Infections of the Genitourinary

Question 1

Community-­‐
acquired
UTI

Answer 1

• Escherichia coli
• Staphylococcus saprophyticus

Question 2

Nosocomial
UTI

Answer 2

• Escherichia coli
• Enterococcus spp.
• Pseudomonas aeruginosa
• Klebsiella

KEEP

Question 3

Struvite
stones

Answer 3

Proteus
mirabilis

Question 4

Urethritis

Answer 4

Neisseria
gonorrhoae

Question 5

Sterile
pyuria

Answer 5

Mycobacterium
tuberculosis

Question 6

Hemorrhagic
cystitis

Answer 6

• Schistosoma haematobium
• Adenovirus
• BK polyoma virus

Question 7

Indwelling
catheter

Answer 7

• Escherichia coli
• Candida albicans

Question 8

What are the characteristics of Escherichia coli?

Answer 8

• gram-­‐negaDve
  rods
• lactose-­‐fermenDng
  colonies on EMB or MacConkey’s agar
• *green sheen *on EMB agar

Question 9

Where is the habitat of E. coli?

Answer 9

human
colon

Question 10

Where does E.coli colonizes?

Answer 10

• vagina and
• urethra

Question 11

How is E. coli transmitted to cause UTI?

Answer 11

ascending
infection in UTI

Question 12

What are the pathogenesis factors of E.coli?

Answer 12

• § pili
• § flagellum (H)
• § capsule (K)
• § endotoxin** (O)**

Question 13

E.coli is the most common cause of ?

Answer 13

community-­‐acquired
UTI

Question 14

E.coli is the 2nd most common cause of?

Answer 14

NEONATAL
MENINGITIS

Question 15

Escherichia
coli
TREATMENT for UTI

Answer 15

Ampicillin
or sulfonamides

Question 16

Escherichia
coli
TREATMENT for meningitis and sepsis?

Answer 16

3°
cephalosporins

Question 17

how is E.coli prevented?

Answer 17

limiting
urinary
catheterization

Question 18

Staphylococcus
saprophyticus
CHARACTERISTICS

Answer 18

Gram-­‐positive cocci in clusters
§ Catalase-­‐posi9ve
§ Coagulase-­‐negative
§ Novobiocin-­‐resistant
§

Question 19

What is the appearance of S. sprophyticus in Blood agar?

Answer 19

Whitish, non-­‐hemolytic colonies
on
blood
agar

Question 20

What is the epidemeology of S. sprophyticus?

Answer 20

2nd most common cause of UTIs
in
sexually
active
women

Question 21

What are the clinical finding in S. saprophyticus?

Answer 21

• dysuria,
• pyuria,
  and
• bacteriuria

Question 22

What is the treatment for S. sprophyticus?

Answer 22

TMP-­‐SMX,
quinolones

Question 23

What are the characteristics of Enterococcus faecalis?

Answer 23

• Gram-­‐posi9ve cocci in chains
• § Catalase-­‐negative
• § Gamma hemolyticc colonies
• § Lancefield group D
• § bile and optochin-­‐resistant
• § hydrolyzes esculin in BEA
• § positive PYR test

Question 24

Where does E. faecalis can grow?

Answer 24

6.5% NaCl

Question 25

Enterococcus faecalis HABITAT

Answer 25

* human colon * urethra and female genital tract

Question 26

Enterococcus faecalis TRANSMISSION

Answer 26

may enter bloodstream during** GIT or GUT surgery**

Question 27

Enterococcus faecalis SPECTRUM OF DISEASES

Answer 27

* UTIs due to **indwelling urinary catheters** and **Urinatry tract** instrumentation * biliary tract infect * Endocarditis in patients who underwent GIT surgery

Question 28

Enterococcus faecalis TREATMENT

Answer 28

* **Penicillin** plus gentamicin * **Vancomycin** for penicillin-­‐resistance * **Linezolid** for vancomycin-­‐resistant strains

Question 29

Pseudomonas aeruginosa CHARACTERISTICS

Answer 29

* gram-­‐negative rod * **moTILE** * **obligate aerobe** * **non-lactose fermenting** * ***oxidase-positive*** * **pyocyanin ( blue- green pigment)** * **sweet grape-like odor**

Question 30

What is the appearance of pseudomonas aeruginosa in blood agar?

Answer 30

yellow green beta hemolytic

Question 31

The reason for the grape like odor of Pseudomonas aeruginosa is?

Answer 31

aminoacetophenone

Question 32

P.aeruginosa may be distinguished from other species by:

Answer 32

ability to grow at 42 deg celcius

Question 33

Describe the appearance of P.aeruginosa on Mconkey agar?

Answer 33

* Flat * blue green colonies with very distinct ***_feathered edges_***

Question 34

What are the two pigments that grow in Maconkey agar

Answer 34

1. red pigment ( pyorubrin) non fluorescent 2. yellow-green color (pyocyanin) fluorescent

Question 35

Pseudomonas: Pathogenesis

Answer 35

Disease begins with attachment to and colonization of host tissue Pili mediate adherance

Question 36

What is the spectrum of disease of Pseudomonas aeruginosa

Answer 36

**URINARY TRACT INFECTIONS** – common cause of **nosocomial UTIs**

Question 37

Pseudomonas aeruginosa TREATMENT

Answer 37

Combination of active antibiotics required because of resistance to multiple antibiotics (multi-drug resistant). *  antipseudomonal penicillins (ticarcillin, piperacillin, azlocillim) *  Penicillin plus beta-lactamase inhibitor (TICARCILLIN-CLAVULANATE, PIPERACILLIN-TAZOBACTAM) *  Third generation cephalosporins (CEFTAZIDIME) *  Fourth generation cephalosporins (CEFEPIME) *  Monobactam (AZTREONAM) – for gram negative only *  Carbapenems (IMIPENEM, MEROPENEM) - erapenem has no action against pseudomonas *  Fluoroquinolones (CIPROFLOXACIN) *  Aminoglycosides (GENTAMICIN, AMIKACIN, TOBRAMYCIN)

Question 38

How is Pseudomonas aeruginosa PREVENTED

Answer 38

* Disinfection of water related equipment * Hand washing * Prompt removal of catheters

Question 39

Klebsiella pneumoniae CHARACTERISTICS

Answer 39

* facultative gram-negative rods with ***large polysaccharide capsule*** * **extended spectrum beta-lactamase ( ESBL) **activity in drug resistant strains * **urease-positive**

Question 40

Klebsiella pneumoniae HABITAT

Answer 40

upper respiratory and GIT

Question 41

Klebsiella pneumoniae TRANSMISSION

Answer 41

* aspiration or inhalation * ascending spread of fecal flora

Question 42

Klebsiella pneumoniae spectrum of disease?

Answer 42

* pneumonia * UTI

Question 43

What is the characteristic of sputum in pneumonia patient caused by Klebsiella pneumoniae

Answer 43

thick, bloody sputum **("currant-­‐ jelly" sputum)**

Question 44

K. pneumoniae causing pneumonia most common cause in \_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 44

alcoholics

Question 45

What is the Klebsiella pneumoniae TREATMENT

Answer 45

culture-­‐guided treatment – cephalosporins alone or with aminoglycosides

Question 46

Proteus mirabilis CHARACTERISTICS

Answer 46

* facultative gram-­‐negative rods * non-­‐lactose-­‐fermenting * urease-­‐positive

Question 47

What type of motility is exhibited by P. mirabilis?

Answer 47

swarming motliity

Question 48

Proteus mirabilis PATHOGENESIS

Answer 48

* ^{urease hydrolyzes urea to form ammonia} * ^{​raises pH producing alkaline urine} * ^{encourages the formation of struvite stones} 

Question 49

What is the composition of struvite stone ?

Answer 49

magnesium-­‐ammonium-­‐ phosphate

Question 50

Proteus mirabilis SPECTRUM OF DISEASE

Answer 50

COMPLICATED URINARY TRACT INFECTION * UTI assoc with **nephrolithiasis** * **staghorn calculi ** form on renal calyces

Question 51

Proteus mirabilis TREATMENT

Answer 51

§ TMP-­‐SMX or ampicillin § surgery for large stones

Question 52

only causes disease in **immunocompromised hosts**

Answer 52

BK polyoma virus

Question 53

what does K polyoma virus cause?

Answer 53

causes** hemorrhagic cystitiss** and **nephropathy** in patients with **solid organ (kidney) and bone marrow transplants**