Microbiology for Renal Module PDF 2023-2024

MICROBILOGY for Renal Module Undergraduate 2nd Year Medical Students By Staff Members Faculty of Medicine Menoufia University 2023-2024 1  ‫رؤية كلية الطب البشري جامعة المنوفية‬ ‫أن تكون كلية معتمدة أكاديميا ذات سمعة محلية وإقليمية ودولي...

MICROBILOGY for Renal Module Undergraduate 2nd Year Medical Students By Staff Members Faculty of Medicine Menoufia University 2023-2024 1  ‫رؤية كلية الطب البشري جامعة المنوفية‬ ‫أن تكون كلية معتمدة أكاديميا ذات سمعة محلية وإقليمية ودولية تتميز بالريادة في جودة التعليم الطبي‬ ‫والرعاية الصحية‪.‬‬ ‫رسالة كلية الطب البشري جامعة المنوفية‬ ‫ان تلتزم كليه الطب – جامعة المنوفية بتخريج طبيب بشرى طبقا للمعايير القومية األكاديمية المرجعية ‪،‬‬ ‫قادرا على تلبية احتياجات سوق العمل المحلى واإلقليمي ‪ ،‬ذو مهارة في إجراء أبحاث علمية لتطوير‬ ‫المهنة والخدمة الطبية المقدمة ‪ ،‬حريصا على التدريب والتعليم المستمر بما يدعم خدمة المجتمع و البيئة‬ ‫المحيطة في إطار االلتزام بأخالقيات المهنة‪.‬‬ ‫‪2‬‬ By the end of this module , students should be able to: 1- Recognize the most important microorganisms and outline the diagnosis of urinary tract infections and sexually transmitted diseases. 2- Describe the most important methods of obtaining the genitourinary specimens. 3- Formulate a systematic approach for laboratory diagnosis of infections of urinary tract infections. 4- Interpret reports of urine analysis and other genitourinary specimens. Theoretical part Topic page Urinary tract infection (UTI) 4 Diagnosis of UTI - Urethritis 5 Gonococcal Urethritis= Gonorrhea 6 Diagnosis of Gonorrhea –Mycoplasma 7 Practical 8 Urethritis causes 9-10 Infection in urinary tract site of infection Types of infection Urethra Urethritis Bladder Cystitis Kidney Pyelonephritis Urinary tract UTI 3  Urinary tract infection (UTI): is an infection in any part of the urinary system. The urinary system includes the kidneys, bladder and urethra. Most infections involve the lower urinary tract — the bladder and the urethra. Women are at greater risk of developing a UTI than are men it is usually caused by bacteria from the gut or sexually transmitted diseases. Significant bacteriuria: is the key diagnosis of UTI Presence of more than 100,000 bacteria /ml urine and associated with urine symptoms Predisposing factors for UTI (risk) 1-Females more common than males why Shortness of female urethra Bacteria can be easily transferred from anus 2-Pregnancy and contraceptive devices. 3-urine catheterization Causative organisms Bacterial causes of UTI: 1. E. coli → The commonest pathogen causing 60-90% of UTI 2. S. saprophyticus is important cause in sexually active young females. 3. S. epidermidis is associated with urethral catheterization. 4. Proteus mirabilis are associated with renal stones. 5. Klebsiella species, P. aeruginosa and Staph. aureus are associated with hospital UTIs following catheterization or gynecological surgery. 4  Symptoms strong urge to urinate that doesn't go away A burning feeling when urinating Urinating often, and passing small amounts of urine Urine that looks cloudy Urine that appears red, bright pink or cola-colored — signs of blood in the urine Diagnosis of UTI 1-Urine sample and direct smear with Gram stain 2- bacterial number (viable bacterial count): Significant bacteriuria is diagnostic Presence of more than 100,000 bacteria /ml urine and associated with urine symptoms Take care of Asymptomatic bacteriuria: Presence of more than 100,000 bacteria /ml urine in absence of clinical symptoms. Sterile pyuria: Pyuria = pus cell in urine without bacteriuria. 3- Culture and Antibiotic sensitivity testing Urethritis Definition Inflammation of urethra -with Dysuria-frequency-urgency-itching Classification Gonococcal Urethritis=specific Non-Gonococcal Urethritis= Non- Gonorrhea specific Causes N.gonorrhea Causes 1-Chlamydia trachomatis 2-Mycoplasma genetalium 3-Ureaplasma urealyticum 4-E.coli -acinetoacter I.P short I.P long Onset sudden Onset gradual Clinically Profuse discharge and pus Clinically Little discharge and pus Specimen Contain Gonococci Specimen No gonococci 5  I-Gonococcal Urethritis= Gonorrhea Neisseria gonorrhoeae (Gonococci) Morphology: Neisseria are Gram-negative diplococci, arranged in pairs with kidney shaped appearance present intracellular and extracellular in pus cells Virulence factor = 1. Antigenic variation in Gonococci 2. Pili (fimbriae) and IgA protease Diseases caused by N. gonorrhea =is Gonorrhea Its Gonococcal urethritis = specific urethritis → sexually transmitted disease and affects both males and females and manifested by discharge and dysuria. N. gonorrhea attacks mucous membranes of the genitourinary tract, eyes A) Venereal infection (gonorrhoea) that affects both males and females. 1-Male gonorrhea : usually symptomatic If acute → purulent discharge and dysuria. If complicated → urethral stricture, prostatitis. 2-Female gonorrhoea: Usually asymptomatic (adapted for discharge ). - Vagina not affected → due to its acidity. 6  But → endocervix affected first = cervicitis and urethritis with mucopurulent discharge- salpingitis and infertility may occur as complication B) Non-venereal infections: Gonococcal bacteremia Ophthalmia neonatorum eye infection of newborn transmitted from mother during labor Gonococcal vulvo-vaginitis : may affect young girls due to contaminated toilets. Diagnosis of Gonorrhea I- Acute gonorrhea: direct smears of urethral discharge stained by Gram stain. II- Chronic infections, I-Specimens: Urethral discharge, cervical discharge. II-Identification: 1- direct detection of antigens by ELISA 2--Culture on chocolate or Thayer-Martin medium in 5-10 % CO2: II-Non-specific (Non-Gonococcal urethritis) or cervicitis 1-50% Chlamydia 2-50% Mycoplasma hominis, M. genitalium and Ureaplasma spp. Mycoplasma Ureaplasma urealyticum→ non-gonococcal urethritis and neonatal sepsis in premature infants. M. hominis → postpartum fever and pelvic inflammatory disease e.g., salpingitis. M. genitalium → non-gonococcal urethritis. The signs of infection include: 1. Pain or burning during urination 2. Itching, redness, or swelling of the head of the penis or urethral opening 3. Discharge from the penis, which is usually yellowish or beige. 7  Practical By the end of this section, students should be able to: 1- Recognize the most important microorganisms and outline the diagnosis of urinary tract infections and sexually transmitted diseases. 2- Describe the most important methods of obtaining the genitourinary specimens. 3- Formulate a systematic approach for laboratory diagnosis of infections of urinary tract infections. 4- Describe the most important methods of specimen handling and principles of infection control. 5- Interpret reports of urine analysis and other genitourinary specimens. 8  Urethritis causes Neisseria gonorrhoea Morphology (Gram stain) Gram-negative diplococcic: with the adjacent sides flattened; “kidney- shaped appearance”, intra, and extra-cellular in pus cells Culture: Chocolate agar chocolate agar as this organism is fastidious need nutrition blood agar heated to 100oC for 2 minutes Enriched media for growth of , Niesseria - Haemophilus and Pneumococci Nutrient agar sterilized in autoclave then blood added Neisseria produces smooth translucent, non-pigmented colonies Confirmatory tests: Oxidase test positive: 9  Proteus Gram negative bacilli Culture 1-Swarming on Nutrient and Blood agar WHY because Highly motile 2-On MacConkey → Non-lactose fermenter → give Pale colony biochemical reaction Oxidase negative -Urease test positive TSI H2S → black butt MacConkey → Non-lactose fermenter Successive wave growth of proteus on Successive wave growth of proteus → give Pale colony nutrient agar due to high motility on blood agar due to high motility TSI Urease test positive H2S → black butt 10 staphylococcus epidermidis Gamma haemolysis blood agar Mannitol salt agar Mannitol non-fermenter 11