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Microbiology > UTI, Genital Tract Infections, GI Tract, Public Health > Flashcards

UTI, Genital Tract Infections, GI Tract, Public Health Flashcards

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1
Q

What is the CFU/ml calculation for the 0.01 ml loop (10 ul)?

A

CFU x 100

Bacteremia = > 10^5 CFU/mL

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2
Q

What is the CFU/ml calculation for the 0.001 ml loop (1 ul)?

A

CFU x 1000

Bacteremia = > 10^5 CFU/mL

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3
Q

Ascending Transmission (UTI)

A

Organisms multiply in bladder —> ureters and kidneys (goes upwards = ascending)

Common in women
Hospital-acquired UTI in both sexes

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4
Q

Hematogenous (descending) Transmission (UTI)

A

From bacteremia, bloodborne

Descends down to kidneys and urethra

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5
Q

Urethritis

A

Infection of the urethra

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6
Q

Asymptomatic bacteriuria

A

Isolation of bacteria without sign of infection

In elderly people, treat with antibiotics even if asymptomatic

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7
Q

Cystitis

A

Infection of the bladder

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8
Q

Cystitis

A

Infection of the bladder

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9
Q

Acute urethral syndrome

A

Primarily in young, sexually active women

Symptomatic (burning, frequent urination), few isolated organisms

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10
Q

Pyelonephritis

A

Inflammation of kidney parenchyma, calices and pelvis

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11
Q

Urine Collection Methods

A
  • Clean-catch midstream urine: least invasive
  • Straight catheterized urine: uncontaminated
  • Indwelling catheter collection: may have contamination like clean catch, collected from catheter port (not collection bag)
  • Suprapubic aspiration: needle goes straight into bladder, uncontaminated
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12
Q

Boric acid

A

Preservative for urine

Do not refrigerate, otherwise urine can form crystals

Up to 48 hrs, but analysis should not exceed 24 hrs

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13
Q

Urine Screening (what you might see if there is infection)

A
  • Pyuria (presence of PMNs/neutrophils) - >400,000 = infection
  • Leukocyte count - >=10/mm^3 = infection
  • Symptomatic women with pyuria without bacteriuria: UTI with <10^5 CFU/ml or have C. trachomatis, U. urealyticum
  • Nitrate (+)
  • Leukocyte esterate (+)
  • Catalase (+), except strep and entero
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14
Q

Media for Urine

A
  • SBA/MAC
  • Columbia colistic-nalidixic (CNA) or PEA: detect G(+) enterics (in case there is G(-) overgrowth — helps isolate)
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15
Q

Counts for UTI detection if there’s a single isolate

A

> 100,000 CFU/ml - significant bacteriuria — probably UTI

10,000-100,000 CFU/ml - possible UTI

<10,000 CFU/ml - do not work up, likely contaminant

If the same organism is seen on repeat urine cultures, likely a pathogen even if colony counts are low

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16
Q

What do you do for 1 isolate? 2? 3?

A

1 isolate: work up
2 isolates: usually work up, 1 might be contamination
3 isolates: likely contamination

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17
Q

UTI in kids

A

Bacteria is more common in boys than girls - circumcision can help keep area clean

Preschool girls (and up) develop more UTIs

May be asymptomatic

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18
Q

Acute, uncomplicated UTI in women

A

Immediate symptoms

Dysuria, urgency, frequency, suprapubic pain

Less bacteria in urine because infection just started >10 WBC/mm^3 or >10^3 CFU/ml

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19
Q

Acute, uncomplicated pyelonephritis

A

Involves kidneys

Fever, chills, flank pain

More bacteria - >10^4 CFU/ml

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20
Q

Uncomplicated UTIs

A

Occur in healthy women and men, responds well to antibiotics

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21
Q

Complicated UTIs

A

Occurs in both sexes

More difficult to treat, greater morbidity and mortality

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22
Q

Normal Flora of Urethra

A

Coag (-) staph (except S. saprophyticus)
Viridans and nonhemolytic strep
Lactobacilli
Diphtheroids
Nonpathogenic Neisseria in females
Anaerobic cocci
Anaerobic G(-) rod
Propionibacterium sp.
Commensal Mycobacterium sp.
Commensal Mycoplasma sp.

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23
Q

Female genital tract - in prepubescent and postmenopausal women

A

Staph and Corynebacteria

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24
Q

Is GBS common in elderly population?

A

Yes, work up if <50 yo. Otherwise, it’s normal

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25
Common STD agents
C. trachomatis N. gonorrhoeae Trichomonas vaginalis HIV Ureaplasma urealyticum Mycoplasma hominis Adenovirus Coxsackievirus Molluscum contagiosum (poxvirus) HPVs
26
Anorectic lesion
Inflammation of anal muscle May cause proctitis
27
Vaginitis
Symptoms: abnormal discharge, offensive odor, itching Agents: - Candida albicans - 80-90% of cases, thick and cheese discharge - Trichomonas vaginalis: slightly offensive, yellow-green discharge. Dies quickly so process immediately - Gardnerella vaginalis: BV, polymicrobic (caused by many organisms, possibly the result of loss of lactobacilli). Clue Cells
28
Cervicitis
Symptoms: Increased PMNs in endocervix, purulent discharge (pus) Agents: N. gonorrheae, C. trachomatis, HSV, HPV
29
Pelvic Inflammatory Disease (PID)
Cervical microorganisms travel to endometrium, fallopian tubes, other pelvic structure May produce endometritis, salpingitis (inflammation of fallopian tubes), peritonitis (inflammation of abdomen lining), abscesses. Can cause scarring of fallopian tubes or infertility if left untreated Agents: N. gonorrhoeae, C. trachomatis, anaerobes, G(-) rods, strep, mycoplasmas
30
Infections after gynecologic surgery
Cellulitis, abscesses Agents: Aerobic G(+) cocci, G(-) rods, anaerobes, Mycoplasmas
31
Infections with pregnancy
Spread hematogenously (from blood) to upper tract
32
Transplacental Prenatal Infection Agents
Through placenta Bacteria: Listeria monocytogenes, T. pallidum, Borrelia burgdorferi Viruses: Cytomegalovirus (CMV), rubella, HIV, parvovirus B19, enteroviruses Parasites: Toxoplasma gondii, Plasmodium sp.
33
Ascending Prenatal Infection Agents
During delivery Bacteria: GBS, E. coli, L. monocytogenes, C. trachomatis, genital mycoplasmas Viruses: CMV, HSV
34
Natal Infections Agents (passing through birth canal)
Similar to Ascending Prenatal Agents Bacteria: GBS, E. coli, L. monocytogenes, N. gonorrhoeae, C. trachomatis Viruses: CMV, HSV, enteroviruses, hepatitis B virus, HIV
35
Postnatal Infection Agents
Route of infection: transplacental, ascending, passing through birth canal, from nursery, environment, breastfeeding, etc. Agents: all agents from prenatal and natal infections
36
Orchitis
Inflammation of testicles Typically acquired by bloodborne dissemination of viruses
37
Prostatitis
Enlarged prostate gland - gets bigger naturally as men age Lower back, lower abdominal pain, urinary discomfort ejaculatory complains
38
Syphilis
T. pallidum
39
Nontreponemal serological tests
VRDL (cardiolipin antigen) and RPR non-specific reagin test
40
Specific treponemal test
Antibody against antigen of the organisms FTA-ABS, TP-PA, EIAs, MHA-TP
41
Chlamydia
C. trachomatis Non-gonococcal urethritis - most common STD in US Symptoms: asymptomatic in 50% males, 70-80% females Can cause: cervicitis, bartholinitis, proctitis, salpingitis, epididymitis, acute urethral syndrome, PID, lymphogranuloma venereum (small lesion on genital area) Similar to gonorrhea
42
Gonorrhea
N. gonorrhoeae Symptoms: occur 2-5 days after infection in women, up to 1 month in men Intracellular G(-) diplococci Extracellular G(-) diplococci in women = normal flora
43
Trichomoniasis
Trichomonas vaginalis - flagellated protozoan Transmission: direct contact with contaminated clothing or towels Trophozoite Symptoms: purulent discharge, itchy skin/vulval pruritus, odor, edema, erythema 25-50% asymptomatic women, fewer in males Diagnosis: wet mount, Giemsa/papanicolaou smear, culture, antigen detection, PCR
44
Specimen Transport (for gonococci or chlamydia/mycoplasmas)
Gonococci: swab in modified Stuart’s or Amie’s charcoal media, room temp Chlamydia/mycoplasma: swab in media with antibiotics, on ice
45
3 major causes on BV
G. vaginalis Candida sp. T. vaginalis Detected by hybridization assay
46
Does the upper small intestine or distal ileum have a higher count of resident flora?
Distal ileum
47
Invasive infection
Has leukocytes
48
Toxic infection
No leukocytes
49
Gastroenteritis
Syndrome with symptoms of n/v/d and abdominal discomfort
50
Dysentery
Inflammatory disorder of GI tract Usually has blood and pus in feces with pain, fever, abdominal cramps Resulting from large intestine disease
51
Enterocolitis
Inflammation of mucosa of small and large intestines
52
Toxin Production - Enterotoxin
Causes gastroenteritis in intestines Ex. of microorganisms: Vibrio, Shigella dysenteriae, ETEC, Salmonella, C. difficile, Aeromonas, Campylobacter jejuni
53
Toxin Production - Cytotoxin
Causes destruction of cells Ex. of microorganisms: Shigella sp., C. difficile, EHEC
54
Toxin Production - Neurotoxin
Causes paralysis C. botulinum, S. aureus, B. cereus
55
Microorganisms with Attachment within or close to mucosal cells/adherence
EPEC, EHEC, Cryptosporidium parvum, Isopora belli, Rotavirus, Hep A/B/C, Norwalk virus
56
Pathogenic Mechanism - Invasion
Invade epithelial Shigella, EIEC, Campylobacter jejuni, Plesiomonas shigelloides, Yersinia enterocolitica, Edwardsiella tarda, etc.
57
Enterotoxin-Mediated Diarrhea
Symptoms: - Rapid onset of diarrhea, <12 hrs - Lack of fever (not invasive) - no wbcs to help with infection - Absence of blood or pus - Large number of watery stools
58
Food Poisoning Agents
S. aureus, B. cereus, Type A Clostridium perfringens, Clostridium botulinum
59
Norwalk virus (Norovirus)
From shellfish and salads Cruise ship diarrhea
60
Why do we not accept cultures from inpatients after they’re hospitalized for 3 days if suspected bacterial cause of diarrhea?
Diarrhea is likely from antibiotic usage - C. difficile
61
Virus (stool) transportation
Fresh stool in container, no preservatives, keep refrigerated
62
Parasite (stool) transportation - O&P
Stools in preservative within half an hour of collection Collect 3 samples over 3-9 days
63
Media for C. difficile
CCFA CDSA
64
Pseudomembranous colitis
C. difficile
65
Acceptable additive for urine
Boric acid
66
V. vulnificus vs. V. cholerae vs. Yersinia enterocolitica
V. cholerae - yellow on TCBS (ferments sucrose). Rice water stools V. vulnificus - green on TCBS. Ferments lactose while all others are non-lactose fermenters - Raw tilapia, liver disease Vibrios - 6.5% NaCl growth or fresh water, grows better in summer (20°C), O/129 Test (S) Y. enterocolitica - bullseye on CIN, urease (+)
67
Criteria for accepting stools for culture
Preservative (for bacteria, no preservative for viruses) Refrigerated if not inoculated within 2 hrs of collection
68
Vaginal flora changes with age
Lactobacilli is predominant Prepubescent and postmenopausal women - Staph and Corynebacteria Reproductive age women - facultative anerobes Some women carry GBS - also popular in elderly population, normal if >50. Work up and report if <50 yo
69
Trichomonas vaginalis culture media
Diamond’s medium or plastic envelopes with inoculum
70
Urogenital specimen collection
Swab in sterile saline (T. vaginalis, different swab for gonococci, chlamydiae, ureaplasma) Aspiration with syringe for Batholin gland exudate (not swab)
71
Gonococci swab transport
Modified Stuart’s or Amie’s charcoal media in RT
72
Chlamydia or mycoplasma specimen transport
Media with antibiotics, on ice or stored at 4°C
73
Whiff test
BV diagnosis Fishy odor Indicates decrease in Lactobacillis and gold standard (Clue cells)
74
Pathogens with virulence factors for UTIs
- Uropathogenic E. coli - Proteus sp. - S. saprophyticus Adherence
75
Esophagitis
painful, difficulty swallowing, patients with underlying diseases (HIV) Candida, HSB, CMV
76
Gastritis (stomach ulcers)
Inflammation of gastric mucosa H. pylori - urease (+)
77
Proctitis
Inflammation of rectum STIs
78
EHEC/O157:H7
Bloody (hemorrhagic), watery diarrhea, abdominal cramps Low-grade or no fever No leukocytes in stools Pink colonies (shiga toxin producing) on chromagar MUG (-), SMAC (-)
79
Shigella sp.
Highly infectious Dysentery - often bloody diarrhea High fever, chills, abdominal cramps, pain with tesnesmus (feels like having to go but no stools)
80
Salmonella sp.
n/v/watery d, fever, chills, abdominal pain Self-limiting
81
Campylobacter sp.
Gull wing, G(-) Self-limiting Modified Skirrow’s, Campy blood agar, 42°C
82
Clostridium difficile
Pseudomembranous colitis - from antibiotic use Culture on CCFA or CDSA Toxin production for diagnosis of C. difficile (vs just antigen (+)
83
Rabies
Virus that infects CNS Bats/dead wild animals
84
Lyme Disease
Borrelia burgdorferi Bulls eye rash, fever, fatigue, can spread to joints, heart CNS
85
Francisella tularensis
Contact, ingestion of contaminated food/water, inhalation Hunters and outdoor enthusiasts are more likely to get infected Market men’s disease, water trapper’s disease, Ohara’s fever, rabbit fever, deer-fly fever Rabbit = most common mammal associated Small G(-) coccobacilli *Beta-lactamase (+)* Grows on Cysteine enriched media (thio, cysteine-heart agar, TM, chocolate, BCYE) Slow grower Oxidase (-) Catalase weak +/-
86
Brucella sp.
Break in skin, ingestion of unpasteurized milk, inhalation Malaise, night sweats, fever, chills, can relapse Highly infectious, do not sniff B. melitensis, B. suis are more infectious than B. abortus Small, G(-) coccobacilli Catalase (+) Oxidase (+) Non-motile
87
Bacillus anthracis
Large G(+) boxcar Medusa Head, ground glass colonies Non-hemolytic Non-motile Catalase (+) Woolsorter’s Disease

Microbiology (9 decks)

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