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DEN303 - IHD > Genito-urinary Infections > Flashcards

Genito-urinary Infections Flashcards

1
Q

Infections

Common route

A

Most common bacterial infections
Main defence mechanism is flushing by urine
Usually ascends from external site up UT continuum
Catheterisation

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2
Q

Infections can lead to

A

Involvement of kidneys

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3
Q

Symptoms of UTI

A

Frequent urination

Painful urination - burning

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4
Q

UTI definitions

Urethritis

cystitis

dysuria

pyuria

pyelonephritis - characterised by

A

urethra

bladder

painful

urine that contains pus

kidney infection characterised by fever and back pain

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5
Q

Females are

A

More susceptible via fecal contamination

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6
Q

Host factors

A

Renal calculi - bacteria can stick to them
Ureteric reflux
Tumours in and adjacent to urinary tract
pregnancy, bladder stones
neuro issues - incomplete bladder emptying large volume of residual ruin

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7
Q

Pathogen factors

A

Haemolysins
Capsular antigens
Urease producing

Adhesion to uroepithelium via timbre and pillae

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8
Q

Diagnosis of UTI

A 
Midstream urine 
Cloudy or clear
Haematuria - pink urine? 
Culture on agar plates > 2x10^5 cells/ml
Raised nitrites 
Pure or mixed growth 
Gram stain of isolated bacteria or direct staining from sample
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9
Q

Community bacterial causes

A

E.coli gram -ve rod

Proteus mirabilis - gram negative pleomorphic rod - swarming mobility

Staph saprophyticus - gram +ve coccus

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10
Q

Which media

if e coli suspected??

A

Cysteine-lactose-electrolyte-deficient (CLED) media
- rich media containing lactose and lacking electrolytes which represses swarming

Macconkey agar

Some use pH indicator containing which stains E.coli pink

Lack of electrolytes suppresses proteus swarming
Cystine promotes growth of some e.coli strains
Lactose gives lac fermentation info
Bromothymol Blue is the pH indicator in this media.

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11
Q

E.coli

A

Gram -ve
causes GI infections but UTIs commonly caused by specific strains of e.coli
have 1000 extra genes
possess potent adhesions for epithelial attachment

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12
Q

Pilus adresins
Type 1 pili

P-fimbriae

A

Binds mannose receptors, common on glycoproteins in uroepithelium

P - pyelonephritis
binds to globobiose
linked ceramide host lipids

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13
Q

E. coli

Proteus

Staph aureus

A

Large yellow colonies, opaque, centre slightly deeper yellow

Translucent blue colonies

Deep yellow - uniform in colour

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14
Q

Further diagnosis of UTI caused by e. coli

A

Lactose fermenting strain so will produce pink colonies on macconkey agar

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15
Q

Proteus mirabilis

swarming

found more in

A

Change shape - dimorphic

Ability to move over a surface
Proteus forms short curly extensions and swarms

older people and in care homes - linked to incontinence and neurological degeneration

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16
Q

virulence factors of PM

A

urease - converts urea to ammonia and co2
raise pH of urine
can cause precipitation of minerals to form kidney and bladder stones

IgA protease - reduced flushing

many pili adhesins

17
Q

staphylococcus saprophyticus

A

gram +ve
haemagglutinin key to attachment to cells
common cause of UTIs in young women

coagulase negative (coagulase positive is ALWAYS STAPH AUREUS)

novobiocin resistant

most common in young women

18
Q

Treatment of community infection

Common antibiotics - NICE

A

Swift antibiotic tx to prevent complications of kidney infection
3 day course in women - 7 in men

Common antibiotic - nitrofurantoin , ciprofloxacin, penicillins and trimethoprim

resistance is a growing issue esp for e.coli

19
Q

Complications leading to UTI catheterisation

Common findings

Problematic??

A

Commonly UTIs stem from long term in dwelling catheters

Skin commensals like S.aureus (coag +ve)

Pseudomonas spp.

Klebsiella and enterococcus - PROBLEMATIC DUE TO RESISTANCE

20
Q

Hospital infections - common sources

A

urinary tract
surgical wound
LRT
Bacteraemia

21
Q

Treatment of hospital infection

May require?

A

Similar to community
May require IV antibiotics
Removal and changing of catheter and bag
Resistant e.coli infections now treated with plazomicin in USA

22
Q

Transmission of STDs

A

Any form of sexual activity in which no barrier is used and exchange of fluid or contact with mucosal epithelium occurs

23
Q

Recent rise in STIs is due to

A 
Behaviour is difficult to change 
420000 new cases in 2016
Chlamydia most common 
No vaccines 
Recent rise in single Over 50s - protection less likely
24
Q

Syphilis

A

Particularly MSM

25
Q

Main organisms

A 
Gonorrhoea 
Chlamydia 
Syphilis 
HIV virus
Genital herpes
Hepatitis B
26
Q 
Neisseria gonorrhoeae (Gonoccus) 
Characteristics

Progression

A

Fully virulent human pathogen - not a commensal
Asymptomatic carrier state

Acute urethritis - in 95% males, only 50% females suffer discharge and dysuria

Ascend to fallopian tubes

  • acute salpingitis, pelvic inflammatory disease
  • endometritis
  • cophoritis (ovaries)
  • sterility

Ophthalmia neonatorum - infant blindness

Oral gonorrhoea - very rare but can result from oral sex with infected man

27
Q

Pathogenesis of n gonorrhoeae

A

AEROBIC
Surface pili - bundle forming
Opa proteins
Lipo-Oligosaccharide sialylated - complement resistance - host mimicry and release sialic acid
Por proteins - nucleate actin aiding cell invasion
Possesses IgA protease - aids survival inside host cells
Antigenic variation hinder vaccination development
Release into bloodstream disseminates infection to other sites, arthritis, endocarditis

28
Q

N. gonorrhoeae epidemiology

A

In 1980s, fear of HIV infection and increased condom usage (barrier methods) decreased infection in developed countries

Very recently, number of cases increasing again due to promiscuity, travel (including sex trade) and use of oral contraceptives over barrier methods

Co-infection of HIV and N. gonorrhoeae increases transmission of HIV by 500% (WHO)
Infection with N. gonorrhoeae also increases likelihood of contracting HIV 5x

29
Q

Diagnosis and treatment of n.g

A
  1. urethral swab
    - sub-culture on chocolate agar
    - oxidase positive
    - gram -ve diplococcus

Antibiotic prophylaxis of contacts
Historically treated with penicillin and tetracyclines

Ceftriaxone and azithromycin recommended

3rd world strains are penicillin and tetracycline resistance

30
Q

Syphilis history

A

Major venereal disease for at least last 600 years

“French disease”

Treatment with mercury - ‘ A night in the arms of Venus leads to a lifetime on Mercury’

31
Q

Syphilis - caused by

Transmission

Symptoms

Dental link

A

Treponema pallidum
Exclusively human
3rd most frequent STD in USA

Sexual contact via minute skin abrasions
Vertical transmissions - cross placental congenital syphilis

  1. primary chancre at site of infection
  2. enlarged inguinal nodes
  3. flu like illness, headache, fever, myalgia, mucocutaneous rash, spontaneous resolution
  4. tertiary syphilis - neurological issues, paralysis, aortic lesions, heat failure, progressive destructive disease, splenomegaly

Teeth can be malformed

32
Q

Co infection

A

With HIV
Hinders tx
Increases infectivity and spread of HIV

33
Q

Congenital syphilis

Transmitted

A

Transmitted cross placenta

  • still birth
  • congenital infection
  • birth deformities, silent infection, presents as facial and dental deformities at 2 years of age
34
Q

Chlamydia

Trachoma

A

Most common STI in the UK
Often asymptomatic in females
50% symptomatic in males
Re-infection common as immunity weak
7-14 day incubation
Disease due to direct damage to cells and immunopathology causing fibrosis and scarring
Can cause conjunctivitis - common co-occurence

Trachoma biggest cause of preventable blindness

35
Q

Conjunctivitis and trachoma

A 
Common cause of conjunctivitis
Also in neonates- infection in birth
Major cause of blindness worldwide
with 6 million cases of blindness due to trachoma
-not STI in true sense
36
Q

Chlamydia in men

A 
Asymptomatic infection ~ 50%
Non specific urethritis 
Strong associations with: 
	Acute epididymitis
	Prostatitis
	Male infertility
37
Q

Chlamydia in women

A

Asymptomatic infection ~ 70 %
Mucopurulent cervicitis
Urethral infection

Pelvic inflammatory disease in up to 40% - ascending infection involving uterus, fallopian tubes, and other pelvic structures
Complications include chronic pelvic pain, ectopic pregnancy and infertility

38
Q

Other diseases
proctitis - in

reactive arthritis - in - symptoms

A

homosexual men

mainly men - acute onset urethritis - genital swelling - knees ankles and toes - REITER’S syndrome

Neonates infected during birth –> 20% conjunctivitis +/or peumonia

39
Q

Chlamydia epidemiology

Restricted cell range

A 
Small 
Obligate intracellular parasite 
Small genome
Enters through minute abrasions 
Specialised life cycle 
Avoid but not stimulate immune responses

Prefers to infect non-ciliated columnar and cuboidal epithelium - genital tract from urethra up to fallopian tubes and rectum
also respiratory and conjunctival cells

DEN303 - IHD (58 decks)

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