4. STD and Tuberculosis Flashcards

1
Q

Sexually Transmitted Diseases

Bacterial

  • ____
  • Syphilis
  • ____

Viral

  • ____
  • HIV
  • ____
  • KS - associated herpesvirus
A

gonorrhea
chlmaydia

herpes simplex virus
HPV

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2
Q

Gonorrhea
Neisseria gonorrhoeae
• Gram ____
• Diplococci
○ “____ bean” appearance
• Colonies:
○ ____
○ Transparent or ____ on chocolate agar
• ____ are the ONLY reservoir
• 40,000 cases are reported to the CDC in the US every year
○ Estimated half of total cases are ____
• Only transmitted via ____, NOT from a dirty toilet seat

A
negative
coffee
small
white
humans
unreported
sex
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3
Q

Clinical Manifestations of Gonorrhea

• The symptoms are often mild and people are \_\_\_\_ they're infected
	○ Inflammation doesn't produce much pain, but can cause \_\_\_\_
• Male STD:
	○ Site of infection is primarily \_\_\_\_
	○ Urethritis is characterized by \_\_\_\_ discharge and \_\_\_\_
		§ Dysuria: Painful \_\_\_\_
	○ 20% chance of acquiring it after interaction with an infected woman
		§ Higher than \_\_\_\_

• Female STD:
	○ Site of infection is primarily \_\_\_\_
		§ Scarring of the \_\_\_\_ tube can result in infertility
	○ \_\_\_\_ is characterized by vaginal discharge, dysuria, and abdominal pain
	○ 50% chance of acquiring it after interaction with an infected man
		§ Higher than HIV

• Gonococcal Arthritis: Most common teen/young adult arthritis
	○ Mostly of the \_\_\_\_ and mostly impacts \_\_\_\_

• Neonates:
	○ \_\_\_\_
		§ Major cause of infant blindness before antibiotics
	○ Purulent \_\_\_\_
	○ Can be acquired by the newborn at birth during passage through the \_\_\_\_
A

unaware
scarring

uretheral
purulent
dysuria
urination
HIV

endocervix
fallopian
cervicitis

knee
women

ophthalmia
conjunctivitis
birth canal

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4
Q

Virulence Factors of Gonococcus

• Adherence and invasion:
	○ \_\_\_\_ –> responsible for initial association
		§ Very antigenic 
	○ \_\_\_\_: Forms a tight interacting with target receptors leading to endocytosis of the bacteria
	○ P.I: Prevents \_\_\_\_ formation
		§ Preventing the bacteria from being \_\_\_\_

• Antigenic variation: A particular Ag (pili) undergoes a constant change by being synthesized from among a large repertoire of \_\_\_\_ types
	○ This makes it difficult to formulate \_\_\_\_ against gonorrhea
		§ Will express different pili so the immune system will not recognize the different pili being expressed –> won't be degraded
	○ Phase Variation: Turning on or off the \_\_\_\_ components

• Lipooligosaccharide (LOS): An \_\_\_\_ responsible for most of the symptoms of gonorrhea 
	○ Causes \_\_\_\_
	○ All gram negative bacteria have \_\_\_\_ or \_\_\_\_
A

pilli
P.II
phagolysosome
degraded

antigenic
vaccine

surface

endotoxin
inflammation
LPS
LOS

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5
Q

Treatment and Prevention of Gonorrhea
• Cephalosporins and ceftriaxone
○ Ceftriaxone: ____ generation of cephalosporins
• ____ and ____ are key in prevention

A

third
condoms
sex education

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6
Q

Syphilis

Treponema pallidum
	• \_\_\_\_
	• Gram \_\_\_\_
	• NEVER grown in a \_\_\_\_ culture
		○ Cannot be grown in a \_\_\_\_
	• NEVER form \_\_\_\_
		○ Prevents them from being \_\_\_\_
A
spirochetes
negative
cell-free
lab
colonies
studied
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7
Q

Fluorescence Microscopy of Treponema pallidum

• Involves the use of \_\_\_\_
A

Ab

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8
Q

Natural Course of Syphilis
3 Phases:
1. Primary Syphilis: Highly ____
○ Primary ____: Localized lesion where Syphilis first occurs
§ Will be seen within a week
○ Hematogenous dissemination can occur ____ weeks after the appearance of the Primary Chancre

2. Secondary Syphilis: Highly \_\_\_\_
	○ Has spread to the \_\_\_\_ becoming systemic
	○ \_\_\_\_ and fever are present
	○ Latent Syphilis:
		§ No \_\_\_\_ can occur, which occurs in most people
			□ \_\_\_\_% of untreated cases relapse into Secondary Syphilis

3. Tertiary Syphilis: Leaves the \_\_\_\_and can invade organs that can be extremely devastating
	○ Loss of \_\_\_\_ if it impacts the nervous system
	○ NOT \_\_\_\_
A

contagious
chancre
3-10

contagious
BS
rash
recurrence
25

BS
vision
contagious

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9
Q

Treatment of Syphilis
• ____ for early Syphilis
• ____ for late Syphilis and congenital Syphilis
• ____ and ____ for patients allergic to Penicillin

A

benzathine penicillin
penicillin G
tetracycline
doxycycline

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10
Q
Chlamydia 
Chlamydia trachomatis
	• Gram \_\_\_\_
	• Very \_\_\_\_ –> .3μm in diameter
		○ Was mistaken for a \_\_\_\_ initially
	• Obligate \_\_\_\_ parasite
		○ Can only replicate within cells
		○ Small genome means they're dependent on host cells for things like \_\_\_\_
	• Most common \_\_\_\_ in the US
A
negative
small
virus
intracellular
ATP
STD
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11
Q

Clinical Manifestations of Chlamydia
• Transmission:
○ ____
○ Airdrops and ____
○ Touching
○ Non-sexual methods of transmission are seen to cause ____
• Male STD:
○ Urethritis manifested by urethral discharge and ____
○ Most often ____ in men
• Female STD:
○ ____ characterized by vaginal discharge, dysuria, and bleeding
○ Often ____ in women
○ May cause ____
• Trachoma: Chronic inflammation of the ____ (conjunctivitis) causing them to turn ____
○ Corneal ulceration
○ Often leads to ____
○ Most commonly seen in poor 3rd world countries

A

sexually
aerosols
trachoma

dysuria
aysymptomatic

cervicitis
asymptomatic
sterility

eyes
inwards

blindness

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12
Q

Mature Chlamydia inclusion containing both elementary body (EB) and reticulate bodies (RB)

• Elementary Body (EB): \_\_\_\_ form for transmission
	○ NOT \_\_\_\_ active that cannot replicate on its own –> requires a host cell
• Reticulate Bodies (RB): Similar to a \_\_\_\_ that can survive outside the body for a long time
	○ This form can \_\_\_\_
A

smallest
metabolically
spore
replicate

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13
Q

Life Cycle of Chlamydia

1. \_\_\_\_
2. Conversion of elementary bodies to \_\_\_\_ bodies
3. \_\_\_\_ 
4. Conversion of replicate bodies to \_\_\_\_ bodies
5. \_\_\_\_ and spread
A
entry
reticulate
multiplication
elementary
cell lysis
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14
Q

Treatment and Prevention of Chlamydia

	• Treatment:
		○ Doxycycline or \_\_\_\_
		○ \_\_\_\_ for children and pregnant women
	• Prevention:
		○ \_\_\_\_ and \_\_\_\_
A

azithromycin
erythromycin
condoms
sex education

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15
Q

Tuberculosis
• Over 9 million new cases and 2 million deaths per year worldwide
• 1/3 of the world’s population is infected with ____
• One of the top ____ killers in the world
• In the US 10-15 million people are infected

A

mycobacterium tuberculosis

3

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16
Q
Incidence of TB in the US
	• Death rate in major cities was \_\_\_\_
		○ Has steadily declined until the 1980s
		○ Due to:
			§ Discovery of \_\_\_\_
			§ Inexpensive \_\_\_\_ methods
A

1%
antibiotics
diagnosis

17
Q

Patients with TB in NYC
• Increase in the 80s
○ Major reason is due to ____
○ Many AIDs patients die from ____

A

AIDs

Tb

18
Q

Immigrants and TB
• Each of the southern New England states has a higher concentration of immigrants in the population than the US a whole
• Immigrants can bring ____ to the US

A

Tb

19
Q
Mycobacterium tuberculosis 
	• \_\_\_\_ bacilli
	• Grows in \_\_\_\_
	• Colonies:
		○ Very \_\_\_\_ growth on special media (\_\_\_\_ medium)
A

acid fast
cords
slow
lowenstein-jensen

20
Q

• Showing how infectious TB is
○ Very low ____ dose (ID-50)
○ ____ cells can cause TB

A

disease producing

1-10

21
Q

Transmission of TB
• Infectious ____ droplets in the air
• Aerosols can last in the air for very ____

A

aerosol

long

22
Q

Entry and Multiplication of TB
• Ingested by ____ in the Lungs
○ Macrophages cannot ____ them
• Cells get carried from the original site of infection to the ____ or ____ depending on where the macrophages take them

A

macrophages
kill
lungs
lymph nodes

23
Q

Two Courses of Primary TB
1. Effective immune response
○ Infection is limited to a small area of the ____ (tubercles/granulomas)
○ ____ and 95% of people
2. Immune response is insufficient
○ ____ TB and beyond, extra pulmonary or ____ TB
○ Seen with 5% of all people

A

lung
asymptomatic
pulmonary
miliary

24
Q

Clinical Characteristics of TB
Primary TB:

* Inspired bacilli land in the \_\_\_\_ or \_\_\_\_ areas of the Lung
* Formation of \_\_\_\_ in macrophages
* \_\_\_\_: Tubercle/granuloma associated with a swollen lymph node

Secondary TB:
• Reactivation typically resulting from impaired ____ or ____
○ Lower ____ effectiveness
• The most common location of reactivation is the ____ lobe of the Lungs due to higher ____
• Lesions slowly become ____ and cavitation may occur
○ Destruction of tissue –> bloody ____
§ Patients can die of ____
• Disease is now ____

A

middle
lower
tubercles/granulomas
ghon complex

immunity
reinfection
T cell
upper
oxygenation
necrotic
sputum
hemorrhage
contagious
25
Q

Caseous Necrosis of Pulmonary TB

• Seen with ____

A

secondary Tb

26
Q
TB Can Effect Many Organs
	• \_\_\_\_
	• Intestines
	• \_\_\_\_
	• Genitals
		○ Especially the \_\_\_\_
	• GI tract
	• \_\_\_\_
A

brain
bones
epidmysis
kidneys

27
Q

Virulence Factors of M. tuberculosis

• Unusual cell wall
	○ High content of \_\_\_\_ –> 60% of the cell wall
	○ \_\_\_\_: Lipid that makes the bacteria acid fast
		§ Protects them from dry and harsh environments allowing them to survive for a long time
		§ Inhibits degradation by \_\_\_\_
• Ability to survive in macrophages
	○ Inhibition of \_\_\_\_ fusion allowing them to escape into the cytoplasm
	○ Can replicate inside \_\_\_\_
• Avoidance of the activated macrophage response
	○ Inhibit macrophage \_\_\_\_:
		§ \_\_\_\_: Inhibits PKC and blocks the effect of IFN-γ
	○ Resistance to digestions:
		§ \_\_\_\_ prevent ROS formation:
			□ PGL-1 and LAM
		§ Prevent enzyme induction of:
			□ \_\_\_\_
			□ SOD
		§ Stress response:
			□ Induction of \_\_\_\_

• Tissue destruction by eliciting inflammatory responses
	○ This is the cause of pulmonary tissue damage due to the host response against the bacteria in an effort to contain the infection
	○ The damage IS NOT DUE TO A BACTERIAL TOXIN –> IS DUE TO THE  \_\_\_\_ (TNF-α stimulating inflammation)
A
glycolipid
mycolic acid
macrophages
lysosome
vesicles
activation
LAM
oxygen scavengers
catalase
Hsp65/70
host response
28
Q

Diagnosis of TB

• TB Skin Test: \_\_\_\_
	○ A screening test that indicates previous exposure
	○ The "bump"
		§ Complicated since other acid fast bacteria can cause this
		§ NOT for \_\_\_\_
• Microscopic and cultural diagnostic test:
	○ Positive acid fast stain or cultures indicate an \_\_\_\_ Pulmonary infection
	○ Takes w\_\_\_\_ to read the response due to slow bacterial growth
	○ Can now due \_\_\_\_ to identify the bacteria
• Chest X-ray Examination:
	○ Can find:
		§ Isolated \_\_\_\_
		§ \_\_\_\_ to detect Ghon complexes
		§ Old \_\_\_\_ in the lung
		§ Active \_\_\_\_
A

PPD
diagnosis
active
weeks

PCR

granulomas
ghon focus
scarring
TB pneumonia

29
Q

Treatment of TB
• Major problem is people typically stop after the first ____ weeks/2 months since they “feel better”
• ____ is another drug used too
First 8 weeks:
• ____, rifampin, and ____ ALL together daily
○ Due to the bacteria’s ability to be ____ to drugs
Next 16 weeks:
• ____ and ____ daily or twice weekly

A
8
ethambutol (EMB)
isoniazid
pyrazinamide
resistant
isoniazid
rifampin
30
Q

Prevention of TB

• BCG Vaccine: A ____ strain that lost its ____ after prolonged ____ in vitro

A

bovine
virulence
cultivation