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Renal I > Microbiology : UTI > Flashcards

Microbiology : UTI Flashcards

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1
Q

Who is more at risk for UTI: Young Man or Elderly Female ?

A

Elderly Female . Much more

Females > Males
Elderly > Young, Adults

Old Woman = A walking UTI machine.

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2
Q

Which is the more common way for bacteria to get into the kidney: Ascending UTI Infection or hematogenous spread ?

A

Ascending UTI (Urethra –> Bladder–> Ureters –> Kidney)

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3
Q

What doe most renal infections seeding from bacteremia produce ?

A

Abscess !

Infection is usually seen in the parenchyma

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4
Q

What are common causes of Ascending UTI’s ?

A

Sexual Intercourse (Staph Saprophyticus)
Fecal Incontinence
Urinary Catheters (Staph epidermidis)
Retrograde Urine flow

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5
Q

Which local factors would render a person more susceptible to UTI ?

A 
Physiological obstruction
   Infrequent voiding
   Neurogenic or Neuropathic bladder
   Detrusor muscle instability
Congenital abnormality
   Retrograde urine flow 
Catheter
Instrumentation
Trauma
Malnutrition
Diabetes
Hyperosmolality 
IC
Tolerance to pathogen (cross-reactivity of host)
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6
Q

What is vesicoureteral reflux ?

A

Urine from the bladder flows retrograde back into the ureters and causes a backup of in the kidney. This flow of urine can lead to seeding of bladder infection into the kidneys .

Another variant is urethravesicular flow (urine flows from urethra into the bladder )

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7
Q

How does hyperosmolarity predispose someone for UTIs ?

A

Inhibits PMN migration to damaged tissue

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8
Q

Describe the inherent anti-microbial (UTI protection) in humans

A 
Antibacterial activity of urine :
    low pH; high organic acids 
    high urea concentration
    high urine osmolality
    Low vaginal pH
Flushing mechanism of bladder
Peristaltic movement of ureters 
Estrogen (young women)
Anti-adherence effect of uromucoid
Local secretion of immunoglobulins (IgA)
Antibacterial activity of prostate secretions of post-pubescent males
Long urethra in males
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9
Q

What do indwelling catheters form that lead to UTI susceptibility ?

A

A nidus.

Allows for bacterial colonization

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10
Q

What common disease state in older males may lead to UTI ?

A

Prostatic hyperplasia

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11
Q

What is the most important factor that allows for bacterial colonization in the urinary tract ?

A

ADHESION !

Adhesion determines the extent of bacterial colonization

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12
Q

What is adherence specificity >

A

The type of adhesion molecules determines where in the urinary tract a bacteria can colonize

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13
Q

p-Fimbrae and Pilli are bacterial constituents that allow for …

A

adhesion !

Mutant fimbrae –> decreased pathogenicty

Maternal ab’s protect against pFimbrae

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14
Q

Define K-antigens

A

capsular acidic polysaccharides that show resistance to bactericidal action of Ig and complement … mainly anti-phagocytic.

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15
Q

What is the most important adhesion molecule made by UTI causing E.coli ?

A

p-Fimbrae

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16
Q

Besides reflux, what allows for the ability to ascend in the GU system ?

A

Intrinsic motility of the organism

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17
Q

Where in the GU is Acute Cystitis often seen ?

A

Lower (bladder)

Typically a superficial infection

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18
Q

What demographic often gets Acute Cystitis ?

A

Young Women

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19
Q

Do individuals who get Acute Cystitis, often have physiologic or anatomical aberrations that lead to the infection ?

A

NOPE…

However, residual bladder urine is associated with it

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20
Q

What are common signs of acute cystitis ?

A 
Frequent urination (urgency)
Lower abdominal discomfort
BURNING PAIN and Feeling of FULLNESS

May see hematuria but not always

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21
Q

Where is inflammation seen in Tuberointerstitial disease ?

A

Kidney parenchyma and renal pelvis.

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22
Q

What will be seen on the kidney in uberointerstitial disease ?

A

Small abscesses

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23
Q

What are common symptoms associated with uberointerstitial disease ?

A

Fever and back pain (may see renal dysfunction)

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24
Q

Describe the clinical onset of Acute Pyelonephritis

A

Abrupt onset
Chills, fever, headache, back pain
Tenderness over costovertebral angle

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25
bladder irritation in Acute Pyelonephritis will lead to ...
dysuria, frequency and urgency.
26
Proteus mirabilis invlovement in Acute pyelonephritis causes what to occur ?
Magnesium ammonium stones
27
What occurs to the renal pelvis in Chronic Pyelonephritis ?
Scarring and deformation of pelvis
28
Is chronic pyelonephritis a cause of renal failure ?
YES !
29
Loss of tubular function in Chronic Pyelonephritis leads to
Polyuria Nocturia Mild proteinuria
30
Acute Urethral Sndrome occurs in 50% of women who also show ...
Dysuria and frequency
31
Acute urethral Syndrome usually always presents with .....
Acute Cystitis
32
What infections typically present like Acute Urethral Syndrome ?
Chlamydia and Herpes
33
What percentage of pregnancies result in an Upper RTI ?
33%
34
What events in pregnancy predispose women to UTI ?
Estrogen and progesterone induced dilation of uterus, bladder, pelvis increased bladder capacity decreased ureteral peristalsis vesicoureteral reflux
35
Who typically gets Complicated UTI (Cystitis and Pyelonephritis ) ?
Pre-menstral girla Post-menopausal women HOWEVER, if a man gets a UTI its is most likely going to be COMPLICATED
36
What percentage of nosocomial infections are catheter related ?
35-40% Most asymptomatic Greater risk in women
37
What class of bacteria are most commonly seen in catheter associated bacteremia ?
Gram -'s | CATHETER ASSOCIATED BACTERIMIA IS MOST COMMONLY ASSOCIATED WITH CATHETER USE !
38
List the most common causative agents of G - UTI
``` Enterobacters E.coli Proteus mirabilis Morganell morganii Kleb pneumo Psedomonas aeruginosa Mycoplasma ```
39
What are the most common forms of G + bacteria associated with UTI ?
Staph. saprophyticu Staph epidermidis Less common: Staph aureus, Clostridium
40
What is the most common yeast associated with UTI
candida
41
What is the most common pathogen seen in UTI ?
E.coli (90% of acute bacterial cystitis) 80% community 30-50% nosocomial UTI's
42
K Antigens associated with E.cloi ?
O1, O2, O4, O6, O7, O75
43
E.coli K groups associated with Children ?
11, 24, 36, 37
44
What type of Pilli do all serotypes of E.coli have ?
Type I
45
What does Type I pilli bind to in order to adhere ?
Mannose Receptors
46
Strains that causes cystitis have a higher affinity for what than fecal strains ?
uroepithelial cells
47
Describe the symptoms seen in HUS caused by EHEC
Acute Renal Failure Microangiopic Hemolytic Anemia Thrombocytopenia
48
HUS due to EHEC is seen in what age group predominantly ?
Children under 10 years of age
49
What foods often contain EHEC ?
Contaminated (undercooked) beef Unpasteurized milk Fruit juices
50
EHEC infection often presents with bloody diarrhea. What is the most common serotype of EHEC ? What will it not do on MacKonkey agar ?
O-157: H7 It will not ferment sorbitol !!
51
What is phase variation ?
Although a bacteria has the potential to produce many different fimbrae with affinity for different body cavities, it usually will not produce all of them at once making the infection very specific for a certain type of fimbrae.
52
E.coli is associated with which disease which causes entrapment of air within the kidney ?
Emphysematous pyelonephritis
53
Who is most at risk for emphysematous pyelonephritis ?
Diabetics (especially women)
54
What are the main treatment options for emphysematous pyelonephritis ?
Nephrectomy | Anti-bacterial
55
Is Proteus mirabilis more associated with community acquired UTI or nosocomial ?
Nosocomial
56
Proteus produces which kind of pilli ?
Type I
57
Why is proteus' ability to change its surface composition important ?
Allows it to adapt to conditions that may need a different attachment protein Escape from phagocytosis
58
What kind of motility does proteus have ?
SWARMING
59
Proteus is urease + or - ?
+ !
60
Salmonella can cause what condition, which is associated with sepsis ?
Bacteriuria (often seen in the elderly)
61
Klebsiella: Nosocomial or CA UTI ?
Nosocomial
62
Enterobacter:Nosocomial or CA UTI
Nosocomial
63
Pseudomonas: Nosocomial or CA UTI
Nosocomial
64
Psedomonas, like salmonella, is a cause of bacteriuria. Unrelated to this is the fact that it is Oxidase (+/-) ?
+ !
65
Mycoplasma genitalium can be found in the healthy male urethra but also may be associated with which two infective states ?
Pelvic Inflammatory Disease Non-gonnococal urethritis
66
Ureaplasma urealyticum causes what complication in pregnancy ?
Chorioamniotis Premature delivery In addition : frequently transmitted from mothers to their infants, causing pneumonia, persistent pulmonary hypertension, chronic infection of the central nervous system and bronchopulmonary dysplasia.
67
What are the lab diagnostics for S.aureus
G+ Catalase + Coagulase + Non-Motile
68
What deadly complication can be seen with S.aureus UTI ?
Bacteremia
69
Lab diagnostics for S. saprophyticus
Gram + | Catalase and Coagulase -
70
Who is most at risk for UTI due to S. saprophyticus
young sexually active women (Honeymoon Cystitis)
71
Does Staph. epidermis typically cause infection in healthy adults ?
Nope, it is opportunistic
72
Which pathogen(s) are commonly found in patients with diabetes ?
Clostridia | Yeasts: Candida Torulopsis glabrata
73
Clostria, yeast and e.coli can often cause which disease that results from a direct UTI or a fistula from the GI tract connecting to the UT ?
Empysematous cystitis
74
In addition to chemotherapy and radiation. Which three viruses are responsible for hemorrhagic cystitis ?
``` Adenovirus (Type 11, more selective for UT) Varicella Zonster BK polyoma (may also be indicated in bladder cancer) ```
75
What are the four most common bacterial causes of prostatitis ?
E.coli Proteus Klebsiella Enterococcus
76
In urinary tuberculosis where will you see the first lesion in this infection ?
Kidney May progress to gall bladder, prostate, seminal vesicles.
77
How is TB spread to the UT ?
hematogenous spread
78
In which patients do you often see Urinary TB
Older patients with latent TB
79
In schistasomiasis, the eggs lead to what kind of reaction ?
granulomatous
80
What other disease is associated with schistosomiasis ?
BLADDER CANCER
81
What is the best way to diagnose UTI ?
Urine sample ! Use a hemocytometer on uncentrifuged urine You can also gram stain centrifuged urine

Renal I (8 decks)

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