Podcast
Questions and Answers
What are the primary risk factors for exposure to Leptospira interrogans?
What are the primary risk factors for exposure to Leptospira interrogans?
Which symptom is indicative of the second phase of leptospirosis, known as Weil disease?
Which symptom is indicative of the second phase of leptospirosis, known as Weil disease?
What method is NOT commonly used for diagnosing leptospirosis?
What method is NOT commonly used for diagnosing leptospirosis?
What is the main virulence factor associated with Leptospira interrogans that prompts inflammation?
What is the main virulence factor associated with Leptospira interrogans that prompts inflammation?
Signup and view all the answers
During which phase does leptospirosis first manifest with flu-like symptoms?
During which phase does leptospirosis first manifest with flu-like symptoms?
Signup and view all the answers
Which treatment is specifically used for leptospirosis?
Which treatment is specifically used for leptospirosis?
Signup and view all the answers
What is a significant sign of renal failure in the second phase of leptospirosis?
What is a significant sign of renal failure in the second phase of leptospirosis?
Signup and view all the answers
Which preventative measure is advisable to avoid leptospirosis?
Which preventative measure is advisable to avoid leptospirosis?
Signup and view all the answers
Which of the following is NOT a common transmission pathway for leptospirosis?
Which of the following is NOT a common transmission pathway for leptospirosis?
Signup and view all the answers
How do Leptospira bacteria primarily infect humans?
How do Leptospira bacteria primarily infect humans?
Signup and view all the answers
What physiological change leads to an increased risk of urinary tract infections due to bacteria rising into the bladder?
What physiological change leads to an increased risk of urinary tract infections due to bacteria rising into the bladder?
Signup and view all the answers
What type of organism is responsible for transmitting leptospirosis to humans?
What type of organism is responsible for transmitting leptospirosis to humans?
Signup and view all the answers
Which situation presents a high risk for leptospirosis infection?
Which situation presents a high risk for leptospirosis infection?
Signup and view all the answers
Which symptom is NOT typically associated with uncomplicated lower urinary tract infections in adults?
Which symptom is NOT typically associated with uncomplicated lower urinary tract infections in adults?
Signup and view all the answers
Which animal is NOT typically associated with the transmission of leptospirosis?
Which animal is NOT typically associated with the transmission of leptospirosis?
Signup and view all the answers
Which pathogen is most commonly responsible for urinary tract infections in women?
Which pathogen is most commonly responsible for urinary tract infections in women?
Signup and view all the answers
What is a common symptom of both cystitis and acute pyelonephritis?
What is a common symptom of both cystitis and acute pyelonephritis?
Signup and view all the answers
What factor greatly increases the survival of Leptospira bacteria in the environment?
What factor greatly increases the survival of Leptospira bacteria in the environment?
Signup and view all the answers
What is the role of snails in the life cycle of Leptospira bacteria?
What is the role of snails in the life cycle of Leptospira bacteria?
Signup and view all the answers
What is the most reliable finding in urinalysis for acute pyelonephritis?
What is the most reliable finding in urinalysis for acute pyelonephritis?
Signup and view all the answers
Which of the following is a rare method of human-to-human transmission of leptospirosis?
Which of the following is a rare method of human-to-human transmission of leptospirosis?
Signup and view all the answers
What is the transmission method for urinary schistosomiasis?
What is the transmission method for urinary schistosomiasis?
Signup and view all the answers
In which situation are patients more susceptible to developing acute pyelonephritis?
In which situation are patients more susceptible to developing acute pyelonephritis?
Signup and view all the answers
Which symptom is NOT associated with urinary schistosomiasis shortly after infection?
Which symptom is NOT associated with urinary schistosomiasis shortly after infection?
Signup and view all the answers
Study Notes
Urinary Tract Infections (UTIs)
- UTIs occur when microorganisms invade the urinary tract and multiply
- Infections can be located in the kidneys (pyelonephritis), ureters, bladder (cystitis), or urethra (urethritis)
- E. coli is the most common cause of UTIs, responsible for over 95% of cases
- Other bacteria like Staphylococcus saprophyticus, Klebsiella, Proteus, and Enterobacter can also cause UTIs
E. Coli Bacteria Structure
- E. coli bacteria have flagella, DNA, outer membrane, cell wall, periplasmic space, plasma membrane, cytosol, ribosomes, and pili
- Avg size: 3 microns
UTI Types
- Re-infection: Occurs more than 4 weeks after a previous UTI caused by different pathogens. Common in females due to their short urethra
- Relapse UTI: Occurs within 2 weeks of treatment (TRT) for a previous UTI caused by the same pathogen
Pyuria
- Pyuria is the presence of pus cells (WBCs) in the urine
- Causes of pyuria can include cystitis, prostatitis, bacterial and parasitic infection, tuberculosis, urinary tract stones, and tumors in the urinary tract
- Levels of WBCs (Leukocytes) can be determined in a urine sample
Chyluria
- Chyluria is characterized by a milky white appearance of urine due to the presence of chyle (lymph and dietary fats)
- This is commonly associated with filariasis infection (Wuchereria Bancrofti)
- Other causes include abdominal injury, radiation, and abscesses
Hematuria
- Hematuria is the presence of red blood cells (RBCs) in the urine
- Causes of hematuria can include bacterial infections, kidney/bladder stones, schistosomiasis, cancer, kidney diseases (e.g., glomerulonephritis), kidney injuries (e.g., sickle cell anemia), some medications (e.g., aspirin, heparin), strenuous exercise, and dehydration
Bacteriuria
- Bacteriuria is the presence of bacteria in the urine, with or without symptoms
- Asymptomatic bacteriuria (ASB): Bacteria present in the urine but without symptoms
- Symptomatic bacteriuria (SBU): Bacteria in the urine accompanied by symptoms like dysuria, frequency, urgency, fever, and flank pain
Risk Factors for UTIs
- Insufficient fluid intake/dehydration
- Poor personal hygiene
- Incomplete bladder emptying
- Diabetes or immunosuppression
- Prostatic hypertrophy and vaginal atrophy (estrogen deficiency)
- Catheterization
- Lack of circumcision (colonization with ANO2 bacteria)
- Spinal cord injury
- Kidney stones
- Short female urethra
- Sexual intercourse
Natural Urinary System Defenses
- Flushing action of urine
- Acidic pH of the urine
- Secretory IgA
- High urea concentration
- Presence of antibacterial proteins
- Normal flora
UTI Prevalence by Age Groups
- Newborns (first 3 months of life)
- Pre-school children
- Adults
- Older adults
UTI in Pregnancy
- Physiological and anatomical changes during pregnancy can increase UTI risk
- Untreated UTIs during pregnancy can have complications
Normal Microbiota of Urinary System
- Lactobacilli dominate the vagina, producing lactic acid, maintaining a low pH (3.8–4.5)
- Lactobacilli produce hydrogen peroxide inhibiting the growth of other microbes
- Estrogens promote lactobacilli growth by increasing glycogen production which converts to glucose, which lactobacilli metabolize into lactic acid
UTI Prevalence in Pregnancy and Menopause
- Lower estrogen levels result in lower lactobacillus populations, leading to reduced vaginal acidity, increasing risk
- Increased progesterone in pregnancy relaxes urethral muscles allowing bacteria to ascend to bladder, increasing infections risk
- Growing uterus reduces urine flow, leading to stagnant urine that can be a source of infection
UTI Caused by Coagulase-Negative Staphylococci
- S. epidermidis: Common in hospitalized patients over 50 years, often asymptomatic, multiple drug-resistant
- S. saprophyticus: High in healthy women (16-35 years), 90% symptomatic, responds well to antibiotics
Clinical Signs and Symptoms of UTIs
- Neonates and children <2 years often experience nonspecific symptoms
- Adults with uncomplicated lower UTIs may exhibit dysuria, frequency, urgency, suprapubic pain, hematuria
- Acute complicated UTIs, like pyelonephritis, may present with flank pain, nausea, vomiting, fever, chills, night sweats, and costovertebral angle tenderness
UTI Diagnosis, Workup, and Interpretation of Results
- Workup involves analysis methods such as Urinalysis, Gram staining, culture, ELISA (Enzyme-linked immunosorbent assay), PCR, and VDRL (Veneral Disease Research Laboratory) testing to detect specific bacteria
- Presence of multiple uropathogens indicates contamination
- Detection thresholds for bacteria and WBC/hpf should be noted
Laboratory Diagnosis of UTIs
- Voided midstream specimen collection (MSU)
- Catheterized specimen collection
- Suprapubic aspiration (for infants and patients with injury)
- Anaerobic culture
Urine Volume, Pyuria, and Culture Requirements
- 10 mL significant pyuria, 20 mL mycobacteria/fungi
- Timing of urine collection (first morning) is important
- Specimens should be processed within 2 hours or additives added
- Preservatives, such as Sodium borate, can be employed
Normal Urine Constituents
- 95% water, electrolytes (Na, K, Cl, Mg, HCO3)
- Abnormal constituents can include protein (indicating glomeruli damage), glucose (diabetes), ketones (starvation), bilirubin (hepatic disease), RBCs (stones, infections), urobilinogen (hemolytic disease), and galactose (congenital enzyme defects)
Urine Transport
- Urine is a good medium for pathogen growth; proper specimen transport and rejection should be noted. Also, proper standards are important
Automated UTI Screening
- Bioluminescence, photometry, colorimetric particle filtration, and Bac-T-Screen are different methods for automated UTI detection
- Thresholds of detection vary depending on the technique.
Urinary Schistosomiasis
- Caused by Schistosoma haematobium
- Definitive host: human
- Intermediate host: snail
- Infective stage: cercariae
- Transmission: Penetration of skin by cercariae during contact with contaminated water
- Symptoms: Skin rash, irritation at the penetration site
- Important eggs accumulate in the urinary bladder and cause inflammation and damage to the urinary system in the long term.
Leptospirosis
- Caused by spirochete bacteria in the genus Leptospira
- Transmitted via urine of infected animals (dogs, pigs, rodents) in contaminated water/soil
- Human infection occurs via contact, contaminated food/water or mucous membranes
- Symptoms: varied, from flu-like illness to severe diseases such as kidney, lung or liver damage
Genital Infections and Sexually Transmitted Diseases (STIs)
- STIs include Syphilis, Gonorrhea, Chlamydia, Trichomoniasis, Genital herpes, HIV, Hepatitis B, HPV
Natural Defenses in Genital Tract
- pH between 3.8 and 4.5, supporting a defense system against infections
- Normal flora: Lactobacilli, coagulase negative staph, Corynebacterium spp, and Streptococcus agalactiae
Sexually Transmitted Diseases (STDs)
- STDs are generally transmitted via intimate sexual contact, mother to child during pregnancy/childbirth, through blood/tissue transfer
- Exudative STDs: gonorrhea, chlamydia, vulvovaginitis
- Ulcerative STDs: syphilis, chancroid, genital herpes.
- HIV/wart disease: human papillomavirus (HPV)
Venereal Diseases (STDs)
- These are contagious diseases transmitted mainly by sexual contact
- Causal organisms include Treponema pallidum (syphilis), Neisseria gonorrhoeae (gonorrhea), Haemophilus ducreyi (chancroid), Chlamydia trachomatis (Nongonococcal urethritis), Mycoplasma spp, Trichomonas vaginalis, Herpes simplex virus (HSV), HIV, HPV
Urethritis
- Acute infection with dysuria and urethral discharge
- Can be caused by infection ( Neisseria gonorrhoeae, Chlamydia trachomatis), chemical irritation (antiseptics), mechanical injury (catheterization)
- Diagnosis: Purulent discharge, WBC count, Gram stain, culture, sensitivity test,and serology
- Treatment: Antibiotic treatment (Azithromycin, Doxycycline)
Gonorrhea
- Incubation period: 1-4 days
- Anterior and Posterior Urethritis
- Women often asymptomatic (5-10% of cases)
- Treatment: Antibiotic treatment, usually azithromycin & penicillin
Cervicitis
- Inflammation of columnar and sub-epithelial cells of the endocervix
- Can be infectious (e.g., Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma, Ureaplasma)
- Also can be non-infectious (e.g., injury)
- Symptoms typically include vaginal discharge with odor, bleeding, itching and irritation
- Diagnosed using clinical observation, WBC counts, culture, Gram stains, and serology
- Treatment should target suspected infection and usually includes antibiotics (Azithromycin, Doxycycline).
Vulvovaginitis
- Infection or inflammation of the vulva and vagina
- Can be bacterial (e.g., Gardnerella vaginalis, bacterial vaginosis ), fungal (e.g., Candida albicans), viral, or noninfectious
- Symptoms: Vaginal discharge, vulvar itching/irritation, bad smell, fishy odor, pH change
- Diagnosis typically involves microscopic examination of vaginal discharge (e.g., clue cells), culture, and pH measurements
- Treatment varies and depends on the diagnosed causality/infective type.
Prostatitis
- Inflammation of the prostate gland
- Causes include recurrent catheterizations, UTIs, rectal intercourse, and STD
- Symptoms: Lower abdominal pain, lower back pain, rectal pain, pain during intercourse
- Diagnosis is important to determine cause (often includes PSA test, bacterial or non-bacterial)
Genital Ulcerative Disease
- Syphilis: Caused by Treponema pallidum (Gram-negative spirochette); characterized by a painless ulcer (chancre)
- Chancroid: Caused by Haemophilus ducreyi; characterized by a painful ulcer
- Genital Herpes: Caused by HSV (viral); characterized by recurrent sores
- Diagnosis includes serological tests (ELISA, PCR, VDRL) and microscopy. Treatment includes antibiotics (Azithromycin, penicillin)
Syphilis
- Primary: painless ulcer (chancre)
- Secondary: skin rash, swollen lymph nodes
- Latency: no symptoms for years
- Tertiary: severe damage to tissues
- Diagnosed using serological tests (e.g., ELISA)
- Treated using penicillin, doxycycline etc.
Congenital Syphilis
- Infants acquire this through an infected mother's birth canal
- Diagnosed through serological testing
- Outcomes include saddle nose, CNS anomalies, Hutchinson's teeth, and keratitis
- Treatment: Antibiotics (tetracycline, erythromycin, or penicillin G)
Chancroid
- Caused by Haemophilus ducreyi
- Symptoms include a painful ulcer (chancre), bleeding
- Men are more often affected than women
- Diagnosis includes microscopic examination and culture
- Treatment: antibiotics, such as azithromycin.
Herpes
- Viral infection (HSV) characterized by recurrent outbreaks
- HSV-1 often causes oral herpes, HSV-2 often causes genital herpes
- Symptoms include fever, headache, muscle aches, painful genital sores
- Diagnosed via viral culture, serological assays, or immunofluorescence testing
- Treatment involves antiviral drugs like acyclovir
Genital Warts
- Caused by human papillomavirus (HPV)
- Diagnosed with serological tests and visualization
- Treatment includes surgical removal, cryosurgery, or laser therapy.
Chlamydia
- Sexually transmitted infection caused by Chlamydia trachomatis
- Can cause ocular infection (trachoma), cervicitis, pelvic inflammatory disease, and infertility
- Pregnant mothers can transmit to infants, leading to conjunctivitis and pneumonia
Urine Analysis
- Complete urinalysis (lab): Examines urine composition
- Rapid urinalysis (doctor's office): Checks for common renal abnormalities
- 24-hour urine collection (home): Provides deeper picture of renal function
- The analysis includes examining volume, color, odor, specific gravity, and performing chemical and microscopic analysis.
Antibiotic Susceptibility of Urine Culture
- Procedures involve culturing microorganisms from urine samples and testing their response to different antibiotics
- Resistance rates (%) measured for various antibiotic solutions
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
