does the Acute uncomplicated cystitis stop | at the bladder |
| Acute complicated UTI | fever, suspected or documented pyelonephritis, UTI with sepsis **Symptoms |
| Where does the Acute complicated cystitis stop | in kidneys |
| Acute bacterial prostatitis | acute infection of prostate |
| What are the two routes of pathogenesis for UTIs | Ascending route Hematogenous route |
| What is the ascending route of UTI/ who and why is it common | through the urinary tract In women due to smaller urethra and located close to rectum |
| What is one way to get an ascending route UTI | indwelling catheterization lasting for 3-4 days |
| What microbe typically causes ascending route UTI | E. coli |
| What helps increase the adherence of E. coli during ascending route UTI | spermicides increasing colonization of vagina with uropathogens |
| What does E. coli attach to in the vagina during ascending route UTIs | vaginal epithelial cells |
| What is the cause of recurrent UTI and who is it seen in | estrogen deficiency postmenopausal women |
| Hematogenous route of UTI | infection moves through bloodstream |
| What type of bacteria rarely causes UTIs that reach the kidneys | G- bacilli |
| What type of bacteria typically causes UTIs that reach the kidneys | S. aureus |
| What type of bacteria classification is commonly seen by the ascending route | G- bacilli |
| What is the leading cause of UTIs | long-term care facilities from catheter association |
| What are the symptoms of UTI | frequent and painful urination small amounts of turbid urine no fever blood in urine (sometimes) |
| T or F: symptoms of UTI vary by species | F All bacteria in UTI cause the same symptoms |
| Symptoms of cystitis | dysuria, urinary frequency, urinary urgency blood in urine pyuria (in women) |
| Symptoms of Pyelonephritis | Fever Flank pain Costovertebral angle (CVA) tenderness Features of systemic illness nausea and vomiting |
| Symptoms of acute bacterial prostatitis | spiking fever, chills, malaise, myalgia, dysuria, irritating urinary symptoms, pelvic, perineal, glans pain, cloudy urine |
| How does prostatitis typically enter/start | through urethra |
| What are things that cause high risk of acute uncomplicated cystitis | inpatient stay travel to parts of world with high rates of MDR organisms |
| How to diagnose acute complicated UTI | signs and symptoms urine for urinalysis (microscopy or dipstick) culture Gram stain |
| What does the dipstick test in urinalysis detect for | nonspecific signs of infection |
| T or F: most UTIs are multiorganism infections | F its typically a single organism |
| What microbes typically cause recurrent UTIs | Proteus, Pseudomonas Klebsiella, Enterobacter spp., enterococci, and staphylococci |
| 40 yo woman with 1 day history of urinary burning and frequency. No fever or chills. UA shows +++ bacteria and WBC. Culture of urine grows lactose fermenting G- bacillus (E. Coli) | E. Coli infection (UTI) |
| Properties of E. Coli | G- bacillus Indole test + Urease - Facultative anaerobe pink on MacConkey agar |
| What type of pili does E. coli have | Type 1 pilli |
| What does Type 1 pilli do for E. Coli | promote periurethral colonization and attachment to bladder subject to phase variation |
| Virulence factors of E. Coli | Type 1 pilli P-pilli K (capsular) antigens |
| What does P-pilli do for E. coli in terms of virulence | bind to Gal-Gal receptors in bladder mucosa |
| What are some things more likely for UPEC strains to do compared to fecal strains | Produce P fimbriae Be encapsulated Produce cytolytic hemolysin possess multiple systems for iron acquisition |
| Klebsiella pneumoniae characteristics | G- bacillus Indole - Urease + Ferments lactose |
| What is the second most common bacteria/microbe to cause UTI infections | Klebsiella pneumoniae |
| What are the clinical manifestations of Klebsiella pneumoniae | similar symptoms to other bacterial UTIs Renal abscess Perinephric abscess |
| How do renal abscess form in Klebsiella pneumoniae cause UTIs | Hematogenous spread (can cause cortical abscess) |
| What are the risk factors associated with renal abscesses from Klebsiella UTIs | diabetes mellitus, urolithiasis, immunos |
| When there is a renal abscess it is less often seen from the _____ and primarily involves the ______ | bladder; medulla |
| Perinephric abscesses caused by Klebsiella is seen through what two things | hematogenous spread or complication of pyelonephritis |
| How to diagnose a klebsiella pneumoniae UTI | urine culture |
| 22 yo woman saw doctors for a one day history of urinary burning and frequency. Culture of urine grows a G+ coccus that is catalase+ | CoNS (staph infection) |
| What are the three CoNS species | S. epidermidis S. saprophyticus S. lugdunensis |
| What types of infections does S. epidermidis cause | prosthetic orthopedic device infections |
| What types of infections does S. saprophyticus cause | UTI |
| What types of infections does S. lugdunensis cause | bacteremia and endocarditis |
| What are the virulence factors of Staphylococcus saprophyticus | UafA Transport proteins Urease |
| What does UafA doe for S. saprophyticus | allows adherence to human uroepithelial cells |
| What does Transport proteins do for S. saprophyticus | rapid adjustment to osmotic and pH changes |
| What does urease do for S. saprophyticus | allows proliferation in urine |
| What are the clinical manifestations of S. saprophyticus | young women concomitantly with vaginal candidiasis follows sex or menstruation seen in late summer or fall 90% of dysuria, frequency or urgency 80% have pyuria or hematuria |
| How to diagnose an S. saprophyticus infection | resistance to novobiocin nitrite negative urine dipstick |
| 65 yo man in intensive care unit post-op on heart. On 5th day post-op, fever developed. chest Xray is unremarkable and BC is neg. urine culture obtained via Foley cathetar grew G+ coccus. Organism grew on hypertonic salt agar and + bile esculin test | Enterococcus infection |
| Enterococcus characteristics | Nonhemolytic G+ coccus Normal flora of colon |
| What does Enterococcus grow on/in | NaCl bile and hydrolyzes esculin |
| When is enterococcus the most common | after invasive procedures |
| Whats the first most common bacteria/microbe to cause UTI | E. Coli |
| Whats the second most common bacteria/microbe to cause UTI | Enterococci |
| Whats the third most common bacteria/microbe to cause UTI | Pseudomonas aeruginosa |
| Who is most likely to get a recurrent UTI thats caused by enterococcus | older men leading to prostatitis and epididymitis |
| What can enterococcus UTI lead to | pyelonephritis or perinephric abscesses |
| How to differential between a colonization or infection of enterococci | greater than 10^5 is colonization |
| What is the clinical manifestation of enterococcus | fever, CVA tenderness, dysuria |
| How to diagnose an enterococcus UTI | WBC clumps in UA for pyelonephritis presence of abscess on ultrasound for perinephric abscess |
| What is Group B strep resistant to | bacitracin |
| 45 yo woman history of recurrent kidney stones and frequent UTI. urine specimen has pH of 8.0. culture of urine grows non lactose fermenting G- bacilli that swarm over the plate | proteus mirabilis |
| What is something associated with Proteus mirabilis | kidney stones |
| What is demonstrated on a culture plate of Proteus mirabilis | swarming motility |
| What is the primary way to get proteus mirabilis UTI | urinary catheters |
| What are the virulence factors of Proteus mirabilis | MR/P fimbriae Urease |
| What does the virulence factor MR/P fimbriae do for proteus mirabilis | helps in bladder colonization subject to phase variation |
| What does the virulence factor urease do for proteus mirabilis | contributes to colonization and stone formation (changes pH of urine) |
| What are the clinical manifestations related to pseudomonas aeruginosa | ulcerations in mucosa of bladder, ureters and renal pelvis in severe PA infections common UTI symptoms as well |
| What are the two common ways Bacteriuria by S. aureus can occur | ascending infection from urinary cathetar bacteremia |
| S. aureus bacteriuria is associated with... | presence of urinary catheter |
| When a catheter is present in a case of bacteremia what is or is not warranted | routine investigation for bacteremia |
| S. aureus bacteriuria in the absence of a catheter may be an indicator of .. | bacteremia |
| What are the clinical clues of infection in an S. aureus UTI | fever, leukocytosis, back pain |
| What labs are done to determine an S. aureus UTI | blood cultures |
| 75 yo man with indwelling catheter following prostatectomy for prostate cancer. Sudden fever to 104 with BP of 70/40 and HR of 140. Blood and urine cultures grow G- bacillus in red colonies | Serratia marcescens |
| Characteristics of Serratia marcescens | G- bacilli facultative anaerobe Catalase+; DNase+ motile and adheres to cells with fimbriae |
| What are some things that Serratia marcescens can cause | opportunistic UTI bacteremia, pneumonia and endocarditis |
| What percent of Serratia marcescens isolates produce the red pigment characteristic | 10% |
| What is the difference between STI and STD | STI can be asymptomatic and hasn't caused damage STD has caused damage to at least 1 cell |
| What are the impacts of STDs globally | Newborn infection Infertility Ectopic pregnancy Cancer Facilitation of HIV Death |
| When inflammatory STDs are present how much more likely is HIV transmission | 2-5x |
| When ulcerative STDs are present how much more likely is HIV transmission | 5-9x |
| 22 yo man comes to office complaining of pain when urinating (dysuria) for 3 days. Today there is a "drip" from penis tip. Unprotected sex with four new female partners in 4 weeks. | Either Gonorrhea or Chlamydia |
| What does the "drip" on penis generated by gonorrhea look like | yellow/green and gooey |
| What does the "drip" on penis generated by chlamydia look like | clear and less gooey |
| What is the immunologic difference between Gonorrhea and Chlamydia | Gonorrhea: Immunologic response, WBC is the cause of pus Chlamydia: Found in cells, less immunologic response |
| How common is Chlamydia trachomatis in US | most commonly reported infectious diseases in US |
| Characteristics of Chlamydia trachomatis | Obligate intracellular pathogen **Cannot be grown** Small G- Lacks peptidoglycan life cycle involving elementary bodies and reticulate bodies |
| Are EB or RB the infectious form of Chlamydia trachomatis | EB |
| Are RB or EB metabolically active in Chlamydia trachomatis | RB |
| What does the A,B,C form of Chlamydia trachomatis cause | trachoma (eye disease) |
| What does the D-K form of Chlamydia trachomatis cause | nongonococcal urethritis - inclusion body conjunctivitis in neonates and adult neonatal pneumonitis (inflammation of alveoli) |
| What does L1,L2,L3 form of Chlamydia trachomatis cause | lymphogranuloma venereum (swollen lymph nodes in groin and legs) |
| What is the route of transmission for Chlamydia | direct mucosal contract with infected mucous membranes or fluid |
| What is the co-infection rate between GC and Chlamydia | 25-50% |
| Are recurrent infections common? | Yes |
| Who are the cornerstone for the epidemic of C. trachomatis | teenagers and young adults |
| What percent of male and female Chlamydia infections are asymptomatic | 75% female 50% male |
| What are the clinical manifestations of Chlamydia in men | Urethritis. Epididymitis, Prostatitis, Conjunctivitis, Infertility, Anorectal Infection, Reactive arthritis, Lymphogranuloma venereum |
| What are the clinical manifestations of Chlamydia in women | Urethritis. Cervicitis, Endometritis, Salpingitis, PID, Perihepatitis, Conjunctivitis, Infertility, Anorectal Infection, Reactive arthritis, Lymphogranuloma venereum. Ectopic pregnancy |
| What are the 3 stages of Lymphogranuloma Venereum | 1. Lesion (painless) 2. Inguinal lymphadenopathy (painful swollen lymph nodes) 3. Proctitis |
| What are the other sides of infection of Chlamydial | Peri-rectal Conjunctivitis Dysuria-Pyuria Syndrome |
| How to diagnose Chlamydia Lab Diagnosis | PCR or molecular amplification assays |
| What is Neisseria gonorroheae always considered | a pathogen |
| Neisseria gonorroheae route of transmission | direct mucosal contact with infected mucous membrane or fluids |
| Who are the cornerstone of the Gonorrhoeic epidemic | adolescents |
| What % of males infected with N. gonorrhoeae become symptomatic and within how long | 90%; 5-7 days |
| What % of women infected with N. gonorrhoeae become symptomatic and within how long | 50%; 2 weeks |
| What are the virulence factors for N. gonorrhoeae | Pili, Por Protein, Opa Protein, Lipooligosaccharide, IgA protease |
| What does the pili do for N. gonorrhoeae | Allow for attachment Antigenic variation allows for no significant immunity |
| What does the Por Protein do for N. gonorrhoeae | Promotes intracellular survival of the organism by allowing it to evade destruction by the phagolysosome |
| What does the Opa Protein do for N. gonorrhoeae | mediate binding to epithelial cells |
| What does the IgA protease do for N. gonorrhoeae | cleave secretory IgA |
| What is the infectious dose of N. gonorrhoeae | 100-1,000 organism |
| What clinical symptoms do both men and women get with N. gonorrhoeae | Conjunctivitis, Anorectal Infection, Pharyngitis, Septicemia, Arthritis |
| How to diagnose N. gonorrhoeae in the lab | Nucleic acid amplification tests (NAATs) |
| What media is needed to grow N. gonorrhoeae | Modified Thayer-Martin media |
| Characteristics of Mycoplasma genitalium | Bacterium lacks cell wall Fried-egg shaped colonies on agar |
| 23 yo presents with generalized rash involving hands. 2 months ago has painless ulcer on his penis. ulcer resolved wo trtmnt no urethral discharge, no pain in urination, bacterial exam shows undulating, spiral shaped organism | Treponema pallidum |
| What does Treponema pallidum an agent of | syphilis |
| characteristics of Treponema pallidum | spiral shaped organism does not stain with typical stains cannot be cultured in vitro grows super slow in vivo does not survive well outside of body |
| What does the slow growth of an organism typically mean | difficult to treat |
| What are the two ways that Treponema pallidum | Horizontal spread: sexual contact Vertical spread: transplacental infection |
| When are patients most infectious for Treponema pallidum | 1st yr of infection |
| What are the 3 phases of the Treponema pallidum | Primary, Secondary, Tertiary |
| What does the primary phase of Treponema pallidum | local disease (painless chancre) smooth and clean ulcer base borders raised and indurated painless regional adenopathy No obvious symptoms |
| How long is the incubation period for primary Syphilis | avg of 21 days range 9-90 |
| How long is the incubation period for secondary Syphilis | 30-180 days 2-8 weeks |
| What does the secondary phase of Treponema pallidum look like | rash, Condylomata lata, alopecia |
| What is the Condylomata lata | grey-white or pink moist plaques found in intertriginous areas (where 2 skin areas touch or rub together) |
| What are the constitutional symptoms of secondary syphilis | 70% affected fever, malaise, anorexia, weight loss, pharyngitis, myalgias |
| What phase of syphilis are linked to Mucous patches | secondary |
| What are the clinical manifestations of latent syphilis | none |
| What is the only evidence seen of latent Syphilis | positive serology |
| What are the symptoms/time span of early latent syphilis | asymptomatic infection less than 1 yr in duration |
| What are the symptoms/time span of late latent syphilis | asymptomatic infection over 1 yr in duration |
| What percent of early latent cases may relapse into secondary | 25% |
| How many years of latency does a syphilis become noninfection and resistant to reinfection | 4 years |
| What are the two types of tertiary syphilis | Gummatous syphilis Cardiovascular syphilis Neurosyphilis |
| What are the 6 delineated syndrome groups of neurosyphilis | Asymptomatic Acute syphilitic meningitis Meningovascular syphilis Tabes Dorsalis General paresis Optic atrophy |
| How to diagnose syphilis | Serologic tests darkfield microscopy |
| What are the two types of Serologic tests | Nontreponemal (Screen) Specific treponemal (confirmatory) |
| 28 yo man develops painful ulcer on penis 6 days after unprotected sex. He has a tender, non-indurated penile lesion and tender inguinal adenopathy (sensitive) | Chancroid |
| What microbe causes Chancroid | Hemophilus ducreyi |
| Is it common in the US? If not then where | No Africa, Asia, Caribbean |
| Characteristics of Chancroid | G- coccobacillus |
| What does the growth of Hemophilus ducreyi look on agar | school of fish |
| What media does Hemophilus ducreyi need to grow | chocolate agar needs heme and NAD |
| Symptoms of Chancroid | soft chancre develops (painful, raggid borders, lack induration) grey or yellow exudate on it |
| How does the Chancroid start | solitary lesion, but can develop into multiple |
| What is Chancroid accompanied by in about 50% of cases | painful inflammatory inguinal lymphadenopathy |
| 25 yo woman presents with malodorous vaginal discharge and pruritus about 2 weeks. Discharge is white and smell worsens after sex. New partner. No vaginal erythema or bleeding | Bacterial vaginosis |
| What bacteria causes bacterial vaginosis | overgrowth of Gardnerella vaginalis or other naturally-occuring bacteria in vagina |
| Characteristics of Gardnerella vaginalis | G-variable, pleomorphic rods |
| What is dysbiosis | disruption of normal vaginal microbiome |
| Clinical manifestation of bacterial vaginosis | unpleasant vaginal odor odor worsens after sex or menses mild vaginal burning or itching thin milky vaginal discharge |
| How to diagnose bacterial vaginosis | wet mount (look for clue cells) Whiff test (strong fishy odor produced) Homogenous thin white vaginal discharge |
Created by:
Kayla_K