Uti, Endocarditis/meningitis & STIs Flashcards
(111 cards)
1
Q
Describe gonorrhoea bacteria
A
Gram negative diplococcus (coffee bean shaped)
Fastidious and susceptible to drying, requires transport medium
2
Q
How is gonorrhea transmitted
A
Through contact of mucous membranes sexually or perinatally
Typically spread in the 20-25 age group
3
Q
What are the clinical manifestations of gonorrhea
A
Pelvic inflammatory disease Pharyngitis Conjunctivitis Joint infection Neonatal conjunctivitis
4
Q
How is gonorrhea diagnosed
A
Nucleic acid amplification testing
Or
Culture of urethral/cervical swabs
5
Q
Benefits of nucleic acid amplification test?
A
More sensitive than a culture as it can also detext dead organisms
Can defect from urine sample (more comfortable)
6
Q
What are some issues with urethral/cervical swabs
A
Less sensitive but very soecific
Resistance becoming a problem
7
Q
What are treatments for gonorrhea
A
- Cefixime (oral beta lactam) or ceftriaxone (injection) combined with azithromycin incase of chlamydia co infection
- ciprofloxacin (flouroquinolone) although increasung resistance
8
Q
Describe chlamydia bacteria
A
Chlamydia trachomatis causative agent
Obligate intracellular bacteria devoid of cell wall, can not be gram stained
9
Q
Why can’t chlamydia bacteria be gram stained
A
Obligate intracellular bacteria that has no cell wall
Must be detected by molecular amplification or cultured
10
Q
Describe chlamydia lifecycle
A
2 alternating forms
Reticulate body: actively replicating then ruptures creating elementary bodies
Elementary body: transmitted infectious form that enters cells and develops reticulate body
Reticulate -> replicate -> rupture
11
Q
What cells does chlamydia infect
A
Urethral, cervical and conjunctivial epithelial cells
12
Q
Describe chlamydia epidemiology
A
One of the most common stis
15-25 age range
Asymptomatic carriers common
13
Q
What are clinical manifestations of chlamydia
A
Urethritis cervitis Pelvic inflammatory disease Proctitis (rectum inflammation) Reactive arthritis Conjunctivitis (esp in babies)
14
Q
Describe chlamydia specimens
A
Men: urethral swabs and urine samples
Women: vaginal swabs, endocervical swabs, urine
15
Q
How is chlamydia detected
A
Nucleic acid amplification test
16
Q
How is chlamydia treated?
A
Tetracyclines ( doxycycline), azithromycin, erythromicin
No cell wall betalactam can not be used
17
Q
Describe syphilis bacteria
A
Treponema pallidum
Tightly coiled spirochaete
Too fine to gram stain must use dark feild microscopy
18
Q
What are the three stages of syphilis
A
Primary (localized) Secondary (systemic) Latent (asymptomatic) Tertiary (late) Congenital
19
Q
Describe primary syphilis
A
1-4 weeks following contact
Chancre (painless ulcer) heals spontaneously
20
Q
Describe secondsry syphilis
A
Skin rash, flu like symptoms, lymphadenopathy
21
Q
Describe tertiary syphilis
A
Cardiovascular and neurological symptoms
Gumma (masses that appear on skin)
22
Q
Describe congenital syphilis
A
Bone, teeth and brain damage
23
Q
What is unique about a syphilis rash
A
Does not spare soles and palms
24
Q
How is syphilis diagnosed
A
Dark feild microscopy for primary disease only! ( chancre)
Serology is main route of diagnoses
Specific tests used
25
How is syphilis treated
Penicillin treatment if choice, doxycycline if allergy
Longer treatment required if CNS involved
Hiv common coinfection so test for that
26
Describe herpes bacteria
Linear double stranded DNA virus
| Neurotopic: invades nerves and becomes dormant reactive if regrowth
27
What is the clinical presentation of herpes?
Primary infection: fever, headache, myalgia, painful lesions, discharge, disuria, tender nodes
Latent: shedding virus without lesions
28
Describe recurrent herpes infections
Less severe than primary infection usually localized to genital area
Tingling/pain 50% of patients
29
Describe congenital herpes infection
Life threatening to baby if passed during birth
30
How is herpes diagnosed
Nuckeic acid amplification test
Swabs of local lesions
Culture on cells (less sensitive)
31
How is herpes treated
Antivirals
| Long term prophylaxis if frequently recurrent
32
Describe UTI prevalance
50% of women have one before 30
Incidence decreases with age
About 25% of women experience a reinfection 6 months after first UTI
33
Define bacteriuria
Presence if bacteria in urine. Does not mean infection
34
Define asymptomatic bacteriauria
Prescence of bacteria and absence if symptoms
| Usually clinically insignificant unless pregnant or undergoing unvasive procedures of urinary tract
35
What is an upper uti called
Pyelonephritis
36
What is a lower uti called
Cystitis and urethritis
37
How are utis classified
Location (upper/lower)
Condition of patient (complicated/uncomplicated)
Evolution (acute, chronic, recurrent)
38
Describe cystitis
Confined to bladder
Disuria, urinary frequency, urinary urgency
Absense of symptoms ir physical signs suggesting inflation at other sites withun urinary tract
39
What bacteria causes acute urethritis
Chlamydia trachomatis
| Neisseria gonorrhea
40
What bacteria causes vulvitis
Contact dermatitis or allergic reaction
| Candida albicans HSV infection
41
Define pyelonephritis
Clinical diagnosis that implies a more invasive infection INCLUDING THE KIDNEYS
Inflammation of kidney renal pelvis assumed as well as tenderness involving flank,nausea,chills,fever,headache
42
Define prostatistis
Inflammation or infection of the prostate gland
43
Define intrarenal abcess/perinephric abcess
Collection of pus in kidney or soft tissue surrounding kidney
44
Define uncomplicated UTIs
Patients with normal genitourinary tracts
| Usually non pregnant premenopausal women
45
Describe complicated UTIs
Structural of functional abnormalities of the genitourinary tract
Pregnant women, elderly,men,children
Chronic symptoms, upper tract disease
46
Describe UTI relapse
Recurrence of infection by same organism after discontinued treatment
47
Describe UTI re infection
Recurrence of infection by different organisms after discontinued Treatment
48
What causes UTIs
Usually due to patients own intestinal flora ascending route of infection
Organisms enter urinary tract in retrograde fashion via the urethra
Complicating factors such as catheters tubes, surgery, stones allow organisns to enter tract and alter typical spectrum of organisms
49
What are risk factors for UTI
```
Aging
Being female
In males inter course or prostatic hypertrophy
Urinary tract obstruction
Impaired bladder innervation
Hematogenous spread (through blood)
```
50
True or false a majority of UTIs are caused by a single pathogen
True
51
What bacteria is responsible for 90% of all UTIs
Enteribacteriacea
Gram negative, facultative anerobic bacilli
Common intestinal flora
52
What is the most commonly isolated pathogen in UTIs
Escherichia coli most commonly isolated 70% in all UTIs
53
What bacteria is responsible for a majority of community acquired UTIs
E.Coli
54
What is a major virulence factor in UTIs
Adherence
| E.coli has fimbrae which bind to p blood group present on uro epithial cells in 99% of population
55
Describe hemolysins, colicin V in UTIs
Aid in resistance to complement dependent bactericidal effect of serum
56
Describe k antigen in UTI
Associated with uppee tract infections
57
Describe type I finbrae and uti
Inter bacterial binding and biofilm production
58
Describe proteus, morganella and providencia
Classical uti pathogens
Highly Motile, produce fimbrae
UREASE PRODUCING organisms
Increases urinary pH which leads to crystal formation and obstruct flow
CAUSE STONES AND CRYSTALIZATION
Swarm agar plate
59
What are biofilms
Colonization on catheter
| Protects bacteria from hosts defenses and antibiotics
60
Describe uro-pathogen staph saprophyticus
1-5% if cystitis
| Typically associated with younger sexually active females
61
Describe UTI dipstick testing
Interested in detection of nitrates and leukocytes produced by infection
Detection of nitrates: reasonably sensitive for gram negative bacteria but highly specific
Detection if leukocytes: sensitive but not specific
Need to find both
62
What is significant bacteruria in a urine culture defined as
10^5 bacteria/ml (10^8/litre)
Lower numbers may be significant in children or catheter specimens
63
Describe clean catch mid stream specimens
Most frequently used method
Urethra cleaned prior to collection
First void urine allowed to pass to clear urethra then mid stream collected in sterile containers
64
Describe collection bag samples
Used in children
Often contaminated
Most meaningful result is a negative culture
65
Describe indwelling catheter specimen collection
Urine obtained by inserting needle into catheter or through diaphragm
Preferably obtain through new catheter not old
66
Describe suprapubic aspiration specimen collection
Invasive.
| Specimen obtained directly from bladder
67
How is a uti specimen transported
Bacteria grows rapidly in urine and sample must be sent as aoon as posible
If not in lab by 1-2 hours must be refrigerated
If not recieved in 24 hrs lab rejected
Unkess tranported by boric acid tube
68
Describe boric acid tube
Preserves and maintain viability of organism w/o further bacterial growth
69
Should all patients with UTI be cultured
No, we know what typically causes a UTI (e.coli) treat empirically
70
What treatment is used in uncomplicated cystitis
Nitrofuratonin (not empiracle choice anymore bc resistance)
Fosfomycin
TMP/SMX
Ciprofloxacin/noroxaxin if no other choice
71
What treatment is used in pyelonephritis
B lactam WITH amynoglycoside
Or
Ciprofloxcin (usually avoided)
72
What is endocarditis
An infection of the endocardial surface of the heart
| The wall of the heart may be involved as well as infection may occur at structural defects
73
Who is particularly susceptible to endocarditis
Patients with artificial valves or other foreign materials
74
Descrube acute endocarditis
Presenting within 6 weeks
More virulent organism that causes damage more quickly (fever chills)
S.aureus and S. Pyrogenes responsible
75
Describe subacute and chronic endocarditis
Presenting from 6 weeks to 3 moths
Chronic after 3 months
Often caused by low virulence organisms with gradual destruction of valves
Viridians (alpha haemolytic) streptococci
76
What bacteria typically infects normal valves
S. Aureus; highly virulent
77
What bacteria are more likely to cause infection on abnormal valves
Low virulence, skin and oral microorganisms
| Alpha haemolytic streptococci, enterococci and coagulase negative staphylococci
78
What are commonest organisms to cause natuve valve IE
Alpha haemolytic “viridians” streptococci
79
What organisms are commonest in PV IE
Coagulase negative staphylococci
80
What is bacteremia
Bacteria circulating in the blood
81
Describe endocarditis pathogenesis
Mucous membranes and skin colonized
Trauma = bacteremia
Adherence (promoted by fibrin, platelet aggregation and endothelial damage)
Further platelet fibrin deposition takes place
Vegetations develop after bacterial division
Vegetarions develop with dormant organisms
Vegetations fragment and embolize other organs
82
What heart valve complications can arise from infection
Cauliflower shaped vegetations may develop of valves
Inflammation may destroy valve
Small emboli in arteries = myocardial infection
Abscessed may develop in the heart muscle = impair electrical conduction
83
What are brain consequences from endocarditis
Micro emboli = confusion or coma
Stroke
Abscesses
Memegiris may occur from ongoing bacteremia or emboli
84
What are other consequences from endocarditis
Kidney: renal artery obstruction; inflammation and damage
Other:
Emboli in spleen, eyes, extremities or other organs
Blood vessels weakened stretched and burst
85
What risk factors can be identified when diagnosing endocarditis
```
Previous heart disease
Dental or other surgical procedures
Intravenous drug use
Recent heart surgery
Long standing in dwelling lines
```
86
What are tools for diagnosis for endocarditis
```
Blood cultures (positive in 90% of cases)
Echocardiography (recognition if vegetation’s)
```
87
How long is endocarditis treated
At LEAST 4 weeks
88
How is endocarditis treated
Combonation treatments, especially with penicillin and aminoglycoside combos
89
Describe endocarditis prevention
Prophylactic antibiotics following at risk dental and surgical procedures
90
Define meningitis
Inflammation of fhe membranes covering rhe brain and spinal cord
Can be acute or chronic
91
What js encephalitis
Inflammation of brain tissue, not to be confused with meningitis
92
What is acute meningitis
Severe and sudden onset
Headache
Neck stiffness
Confusion
93
What causes acute meningitis
```
Streptococcus pneumoniae (kids and adults)
Neisseris meningitidis (esp. young adults)
Haemophilus influenzae (esp.children)
Listeria monocytogenes (esp, babies and elderly)
```
94
What are other causes of acute meningitis
Viral causes (less severe)
Enteroviruses (summer/fall)
Arboviruses (vector transmission)
Herpes viruses
95
What kind if menigitis does not cause outbreaks
Streptococcus pneumoniae
96
True or false there is a vaccine for neisseria menjngitidis
True! Used during outbreaks
97
What type of meningitis is virtually eliminated
Haemophilus influenzae thanks to vaccine!
98
Describe intial pathogenesis for meningitis
- nasopharyngeal colonization
- local invasion
- bacteriemia
- meningeal invasion
- bacterial replication in subarachnoid space
- release if bacterial cell wall components
99
Describe the development pathogenesis of meningitis
- release if bacterial cell wall component
- macrophages release cytokines
- subarachnoid space inflammation
- increase CSF outflow resistance
- cerebral vasculitis
- blood brain permiabilitt
- brain edema
- confusion and coma
100
Do you treat meningitis empirically
Absolutely!! Rapidly progressing !!
101
How is menigitis diagnosed
Cloudy cerebral spinal fluid jncreased white cells, high protein, low glucose
Can be seen on gram stain (may be negative is empirically treated)
Csf cukture for bacteria (pcr may be used)
102
How is viral meningitis disgnosed
Using PCR
103
How is chronic meningitis diagnosed
Test for specific agents
104
How soon should a suspected meningitis case be treated
Less than an hour After arriving at ER
105
How is menigitis treated
Ceftrixalone/vancomycin AND ampicillin for at risk groups when empiracally treated
Usually single antibiotic after cause determined
106
How is S. Pneumoniae meningitis treated
Third generation cephalosporin (ceftriaxone) vancomycin if resistance
107
How is neisseria menigitidis and haemophilus influenzae menigitis treated
Third generation cephalosporin CEFTRIAXONE
108
How is listeria meningitis treated?
Ampicillin
| Resistant to all cephalosporins
109
Describe HPV
Caused by human papillomaviruses
Some serotypes are causative agents of cancers
Transmission by sexual contact
110
What are some consequences of HPV
Cancers (cervical,anal,oral)
| Skin growths on genitalia, perianal area (usually transient infection resolving in months)
111
How are genital warts removed
Chemical means, freezing or surgery if necessary
