Urinalysis & CSF Flashcards
(195 cards)
1
Q
Helminth forms
A
Parasitic worms
2
Q
Causes of CSF infection
A
- bacteria
- viruses
- spirochetes
- parasites
3
Q
CSF infections are associated with:
A
- increased WBC counts
- alterations in normal glucose levels
- alterations in normal protein levels
4
Q
Predisposing risk factors of CSF infection
A
- young
- elderly
- nutritional deficiencies
- immunologic deficiencies
5
Q
- low glucose
- high protein
A
Bacterial meningitis
6
Q
What does bacterial meningitis utilize?
A
Glucose
7
Q
Cloudy CSF fluid specimen could indicate:
A
WBCs / bacterial meningitis
8
Q
The majority of meningitis cases affects what age?
A
Under 5 years
9
Q
How many tubes do you collect for a CSF fluid specimen?
A
4
10
Q
Normal CSF characteristics:
A
- clear
- colorless
- sterile
11
Q
Why should you never refrigerate CSF?
A
The organisms are sensitive to temperature
12
Q
What media is used for CSF testing?
A
- chocolate
- BAP
- thio
13
Q
How many ml are in the CSF tubes?
A
10ml
14
Q
A positive direct smear (gram stain) of CSF is considered:
A
An alert value, report to physician
15
Q
CSF changes seen in bacterial meningitis:
A
- increased turbidity
- increased neutrophils
- increased protein
- decreased glucose
16
Q
What does a cytocentrofuged gram stain do?
A
Concentrates everything (it’s hard to focus CSF on a microscope)
17
Q
What are the protein and glucose levels in Bacterial (acute) meningitis like?
A
- high protein
- low glucose
18
Q
95% of bacterial (acute) meningitis is seen in:
A
Children under 5 years
19
Q
Pathogens:
- Haemophilis influenza B
- Neisseria meningitidis
- Streptococcus pneumoniae
- GNRs
A
Bacterial (acute) meningitis
20
Q
Most common type of meningitis
A
Viral (asceptic) meningitis
less severe
21
Q
Pathogens:
- Enteroviruses
- herpes viruses
A
Viral (asceptic) meningitis
22
Q
Causes flu-like symptoms
A
Viral (asceptic) meningitis
23
Q
What are the glucose and protein levels like in viral (acute) meningitis?
A
- high glucose
- low protein
24
Q
Encapsulates yeast
A
Cryptococcus neoformans
25
Rare cause of meningitis
Parasitic meningitis
26
Pathogens:
- Naegleria fowleri
- Acanthamoeba
- Balamuthis
- Angiostrongylus
- Plasmodium
- Toxoplasma
Parasitic meningitis
27
Rare cause of CNS infection
Fungal meningitis
28
Pathogens:
- Cryptococcus neoformans
- Coccidiodes immititis
- Histoplasma capsulatam
- Blastomyces dermititidis
- Candida
Fungal meningitis
29
Cryptococcus neoformans ID
India ink stain
30
Common in AIDS patients
Cryptococcus neoformans
31
Enters the body through respiratory droplets and multiplies/spreads via the blood
Mycobacterial meningitis
32
Pathogens:
- M. tuberculosis
- M. avium
- M. bovis
Mycobacterial meningitis
33
- acid-fast bacilli
| - won't stain with normal gram stain
Mycobacterial meningitis
34
Very thick cell wall, waxes, & has phospholipids
Mycobacterial meningitis
35
HIV is a risk factor
| Makes you more susceptible
Mycobacterial meningitis
36
Slender, flexible, helically shaped bacteria
Spirochetal meningitis
37
Pathogens:
- Treponema pallidum
- Borellia burgdorferi
Spirochetal meningitis
38
- spiral shaped
| - gram negative
Spirochetal meningitis
39
Causes Lyme disease
Borellia burgdorferi
| LYME BURGERS
40
Causes neurosyphillus
| In patients with HIV
Spirochetal meningitis / treponema pallidum
41
What does an AFB culture look for?
- Acid fast bacilli
| - fungal spores
42
Major organs involved in urinary systems & diseases:
- bladders
- ureters
- kidneys
- urethra
- prostate
BUKUP
43
Most common nosocomial infection:
UTI
| From catheters
44
Most common source of bacteremia:
UTI; urine cultures
45
Most common pathogen, E. coli:
UTI; urine cultures
46
Frequent pathogens, coliforms:
UTI; urine cultures
47
Nitrite, leukocytes, WBC and bacteria in a sediment indicate what?
Infection (UTI)
48
What will happen if a UTI is not treated?
It will spread
49
How is a UTI diagnosed?
By a combination of symptoms
| Urinalysis -> urine culture
50
What tests certain gram negative bacteria?
Nitrate reductase test (Griess)
51
Urine must be in bladder for 4+ hours for this test, and it flags for a microscopic to be done
Nitrate reductase test (Griess)
52
Who is at risk for UTI?
- Immunocompromised (elderly & children)
- pregnant women (uterus puts pressure on bladder)
- kidney transplant recipients (foreign object in body / immunosuppressed / scarring)
53
What is a normal cause of bacteria in a non-sterile urine specimen?
Epithelial cells
54
Cystitis
Inflammation of the bladder
55
Pyelonephritis
Infection of the kidney
56
Bacteriruria
Presence of bacteria in the urine
57
Urethritis
Inflammation of the urethra
58
Prostatitis
GU infection in males involving the prostate
59
Cervivicitis
Inflammation of the cervix
60
Most common non-sterile urine specimen
Mid-stream clean catch
| Noninvasive, patient can do it themselves
61
Sterile urine culture specimens:
- catheterized
- suprapubic aspirate
- cytoscopic
62
Suprapubic aspirate
Urine is aspirated through the belly into the abdominal cavity and into the bladder
(Done when there is an obstruction)
63
Cytoscopic
| Urine specimen
Scopes through kidney
64
Deliver urine specimen to lab within ____ minutes
30
| Refrigerate immediately if unable to process
65
What will happen if a urine culture is left sitting out?
Bacteria will multiply and it will affect urinalysis results
66
Urine culture setup:
1) mix urine thoroughly before streaking (it will settle so needs mixing)
2) inoculate with calibrated loop .001ml (calibrated to deliver a certain amount)
3) T-streak on BAP & MAC or EMB (T-streak: down middle, go to top, side to side all the way down plate)
67
Should bacteria be seen on a sterile urine specimen?
No
68
What is the purpose of a urine specimen count?
To determine actual infection from contaminating bacteria
69
>100,000 colonies/ml of urine
Clinically significant
70
Over 10 colonies in urine =
Infection
71
A (urine) colony count greater than 10cfu is considered:
Significant unless sterile.
| If sterile, ANY growth is considered significant.
72
What media do you do colony counts on?
BAP or MacConkey
73
Urine pathogens
1) GNRs
2) GPCs
3) GPRs
4) fungi
74
(Urine) GNR pathogens
| Leading cause of UTIs
- E. coli
- pseudomonas
- klebisella
- acinetobacter
- enterobacter
75
Leading cause of UTIs
GNRs
76
(Urine) GPC pathogens
- enterococcus (in older men)
- S. saphrophyticus
- S. epidermidis
- S. aureus
- group B strep
77
(Urine) GPR pathogens
```
Listeria monocytogenes
(Only a pathogen in rare cases)
```
78
(Urine) fungi pathogens
- Candida albicans
- Cryptococcus neoformans
- Blastomyces
- Coccidioides
- immititis
- Histoplasms capsulatum
79
Is bacillus in the urine considered contamination?
Almost always
80
Other agents of UTIs
1) anaerobes (when recovered from suprapubic aspirates / anaerobes don't grow in presence of oxygen (sterile site in body = anaerobic))
2) C. trachoma & N. gonorrhoeae (these urine cultures are on BAP or MacConkey so these wouldn't grow on either. Dr. Must be specifically looking for)
3) mycoplasma & Ureplasma (more common in neonates)
4) Gardnerella vaginalis
81
Microscan and Vitek
Susceptibility testing (antimicrobial) antibiotics & carb/sugar
- bacteria growing in wells = resistant to antibiotic
- bacteria not growing = susceptible
82
CSF infections can be caused by:
- bacteria
- viruses
- fungi
- Spirochetes
- parasites
Can be life threatening
83
95% of all bacterial meningitis occurs in:
Children under 5 years old
84
CSF associated with bacterial meningitis has:
- increased neutrophils (turbidity)
- decreased glucose
- increased proteins
85
Bacterial meningitis pathogens in neonates
1) group B strep
2) GNRs (E. coli, klebsiella spp., enterobacter spp.)
3) listeria monocytogenes
86
Causes bacterial meningitis in children (>2 years) and adults
1) streptococcus pneumoniae
| 2) Neisseria meningitidis
87
Causes bacterial meningitis in older adults (>65 years)
1) streptococcus pneumonia
2) Neisseria meningitidis
3) listeria monocytogenes
4) aerobic gram negative bacilli
88
Parasitic encephalitis (uncommon cause of meningitis) pathogen forms
- protozoan forms (free-living amoeba)
| - helminth forms (parasitic worm)
89
Naegleria fowleri - protozoan form
| Parasitic encephalitis
- almost always fatal
| - in WARM fresh WATER and moist soil
90
Acanthamoeba spp. - protozoan form
| Parasitic encephalitis
Found in solid, fresh & brackish water and sewage
91
Balamuthis mandrillaris - protozoan form
| Parasitic encephalitis
No environmental sources identified
92
Protozoan forms
Free-living amoeba
93
Helminth forms
Parasitic worms
94
Angiostrongylus Cantonensis - helminth form
| Parasitic encephalitis
- Thailand, Malaysia, Vietnam
| - ingestion of GREEN LEAFY VEGETABLES
95
Plasmodium falciparum - helminth form
| Parasitic encephalitis
CEREBRAL MALARIA, infected by the bite of an infected MOSQUITO, characterized by changes in MENTAL status, SEIZURES, motor deficits & COMA
96
Toxoplasma gondii - helminth form
| Parasitic encephalitis
Eating RAW, undercooked MEAT or contact with cats, organ transplants
97
Fungal encephalitis pathogens
1) Cryptococcus neoformans
2) Coccidiodes immititis
3) Histoplasma capsulatum
4) Blastomyces dermatiditis
5) Candida spp. Including C. albicans, C. tropicalis, & C. parapsilosis
98
Coccidioides immitis
| Fungal encephalitis
SW USA, Mexico, central/South America
99
Histoplasma capsulatum
| Fungal infections
MS and Ohio river basins / patients with candidiasis (overgrowth of yeast)
100
Candida spp. Including C. albicans, C. tropicalis & C. parapsilosis
(Fungal encephalitis)
Like Histoplasma, seen in patients with overgrowth of yeast, (disseminated yeast infection causes cerebral abcess) / acquired as nosocomial infection in patients with catheters or microbial therapy)
101
Blastomyces dermatiditis
| Fungal encephalitis
MS and Ohio river basins / spread by inhalation that results in pulmonary infection & spreads
102
Griess
Nitrate reductase test
103
Antimicrobial susceptibility testing
Rapid method most commonly used
104
E. coli (GNR)
| UTI pathogen
antibiotic-susceptible strains emanating from patient's fecal flora
105
Enterococcus (GPC)
| UTI pathogen
Primarily in older men
106
S. saphrophyticus (GPC)
| UTI pathogen
Predominantly in symptomatic sexually active women younger than 40 years
107
S. epidermidis (GPC)
| UTI pathogens
Only 20% of cases, hospitalized patients >50 years, usually have had urinalysis tract surgery, indwelling catheters or chronic urinary tract disease
108
```
Listeria monocytogenes (GPR)
(UTI pathogen)
```
In rare cases and only considered significant after consultation with physician
109
Bacillus spp. (GPR)
| UTI pathogen
Isolation can almost always be considered contamination
110
```
Candida albicans (fungi)
(UTI pathogen)
```
Rare in healthy adults, common in hospitalized patients,nearly colonies can resemble CoNS
111
Cryptococcus neoformans, Blastomyces dermatiditis, Coccidioides immitis, Histoplasma capsulatum (fungi)
(UTI pathogen)
Recovery of any of these in urine culture is considered highly significant and indicates a disseminated (spread) infection
112
Anaerobes
| UTI
Significant when recovered from suprapubic aspirates
113
C. trachomatis and N. gonorrhoeae
| UTI
Can cause:
- urethritis
- cystitis
- prostatitis
114
Mycoplasma & Ureaplasma
| UTI
Neonates from lower socioeconomic groups
115
Gardnerella vaginalis
| UTI
Commonly reflects vaginal contamination but also is an emerging UT pathogen. Repeated cultures with this organism as the primary isolate should be considered significant
116
What does CFU stand for?
Colony forming units
117
What is considered a significant colony count from a urine culture from a clean catch specimen?
Greater than 10 cfu
118
Why are UTIs the most common cause of nosocomial infections?
Because of patients with catheters
119
Why are UTIs more common in women than in men?
Because women have shorter urethral and their urethral openings are closer to the anus
120
Name two conditions that would make an individual more susceptible to an infection of the CSF:
- extremities of age (older young)
| - nutritional & immunologic deficiencies
121
What percentage of bacterial meningitis cases occur in children
95%
122
What action should be taken by the MLT if bacteria is observed on the CSF gram stain? Why?
Call the physician if positive because it is considered an alert value
123
Cervicitis
A GU infection seen in females only
124
Cystitis
Inflammation of the bladder
125
Pyelonephritis
Infection of the kidney
126
Urethritis
Inflammation of the urethra
127
Prostatitis
A GU infection seen in males only
128
Bacteriuria
Presence of bacteria in the urine
129
If a urine specimen cannot be immediately processed, what action should be taken to preserve the specimen?
Refrigerate immediately and process within 2 hours
130
What urine pathogen is seen primarily in older men?
Enterococcus
131
Name three gram negative rods that are known to cause encephalitis in neonates:
E.coli, klebsiella, enterobacter
132
How do neonates acquire encephalitis?
Vertical transmission from mother to infant
133
What will the chemistry results be in a patient who has viral encephalitis?
Increased glucose, decreased proteins
134
Name four conditions that would make an individual more susceptible to contracting a UTI:
- extremities of age (elderly & children)
- pregnant women
- catheterized patients
- kidney transplant patients
135
Name the CSF pathogen that is associated with eating raw or undercooked meat, contact with cats and organ transplants:
Toxoplasma gondii
136
Causative agent for lyme's disease
Borrelia burgdorferi
137
Causes cerebral malaria
Plasmodium falciparum
138
Found in soil, fresh & brackish water, sewage
Acanthamoeba
139
Found in MS & OH river basins
Blastomyces
140
Associated with war,, natural bodies of water
Naegleria fowleri
141
Causes neurosyphillis
Treponema pallidum
142
Associated with HIV patients
M. tuberculosis
143
Green leafy vegetables, snails & slugs
Angiostrongylus
144
What type of encephalitis causes mild, flu-like symptoms and will usually resolve on its own?
Viral
145
What urinary pathogen is mainly seen in women
S. saphrophyticus
146
How are most diarrheal pathogens acquired?
By ingesting a contaminated food or beverage
147
Name four host defenses of the GI tract and explain the role each one plays in the host defense process:
Normal flora - fights off pathogens
Stomach acidity - low pH kills organisms
Mucous layer - constant motion reduces chances for adherence
Colon / IgA fights off some organisms
148
What is the most common cause of diarrheal illness in children
Rotavirus
149
What diarrheal pathogen is associated with infectious outbreaks on cruise ships?
Calcivirus
150
What is the specific strain of diarrheal pathogen that produces shiga-like toxins?
E.coli 0157:H7
151
What is the most common cause of bacterial gastroenteritis in the world and is associated with contaminated poultry?
Campylobacter jejuni
152
Can migrate to liver
Entamoeba histolytica
153
Toxins have cytotoxic & neurotoxic effects
Shigella sonnei
154
Travelers returning from endemic areas
Cyclospora
155
Associated with AIDS patients
Microsporidia
156
Associated with hikers, mountain streams
Giardia lamblia
157
Resistant to chlorine
Cryptosporidium
158
Only known host is human, intracellular
Salmonella typhi
159
Resistant to refrigeration
Yersinia enterocoligica
160
Associated with fried rice
Bacillus cereus
161
Peptic ulcer disease
Helicobacter pylori
162
Antibiotic associated diarrhea
Clostridium difficile
163
Produces "rice-water" stools
Vibrio cholerae
164
Name two complications of Campylonacter infection:
Guillain-Barré syndrome and relative arthritis
165
Why will treatment with antibiotics delay the clinical improvement of patients with a Shigella infection?
If the antibiotic breaks down the cell wall, the organism releases the toxins and makes the patient sicker
166
Name two types of media that could be inoculated for the recovery of Salmonella in a stool specimen:
GN broth and Selenite
167
What temperature should media intended for the recovery of Campylobacter be incubated at?
42 degrees Celsius
168
What temperature should media intended for the recovery of Yersinia be incubated at?
Room temperature
169
What is the mortality rate of newborns that acquire bacterial meningitis?
20%
170
If a patient had viral meningitis, what will be seen on the gram stain of the CSF collected from this patient?
Nothing - viruses are not seen on gram stains
171
Name two common organisms known to cause meningitis in both adults AND children:
N. meningitidis
| S. pneumoniae
172
1) Name the media used for urine culture setup:
| 2) Which of these is the colony count performed on?
1) BAP, MAC, or EMB
| 2) BAP
173
Name two sterile urine collection methods and a non-sterile collection method for urine cultures.
Sterile: suprapubic aspirate and cytoscopic
Nonsterile: mid-stream clean catch
174
On a direct gram stain of a CSF a yeast is observed. The yeast has a large halo around it on an India ink stained slide. What is the organism?
Cryptococcus neoformans
175
The primary etiologic agent for UTI is:
E.coli
176
Name a parasite that can cause encephalitis:
Naegleria fowleri
177
What is cystitis?
Inflammation of the bladder
178
Why should CSFs never be refrigerated before the culture has been set up?
Potential pathogens are sensitive to temperature
179
What are the expected chemistry results on a CSF in a patient with bacterial meningitis?
Increased proteins, decreased glucose
180
What is the name of the rapid screening test done on urines to determine the presence of a possible UTI?
Griess test
181
What is the Griess test detecting?
Nitrate reduction to nitrite
182
Loeffler media
Corynebacterium
183
BYCE
Legionella
184
Lowenstein-Jensen
Mycobacteria
185
Bordet-Gengou
Bordatella
186
A cytoscopic urine is collected and inoculated with a .001ml loop and after 24 hours of incubation it has 4 colonies counted from the BAP plate. Is this clinically significant? Explain:
Yes, because a cytoscopic urine is sterile, so any growth is significant
187
Name the 5 major organs of the urinary tract that are involved with infections of the UT:
BUKUP
1) bladder
2) urethra
3) kidneys
4) ureters
5) prostate
188
What media is used for CSF cultures?
Chocolate, thio, BAP
189
The expected colony count in a suprapubic urine specimen from a healthy individual is:
0 CFU/mL
190
Why are urine colony counts performed?
To determine if there is an infection
191
What is the primary population that acquires bacterial meningitis?
Children younger than 5 years old
192
Name a change seen in the physical characteristics of a CSF sample if a bacterial infection is present:
Increased turbidity (from WBCs/neutrophils)
193
Recovery of any of these in a urine culture is considered highly significant and indicates a disseminated infection:
- Cryptococcus neoformans
- Blastomyces dermatidis
- Coccidiodes immitis
- Histoplasma capsulatum
194
What is a disseminated infection?
Spread infection
195
Anaerobes are significant when:
Recovered from suprapubic aspirates
