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- What is the most common cause of ascending UTIs?
- E. coli
- associated with urinary stones
- Proteus mirabilis
- organism produces urease, which acts on urea to produce ammonia
- Proteus mirabilis
- causes UTIs in young sexually active women
- Staph. saprophyticus
- associated with UTI in hospitalized patients
- Staph. epidermis, Enterococcus
- T or F - viral causes of UTIs are rare
- T
- virus establishes latency in epithelial cells in kidney tubules and ureter after entering respiratory tract
- human polyomaviruses
- implicated as cause of hemorrhagic cystitis
- adenovirus
- virus infects capillary blood vessels in kidney and can cause renal syndrome
- hantavirus
- Fungi that can cause UTIs
- Candida, Histoplasma capsulatum
- Protozoan causes urethritis in males and vaginitis in females
- Trichomonas vaginalis
- Infections with this parasite results in inflammation of the bladder
- Schistosoma haematobium
- Mechanical factors that predispose to UTI
-
1. shorter female urethra
2. sexual intercourse
3. uncircumcised male - Obstructions to complete bladder emptying (5)
-
1. residual urine >2-3ml
2. loss of neruologic control
3. vesicoureteral reflux
4. diabetes mellitus
5. catheterization - Where do most urinary tract pathogens originate?
- fecal flora
- Which species can actually colonize and infect urinary tract?
- aerobic, facultative (E.coli)
- a product of E. coli that is linked with the capacity to cause kidney damage
- hemolysin
- normal pH of urethra
- 4.6-8
- 3 factors that enable healthy urinary tract to be resistant to bacterial colonization
-
1. pH
2. chemical content
3. flushing mechanism - Clinical features of acute lower UTI
-
1. dysuria
2. urgency
3. frequency - Appearance of urine in acute lower UTI
- cloudy due to pyuria, bacteria, may contain blood
- people lacking antibacterial substances normally found in prostatic fluid may be susceptible to this
- acute bacterial prostatis
- Infection of kidney complicated by lower UTI symptoms, fever, and pain in kidney
- pyelonephritis
- common cause of upper UTI
- Staphylococci
- Complications of repeated upper UTIs
- loss of function of renal tissue, hypertension
- Quantitative definition of bacteriuria
- over 10^5 organisms/ml (only one bacterial species)
- treatment of UTIs
-
antibacterial agents
(ex: augmentin) - Prevention of UTI
-
1. regularly emptying bladder
2. prophylactic use of antibio
3. good catheter care - Host factors that increase risk of STD
-
1. genital lesions/ulcers
2. uncircumcised men
3. multiple infection - Causes syphilis
- Treponema pallidum
- 3rd most common STD
- syphilis
- T or F - Treponema pallidum is sensitive to drying, heating, and disinfectants
- T
- Characterizes intial contact stage of syphilis
- primary painless chancre
- Characterizes primary syphilis
- enlarged inguinal nodes followed by spontaneous healing
- Why are inguinal nodes enlarged during primary syphilis?
- proliferation of treponemes in lymph nodes
- Characterizes secondary syphilis
- flu-like illness, mucocutaneous rash, headache, fever
- What is the pathogenesis during secondary syphilis?
- multiplication and production of lesions in lymph node, liver, joints, muscles, skin, mucous membranes
- Pathogenesis in latent syphilis
-
treponemes dormant in possibly the liver and spleen
(covered with lipids) - Characterizes tertiary syphilis
- neurosyphilis, cardiosyphilis, progressive destructive disease
- Pathogenesis in tertiary syphilis
- re-awakening and multiplication of treponemes, dissemination and invasion
- 3 results of congenital syphilis
-
1. infection resulting in intrauterine death
2. congenital abnormalities
3. silent infection - appear at 2 - treatment of syphilis
- penicillin, tetracycline, doxycycline, erythromycin
- Causes gonorrhea
- Neisseria gonorrheae
- Reservoir/transmission of gonorrhea
- humans/sexual contact
- T or F - Neisseria gonorrheae is sensitive to drying
- T
- Who forms the major reservoir of infection by N. gonorrheae?
- asymptomatic women
- 4 mechanisms gonococcus uses to attach to mucosal surfaces
-
1. fimbriae for attachment
2. LPS - endotoxin activity
3. IgA protease
4. capsule resists phagocytosis - What type of cells do gonococci invade?
- non-ciliated epithelial
- What actually causes damage in gonorrhea?
- inflammatory responses elicited by organism
- Symptoms of gonorrhea in the male
- urethral discharge, pain on urination
- Symptoms of gonorrhea in women
- vaginal discharge
- Complications of gonorrhea in asymptomatic women
-
1. PID
2. chronic pelvic pain
3. infertility - damaged fallopian tubes - Type of gonorrheal infection in infants
- ophthalmia neonatorum
- Is penicillin recommended for treatment of gonorrhea?
- no
- Treatment of gonorrhea
- ceftriazone, ciprofloxacin, spectinomycin
- Causes chlamydial infection
- chlamydia trachomatis
- Form of C. trachomatis adapted for extracellular survival
- elementary body
- Form of C. trachomatis adapted for intracellular survival
- reticulate body
- Cycle of C. trachomatis
- enters host through mucosal surface, binds and enters cell through endocytosis, fusion of vesicles with lysosomes is inhibited - EB differentiates into metabolically active RB, which divide and produce EB
- Pathogenesis of C. trachomatis in men
- urethritis, epididymitis, proctitis, conjuctivitis
- Pathogenesis of C. trachomatis in women
- urethritis, cervicitis, salpingitis, conjuctivitis
- Treatment of chlamydia
-
doxycycline, tetracycline
babies - erythromycin - Causes of inguinal lymphadenopahty
- genital infections
- Causes lymphogranuloma venereum
- Chlamydiae trachomatis
- Treatment of lymphogranuloma venereum
- tetracycline, doxycycline
- Causes chancroid
- Haemophilus ducreyi
- Characterizes chancroid
- painful genital ulcer, local lymphadenitis
- Most common form of genital ulcers in Africa and Asia
- chancroid
- Treatment of chancroid
- erythromycin, caftraixone, otrimoxazole
- Causes donovanosis
- Calymmatobacterium granulomatis
- Characterizes donovanosis
- genital nodules, which form granulomatous ulcers that bleed on contact
- Regions where donovanosis is found
- Caribbean, New Guinea, India, central Australia
- Treatment of donovanosis
- tetracycline
- Found colonizing genital tracts of healthy sexually active men and women
- Mycoplasma hominis, Ureaplasma urealyticum
- Associated with PID and postabortal and postpartum fevers
- Mycoplasma hominis, Ureaplasma urealyticum
- Treatment of Mycoplasmas and Non-gonococcal urethritis
- tetracycline
- Normal inhabitant of female genital tract
- Candida albicans
- Symptoms of candida infection
- irritant vaginitis with cheesy vaginal discharge
- Treatment of Candida infections
- oral antifungals (fluconazole), nystatin
- Causes trichomonas infection
- Trichomonas vaginalis
- Transmission of trichomonas
- sexual intercourse, bedding, clothing, toilets
- Symptoms of trichomonas in women
- vaginitis with copious foul-smelling discharge, increase in pH
- Treatment of trichomonas infection
- metronidazole
- Causes bacterial vaginosis
- Gardnerella vaginalis, Bacteroides
- Symptoms of bacterial vaginosis
-
1. excessive malodorous vaginal discharge
2. vaginal pH >4.5
3. clue cells
4. fishy odor - What is pathogenicity of bacterial vaginalis related to?
- disrupting normal acidity of vagina
- What is the genital strain of HSV?
- HSV2
- What are symptoms of genital herpes?
- vesicles that break and form shallow ulcers, local lymph nodes swollen, fever, headache, malaise
- Where is the latent infection of genital herpes?
- dorsal root ganglion neurons
- Does condom use prevent genital herpes?
- no
- Treatment of genital herpes
- topical acyclovir
- What causes genital warts?
- papillomavirus 6,11,12,16,18,31
- Incubation period of genital warts
- 1-6 months
- Treatment of genital warts
- podophyllin
- Which strains of papillomavirus are associated with cervical cancer?
- 16,18
- Which genes normally suppress cell division (tumor-suppressor genes)?
- p53, pRb
- Describe papillomavirus
- double-stranded, not enveloped
- How does papillomavirus infect host?
-
viral DNA integrated into host chromosome and expresses E6,E7
E6 binds to p53, E7 binds to pRb - What affect does E6 binding to p53 have?
- cell continuously divides and enters mitosis
- What affect does E7 binding to pRb have?
- e2f binds to promoter and genes are transcribed
- Infection of which cells is the major source of transmitted HIV virus?
- peripheral blood mononuclear cells
- What causes decrease in CD4 and MHC1 expression in HIV?
- nef
- Describe ARC (AIDS related complex)
- weight loss, fever, persistent lymphadenopathy, oral candidiasis, diarrhea
- What is the value that is considered AIDS?
- 200 CD4/ml
- What lab tests are run to diagnose HIV?
- ELISA, followed by Western blotting, oral swab (gp24)
- What could be a problem with an HIV vaccine?
- induced antibodies against gp120 may combine with virus, attach to monocytes, and be ingested - infection
- Treatment of HIV
-
AZT (nucleoside analog of rt)w/ protease inhibitors
neviropine (non-nucleoside analog)
ritonavir (protease inhibitor) - What is the best therapy for HIV?
- HAART - highly active antiretroviral therapy
- What arthropod commonly attaches to pubic hair and causes infestation?
- Phthirus pubis
- Treatment of pubic or crab louse
- malathion
- What causes genital scabies?
- Sarcoptes scabei
- Treatment of genital scabies
- 10% benzyl benzoate, 1% benzene hexachloride
- How is mumps spread?
- airborne droplets, salivary secretions, possibly urine
- Where does the mumps virus settle?
- parotid gland
- What other organs can mumps infect?
- thyroid, pancrease, epididymus
- What type of vaccine is MMR?
- live attenuated
- What are the effects of congenital mumps?
- deafness, mental retardation, cataracts
- What is the largest human herpesvirus?
- cytomegalovirus
- How is CMV transmitted?
- saliva
- How does CMV spread?
- upper respiratory tract, lymphoid tissue, circulating monocytes and lymphocytes, salivary glands and kidney tubules, cervix, epididymus, testes
- What is the most common viral cause of congenital defects in US and what are the symptoms?
- CMV, microcephaly, mental retardation, hearing loss, jaundice
- What does CMV cause in immunodeficient patients?
- interstitial pneumonia
- Treatment of CMV
- ganciclovir
- How is EBV transmitted?
- exchange of saliva
- Where does EBV replicate?
- B lymphocytes binding to cd3 receptor
- What are symptoms of EBV due to?
- action of cytokines released
- What are the major symptoms of EBV?
- sore throat, lymphadenopathy, splenomegaly, lethargy
- Treatment of EBV
- high does of acyclovir
- How has EBV been related to cancer?
- absence of T cell immunity results in polyclonal leukemia-like B cell proliferation
- What disease are EBV and malaria closley associated with?
- Burkitt's lymphoma
- How is malaria a co-carcinogen of EBV?
- it weakens T cell control of the EBV infection
- Which oncogene is related to Burkitt's lymphoma?
- c-myc
- How was global smallpox eradicated?
- widespread vaccination using attenuated strain of virus
- When was smallpox completely eradicated?
- 1980
- What are arboraviruses?
- arthropod-borne viruses
- In arboraviruses, where does the virus multiply?
- salivary gland
- What transmits yellow fever?
- mosquito Aedes aegypti
- What is the reservoir of yellow fever?
- humans
- Treatment of yellow fever
- live attenuated vaccine, insect repellent
- What is the vector of dengue fever?
- mosquito A. aegypti
- What is a particularly severe form of dengue fever?
- dengue hemorrhagic fever syndrome
- Where does dengue fever virus replicate?
- monocytes, vascular endothelium
- Treatment of dengue fever
- no antiviral therapy or vaccine
- To which parts of the world is Burkitt's lymphoma restricted?
- Africa, Papau New Guinea
- To which parts of the world is yellow fever restricted?
- Africa, Central/South Am., Caribbean
- To which part of the world is dengue fever restricted?
- S.E. Asia, Pacific, India, Caribbean
- What is break bone fever?
- dengue fever
- What are rickettsia?
- small bacteria, which are obligate parasites
- What are typical symptoms of rickettsial infections, and where does it multiply?
- fever, headache, rash; skin, CNS, liver
- What is caused by R. rickettsii?
- Rocky mountain spotted fever
- What carries R. rickettsii?
- dog and wood ticks
- Treatment of rocky mountain spotted fever
- tetracycline i.v.
- Caused by R. conorri, carried by dog ticks
- Mediterranean spotted fever
- What transmits epidemic typhus?
- louse Pediculus corporis
- What causes epidemic typhus?
- R. prowazeckii
- What is associated with poverty and war?
- epidemic typhus
- Symptoms of epidemic typhus
- fever, headache, flu-like, maculopapular rash, severe meningoencephalitis with delirium and coma
- What causes and transmits endemic typhus?
- R. typhi, rat flea
- What causes and transmits Lyme disease?
- Borrelia, hard ticks (Ixodes)
- What is the leading vector-borne disease in US?
- Lyme disease
- What is the lesion characteristic of lyme disease?
- erythema chronicum migrans
- Additional disease caused by lyme disease
- neurologic, cardiologic, arthritis
- Treatment of lyme disease
- penicillin, tetracycline
- What is the most virulent species that causes malaria?
- P. falciparum
- What is the vector for malaria?
- female anopheles mosquito
- Which part of the life cycle of plasmodium is in the mosquito's saliva?
- sporozoites
- Where do the sporozoites mature into merozoites?
- liver
- What are hypnozoites?
- merozoites that remain in the liver and lie dormant
- Where do merozoites multiply?
- red blood cells
- What is the stage of plasmodium during the sexual cycle?
- gamaetocytes
- When is the sexual cycle of Plasmodium complete?
- Anopheles mosquito feeds on gamaetocyte containing blood, forms zygote, releases sporozoites
- Most characteristic feature of malaria
- synchronous cycle times of fever (rupture of merozoites)
- What are complications of malaria that make it fatal?
- cerebral malaria, severe anemia, hypoglycemia, lactic acidosis
- Treatment of malaria
- chloroquinine
- Causes African trypanosomiasis
- Trypanosoma brucei gambiense and T. rhodesiense
- Vector of trypanosomiasis
- tse-tse fly
- Symptoms of trypanosomiasis
- swollen chancre, swollen lymph nodes, CNS, coma
- Treatment of trypanosomiasis
- arsenical drugs (tryparsamide, melarsoprol), non-arsenical drugs (suramin, nitrofurazone, pentamidine)
- Causes chaga's disease
- T. cruzi
- Transmission of chaga's disease
- reduviid bug
- Major cause of death in chaga's disease
- myocarditis
- Treatment of chaga's disease
- arsenicals
- Transmission of leishmaniasis
- sandflies
- Visceral leishmaniasis; where does it grow
- L.Donovani; liver, spleen
- Cutaneous leishmaniasis
- L. Tropica
- Where does leishmaniasis inhabit?
- macrophages
- What is the form of leishmaniasis that results in liver failure?
- kal-azar
- Treatment of leishmaniasis
- antimonial compounds
- What leads to pathology of disease in schistosomiasis, and what effect is on the body?
- egg production, hypersensitivity to antigens released by eggs
- Treatment of schistosomiasis
- praziquantel removes worms, but pathology irreversible in advanced cases
- Causes lymphatic filariasis
- Brugia, Wuchereria
- Transmission of filariasis
- mosquito
- Introduction to body of schistosomiasis
- through skin
- Intro. to body of filariasis
- through skin
- Locations of filarial worms
- lymph nodes, lymphatics of limbs and groin
- Which parasite leads to obstruction of lymphatics and gross enlargement of breasts, scrotum, and limbs?
- filarial nematodes
- Treatment of filariasis
- diethylcarbamazine (larvae), suramin (adults)
- Arenavirus that infects bush rats of West Africa
- lassa fever virus
- What is the most commone febrile illness in Sierra Leone?
- lassa fever virus
- How is lassa fever virus acquired?
- human exposure to infected rats or their urine
- What virus is associated with Korean Hemorrhagic fever?
- Hantaan virus
- How has Korean Hemorrhagic fever presented in US?
- pulmonary disease
- What type of virus causes Marburg and Ebola Hemorrhagic fevers?
- filovirus
- Symptoms of Marburg and Ebola Hemorrhagic fever
- fever, hemorrhage, rash, disseminated intravascular coagulation
- Infection of this virus first noticed after exposure to African green monkeys from Uganda
- Marburg virus
- Location of Ebola
- Southern Sudan
- Causes Q fever
- rickettsia - Coxiella burnetii
- How is Coxiella burnetii different from other rickettsia?
-
1. not transmitted by arthropods
2. transmission by inhalation
3. main action in lungs, not endothelium - How are humans infected with Q fever?
- placenta of infected animal, unpasteurized milk, tissue fluids
- T or F - Q fever can become chronic
- T
- Treatment of Q fever
- tetracycline, erythromycin
- What causes anthrax?
- Bacillus anthracis
- What are two ways to contract anthrax?
-
1. spores
2. infected herbivore - Describe cutaneous anthrax
-
spores germinate at site of entry, producing anthrax toxin, consisting of edema factor
-center becomes black and necrotic (eschar) - What is released from bacilli in pulmonary anthrax?
- lethal toxin
- Treatment of anthrax
-
penicillin
vaccine of purified protective antigens - What causes the plague?
- Yersinia pestis
- What is the reservoir of the plague?
- rodents
- What is the vector of the plague?
- rat flea
- Is bubonic plague transmitted from person to person?
- not generally
- How can the plague spread from person to person?
- droplets causing pneumonic plague
- Sign of plague
- lymph nodes in armpit and groin become tender and form buboes with hemorrhagic inflammation
- Treatment of plague
-
streptomycin, tetracycline
vaccine of formalin-killed bacteria - What causes tularemia?
- Franchisella tularensis
- How is tularemia spread?
- arthropod vectors
- Can tularemia spread from person to person?
- no
- Describe symptoms of tularemia
- febrile illness, lymphatic spread, lungs, GI tract, liver
- Treatment of tularemia
-
streptomycin
live attenuated vaccine - What are leptospira?
- tightly coiled spirochetes
- How are humans infected with Leptospirosis?
- ingestion of contaminated food, water; aquired by swimming
- Treatment of leptospira
- penicillin, tetracyclines
- Which species of Brucellae infects cows?
- B. abortus
- Which species of Brucellae infects goats and sheep?
- B. melitensis
- Which species of Brucellae infects pigs?
- B. suis
- Where are Brucellae bacteria present?
- feces, urine, milk of animals
- What are symptoms of Brucellosis?
- fever, drenching sweat, aching, weakness, enlarged lymph nodes, spleen
- Describe the chronic stage of Brucellosis
- tiredness, aches, pains, anxiety, depression
- Where does the adult echinococcus live?
- intestine of dog
- Where do circulating larvae lodge in echinococcus?
- liver
- What are the cysts called formed by echinococcus?
- hydatid cysts
- Treatment of echinococcus
- praziquantel, surgical removal
- What causes trichinella?
- T. spiralis
- How are humans infected with T spiralis?
- eating undercooked meat
- Where does T. spiralis mature?
- striated muscle
- Symptoms of trichinella
- fever, joint and muscle pain, hemorrhage, encephalitis, cardiac abnormalities
- Treatment of trichinella
- antihelmintics (thiabendazole)