Microbiology of the Urogenital System Final Material
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| What is characteristic about Parvovirus B19? | ONLY Single stranded linear DNA virus
Smallest icosahedral virus
Replicates in the nucleus
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| What disease does parvovirus cause? | A childhood disease called Erythema or fetiosum(fifth disease)
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| 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
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| What percentage of women of child-bearing age are immune to congenital parvovirus? | 50%
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| If congenital parvovirus is acquired by a non-immune pregnant women what is the transmission rate? | 33%
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| What effects can congenital parvovirus have on a non-immune pregnant woman? | Fetal loss through hydrops fetalis, severe anemia, congestive heart failure, and edema
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| Risk of fetal death to congenital parvovirus is highest in: | The second trimester
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| How is congenital parvovirus diagnosed? | IgM-sepcific Ab
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| How is congenital parvovirus treated? | Intrauterine infusions in case of hydrops fetalis and administration of digoxin to the fetus
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| What are the characteristics of Herpesviruses? | Double stranded linear DNA
Enveloped and Icosahedral
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| 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
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| What are the clinical manifestations of a herpes infection? | Ulcers, chickenpox, encephalitis
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| What is the herpes virus capable of? | Latency and reactivation
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| What are the types of proteins in Herpesviruses? | IE --> transcription
E --> non-structual proteins
L--> Major structural proteins
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| 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
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| What makes it difficult to diagnose herpes prenatally? | It may be confined to the cervix
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| 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
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| 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
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| How is herpes treated? | Acyclovir/Zovirax or supportice therapy
Herpetic keratoconjunctivitis requires topical trifluridine or vidarabine
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| What is the mortality rate of untreated disseminated disease and encephaltis? | 85%
50%
Brain involvement --> Almost 100% mortality
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| How can herpes transmission to the child be prevented? | C-section
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| What are the characteristics of the VZV? | Alpha herpes virus
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| How is VZV transmitted? | Respiratory or contact with lesion
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| How does VZV manifest? | URTI, Lymph node enlargement, respiratory disease, viremia, skin lesions
Scarring, limb hypolasia, CNS defects, death in infancy
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| What percentage of pregnant women are immune to VZV? | 90%
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| How can VZV spread to the fetus? | It can cross the placenta in late stages of the virus
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| Which form of hepatitis is a major cause of neonatal hepatitis? | HBV
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| 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
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| 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
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| How is HBV diagnosed? | Measure HBsAg, HBeAg, anti-HBe, and HBV DNA in blood
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| Which markers are positive in acute HBV infection? | HBsAg, IgM anti-HBc, HBeAg, and HBV-DNA
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| What markers are positive in chronic HBV infection? | HbSAg, IgG, HBeAg, Anti-HBe, and HBV-DNA
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| What markers are positive in prior HBV infection? | Anti-HBs, IgG, and Anti-HBe
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| What is the treatment for HBV infection? | Symptomatic care and nutrition
Immunization for other forms of Hepatitis
Antiviral infection like IF-alpha
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| How can we prevent HBV? | Testing pregnant women
Treating pregnant women with lamivudine or Telbivudine
Immunize children with HBIG IM after birth
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| What is the prognosis of HBV infection in neonates? | Carrier state after vertical transmission --> 20x liver disease
86x hepatoma
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| What is the chance of spontaneous transmission in case of HCV infection? | 25-50%
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| What are the clinical manifestations of HCV infection? | Commonly asymptomatic
Cirrhosis with liver failure and hepatocellular carcinoma may occur in childhood
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| How id HCV treated? | Interferon, ribavirin, and Sofosbuvir
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| 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
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| How often is HIV vertically transmitted? | 15-25%
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| 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
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| How can HIV be identified? | By antenatal testing in 25-50% of cases (MANDATORY)
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| How many cases of pediatric HIV are due to vertical transmission? | More than 90% of cases
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| 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
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| Which organisms are retroviruses found in? | All vertebrae
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| Which classes are included in the retroviridae? | HIV, FIV, and FeLV
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| What is a characteristic feature of Retroviruses? | Their nucleic acids are RNA in the virus, and DNA in infected cells
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| How are retroviruses transmitted? | Either by exogenous viruses of vertically by endogenous viruses
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| 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
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| How are retroviruses classified? | Alpha, beta, and gamma --> simple genome
Delta, epsilon, lenti, spuma, meta, and errant --> Complex genome
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| 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)
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| 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
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| Which type of HIV is the main cause of infection? | HIV1
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| How many people are living with HIV in the world and how many new cases are there each year? | 34 million
2.5 million
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| 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
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| 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
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| 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
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| 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
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| What are the clinical manifestations of HIV when it is latent? | Patients are contagious but others no specific symptoms
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| Which oppurtunistic infections occur with AIDS? | Pneuocystis jirovecii
Toxoplasmosis, cyrptospoidosis
Candidiasis, crytococcosis, histoplasmosis
Mycobacterim avium, salmonella septicaemia, reccurent pyogenic infection
CMV, HSV, VZV, JCV
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| What is the most common neurological disorder observed in AIDS patients? | Encephalopathy in almost 2/3rds of patients
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| 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
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| 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
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| How do we treat HIV? | HAART
Nucleoside analogue RTI --> Lamivudine, Zidovudine
Non-nucleoside RTI --> Nevirapine
Protease I -->Indinavir, Ritonavir
Fusion I--> Fuzeon (IM)
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| What does HAART consist of? | 2 nucleoside reverse TI and a protease inhibitor
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| 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
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| 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
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| What are the 4 types of Schistosomas likely to infect humans? | 1) S. Mansoni
2) S. Haematobium
3) S. Japonicum
4) S. Mekongi
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| 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
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| Which Schistosoma reaches the venous plexus of the bladder and other pelvic organs? | Haematobium
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| Once reaching the submucosal venules, what do the worms perform? | Oviposition--> deposition of 300 eggs per day for 4-35 ears
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| Where do the ova laid by the schistosomas rupture? | Into the lumen of the bladder and are passed into the urine
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| What are the sizes of the eggs laid by schistosomas? | 60-140 microns
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| What is characteristics of the eggs laid by the schistosomas? | They have a terminal spine
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| 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)
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| What are the methods of prevention of schistosomiasis? | Modern waste disposal
Water purification
Den snail access to newly irrigated lands
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| What severe outcome can result from developing heavy loads? | Possible live cirrhosis, cancer, and subsequent death
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| 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
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| 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
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| 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
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| How is schistosomiasis diagnosed? | Recovery of eggs in urine and biopsy
Painless hematuria
Cytoscopy with biopsy of the bladder
Conventional serology --> Antibodies over 90$
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| How is schistosomiasis treated? | Antihistamine and corticosteroids for dermatitis
Praziquantel --> Effective against all times
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| Candida albicans is able to form hyphae in changes in: | pH, temperature, and available nutrients
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| What are the types of Candidiasis? | Localized and Disseminated
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| 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
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| 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
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| Candida albicans is a member of which flora? | Oropharyngeal, GI, and female genital flora
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| What are the causes of Candida infection? | Infections are usually endogenous except in directmucosal contact with lesions (sexual contact)
Nosocomial infections
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| What determines the severity of infection? | Neutrophil function and count
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| How can we diagnose Candida? | Potassium hydroxide
Gram smears of superficial lesions ==> yeat/hyphae
Direct aspirate, biopsy, or lavage in lung involvement
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| How is Candida treated? | Nystatin, Amphociterin B, Flucytosine, and Azoles
Superficial lesions --> Topical Nystatin and Azoles
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| 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
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| What are the two forms of Chlamydia in the replicative cycle? | 1) Elementary body -small and infectious
2) Reticulate body - larger and IC replicative
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| 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
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| What characteristic does C. trachomatis have which enables it to complete its replication? | It inhibits apoptosis of epithelial cells
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| 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
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| What is the sole reservoir of Chlamydia? | Humans
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| Non-gonococcal urethritis is most commonly caused by : | C. trachomatis
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| Where does LymphoGranuloma Venereum enter through | Skin or mucosa that is not intact
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| What are the characteristics of the early stage of C. Trachomatis? | Release of proinflammatory cytokines such as interleukin-8
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| 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.
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| What diseases can C. Trachomatis cause? | Urethritis, epididymitis in men
Cervicitis, salpingitis, and a urethral syndrome in women
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| What are the clinical manifestation of C. trachomatis infection? | Urethritis --> Dysuria and urethral discharge
Uterine cervix -->Asymptomatic vaginal discharge
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| The scarring produced by chronic or repeated infection is an important cause of | Sterility and ectopic pregnancy
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| More than 50% of infants born to mothers with C.trachomatis show: | Infection during first year
Inclusion conjunctivits
Infant pneumoni syndrome
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| What is LymphoGranuloma Venereum characterized by? | Primary genital lesion, painless and heals
Abscess and fistulas--> chronic
Suppurative involvement of the inguinal lymph nodes
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| 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
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| How is Chlamydia treated? | Tetracycline, macrolides, and floroquiolones
Azithromycin --> Single dose
Erythromycin --> Pregnancy
Doxycycline --> DOC for LGV
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| 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
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| What diseases does it cause? | One half of cases of nongonococcal, nonchlamydial urethritis
Chorioamnionitis and postpartum fever (10%)
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| How is Ureaplasma infection treated? | Tetracycline
Spectinomycin or quinolone
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| What are the characteristics of Gardnerella vaginalis? | Facultative anaerobe
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| Gardnerella vaginalis most commonly cause: | Bacterial vaginosis
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| Gardnerella vaginalis grows on what media? | Small, circular, convex, gray colonies on Chocolate agar
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| What areas can Gardnerella vaginalis be isolated from? | Genitalia, blood, urine, and pharynx
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| Gardnerella vaginalis is associated microscopically with: | Clue cells
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| What are the clinication manifestations of infection with Gardnerella vaginalis? | Gray, thin, and homogenous vaginal discharge
Musty odor
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| How is Gardnerella vaginalis diagnosed? | A wet mount of saline with vaginal secretions examined under microscope
WBCs, lactobacilli, and clue cells
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| How is Gardnerella vaginalis treated? | Oral metronidazole --> contraindicated in pregnancy and lactation
Cephradine
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