Term
| What are 3 causes of Vaginitis and how are they diagnosed/treated? |
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Definition
1) Yeast (Candida)- itching, redness and clumpy white discharge (Topical Imidazole/Oral fluconazole)
2) Bacterial- amine odor, discharge (Metranidazole)
3) Trichomonas- itching, redness and discharge (Metranidazole) |
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Term
| What are 3 causes of Cervicitis, how does it present and how might you treat? |
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Definition
All present with genital discharge, lower abdominal pain and inter-menstrual bleeding
1) C. trachomatis (Empirical treatment)
2) N. gonorrheae (Empirical treatment)
3) HSV |
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Term
| What are 4 causes of PID, how does it manifest and how might you treat? |
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Definition
Presents subtly, with lower abdominal pain, abnormal bleeding and tenderness on cervical motion.
Treat with antibiotic regiment for all causes and hospitalize if 1) surgical emergency is possible, 2) Severe illness, 3) ovarian abscess or 4) failed oral therapy
1) C. trachomatis
2) N. gonorrhoeae
3) Enterobacteria
4) Anaerobic bacteria |
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Term
| When should you hospitalize a women with PID? |
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Definition
1) Surgical emergency is possible
2) Severe illness
3) Ovarian abscess
4) Failed oral therapy |
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Term
| What are 3 causes of genital ulcers in women and how are they diagnosed/treated? |
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Definition
Diagnose based on pain and lymphadenopathy
1) HSV (pain)- treat with Acyclovir
2) Treponema pallidum (no pain)- treat with PCN or benzathine
3) Haemophilus ducreyi |
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Term
| What are 3 causes of Papular genital lesions and how can you diagnose/treat them? |
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Definition
1) HPV (cauliflower-like warts)
- Treat with liquid N
2) Molluscum contagiosum (round, umbilicated papules)
3) Condylomata (secondary syphilis- Moist papules with general rash)
- Treat with PCN or benzathine |
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Term
| How do you diagnose Syphilis? |
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Definition
Serology because of issues with culture.
EIA- Non-Treponemal RPR (Ab against host-cell response)- EIA
1) Treponemal tests to detect antibodies again T. pallidum
including EIAs FTA-ABS and Agglutination tests.
2) Confirm with non-treponemal tests to detect IgM and IgG antibodies to cellular lipids and lecithin (RPR) |
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Term
| What are the defining features of the Chlamydia pathogen? |
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Definition
1) Obligate intracellular parasite with small genome (660 KDa)
2) Outer membrane with LPS and membrane proteins (OmpA for serological classification) )but NO PEPTIDOGLYCAN
3) Obtain high energy Pi from host cell (energy parasite) |
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Term
Upon serological testing, you discover a positive test for OmpA.
What pathogen is this? |
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Definition
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Term
| What is the basic lifecycle of Chlamydia? |
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Definition
Biphasic
SHORT-
1) EB taken up by epithelial cell and prevents endo/lysosomal fusion
2) EB becomes RB and multiples in endosome by binary fission (48-72h)
3) RB becomes EB and is released by cytolysis or exocytosis
LONG
1) Extracellular elementary body (EB) has disulfide cross-links within and between outer membrane proteins (spore-like) and is metabolically inactive
2) EB attaches to epithelial cell and is taken up (EB-prevents endosomal/lysosomal fusion!)
3)EB reorganizes into replicative, reticulate body (RB), which divides in the host cell by binary fission, filling endosome (cytoplasmic inclusion)
4) 48-72 hours after, multiplication ceases and nucleoid condensation occurs (RB to EB transition)
5) EBs released by cytolysis, or by exocytosis (exocytosis may explain asymptomatic cases). |
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Term
| Explain the classification system of Chlamydia. |
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Definition
Order= Chlamydiales
Family= Chlamydiaceae
Genus= Chlamydia and Chlamydophila
Species= Chlamydia trachomatis (18 serovars) |
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Term
| What are the different clinically relevant species of Chlamydiaceae? |
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Definition
1) Chlamydia trachomatis (LGV) is in Africa, Asia and South America, prevalent in male homosexuals (100-300 cases in US per year)
2) Chlamydophila pneumoina leads to bronchitis and pneumonia
3) Chlamydophila psitacci is bird pathgen that can cause pneumonia in humans (KISSING PARICHETES). |
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Term
Which disease is associated with each Chlamydia serovar series?
1) A-C
2) D-K
3) L1-L3 |
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Definition
1) Trachoma (eye disease in developing world)
2) Non-gonococcal urethritis, epididymitis, mucopurulent cervicitis, PID, conjunctivitis, pneumonia, infant conjunctivitis (restricted to epithelial cells)
3) Lymphogranula venereum (LGV)- LN and infect macrophages (invasive) |
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Term
| Explain the basic pathogenesis of Chlamydiae. |
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Definition
SHORT ***No lasting immunity***
EB infects epithelial cells, which elicit innate and adaptive responses, leading to fibroblast proliferation, inflammation and scar tissue formation. Infection is fought by Th1 response.
1) C. trachomatis (A-K) infect and grow within epithelial cells of ocular and genital mucosae, eliciting pathology through HOST immune response.
2) These cells release inflammatory mediators that serve as triggers for influx of leukocytes including PMNs, NK cells, DCs, monocytes and lymphocytes.
3) Chronic immune response leads to epithelial cell necrosis, fibroblast proliferation and scar tissue formation.
4) Recovery depends Th1 phenotype of CD4 T cells. |
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Term
| What key Epidemiological characteristics define Chlamydia infection? |
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Definition
1) Most prevalent STD in US (3-4 million per year)
2) Many men and most women are asymptomatic or minimally symptomatic.
3) Young age, back race home-of-record from south, multiple sex partners, new sex partner, lack of protection and history of STD are all correlative.
4) 95% of persons testing (+) were asymptomatic in 24 hours preceding specimen collection. |
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Term
| What symptoms of Chlamydia infection are seen in males? |
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Definition
1) Dysuria
2) Clear/Mucopurulent Urethral discharge (7-14 days after contact)
3) Epididymitis
4) Sexually reactive arthritis (Reiter's) |
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Term
| What is Reiter's Syndrome and when do you see it? |
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Definition
1% of men (usually HLA B27) presenting with nongonooccal urethritis (typically with Chlamydial infection)
- Immune-mediated inflammatory response including acute arthritis (sexually-reactive arthritis)
- 1/3 of men have full complex with 1) nonbacterial urethritis, 2) arthritis and 3) conjunctivitis. |
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Term
| What symptoms of Chlamydia infection are seen in Females? |
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Definition
Urethritis and Cervicitis, as well as PID
1) Urethritis and Cervicitis
-dysuria/pyuria, discharge, abdominal pain, bleeding
- Sometimes see ascending genital tract infection with Endometritis and Salpingitis
2) PID- ascends from vagina to cervix to involve uterus, ovaries and fallopian tubes- Presents with lower abdominal pain, bilaterally, sometimes with pain and bleeding.
- normally presents sub clinically (asymptomatically), but can lead to infertility and/or ectopic pregnancy (acute) as well as Fitz-Hugh-Curtis syndrome (perihepatitis and ascites). |
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Term
| What is the spectrum of PID presentations in the context of Chlymidia infection? |
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Definition
1) Acute with pain and bleeding
2) Severe with perihepatitis and ascites (Fitz-Hugh-Curtis)
3) Asymptomatic
**Can lead to infertility and ectopic pregnancy** |
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Term
A patient presents with a small painless papule on her vagina. After a week in the hospital, she spikes a fever and is experiencing myalgia and headaches.
What are you concerned about? |
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Definition
This sounds like the early stages of Lymhogranuloma venerum arising from C. trachomatis biovar LGV infection.
- You are worried that it will lead to inflammation of the draining lymph nodes, which may rupture or cause Elephantiasis
** Can also see a more systemic form in homosexual males** |
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Term
| What types of C. trachomatis infections can occur in newborns? |
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Definition
Eyes or Pneumonia with "Staccato cough"
1) Most common form of opthalmia neonatorum (watery ocular discharge becoming progressively more purulent)
- occurs 5-14 days after birth, but can occur earlier
2) Stacatto cough indicating Pneumonia (afebrile) at 4-11 weeks of age (nasal obstruction and staccato cough- see tachypenia and rales without wheezing). |
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Term
A 6 week old child presents with tachypnea and pulmonary rales, but no wheezing.
You hear a staccato cough and observe nasal obstruction.
What is going on? |
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Definition
| Sounds like Afebrile Pneumonia from C. trachomatis! |
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Term
| How is C. trachomatis diagnosed in the lab? |
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Definition
1) PCR****
2) Cell culture
3) IF for inclusion bodies
4) ELISA |
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Term
| What preventative measures are taken for C. trachomatis and how is it treated? |
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Definition
1) Abstinence, barrier protection, ect.
2) Chlamidiae are only metabolically active when they exist as RBs, so they must be treated with agents that penetrate eukaryotic cell (atypical bacteria usually respond to Macrolides, Flouroquinolones and Tetracyclines). |
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Term
You are in the lab looking at a blood sample under dark field microscopy, and you notice tapered, thin spiral rods with corkscrew locomotion and endoflagella.
What pathogen is this? |
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Definition
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Term
| What is the general structure of Treponema pallidum pathogens? |
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Definition
1) Tapered, this spiral rods (Spirochetes) with endoflagella for "corkscrew" locomotion
2) Lack LPS in outer membrane, but have gags for molecular mimicry.
3) Need dark field microscopy and microaerobic environment |
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Term
| What is the basic pathogenesis of Treponema pallidum? |
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Definition
Humans are sole reservoir.
1) Penetration through minor abrasions in skin or mucous membranes, as well as mother-fetal transmission.
2) Adhere to endothelial cells resulting in vasculitis with mononuclear and plasma cells surrounding involved vessels.
3) Tertiary lesions lead to CV, CNS and Gummas (granulomatous lesions with central necrotic mass surrounded by mononuclear and plasma cells) |
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Term
| What is unique about the tertiary lesions sometimes seen in Syphilis infection? |
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Definition
They are irreversible tissue destruction and fibrosis (primary and secondary heal)
1) Gummas (granulomatous lesions with central necrotic mass surrounded by lymphocytes, monocytes and plasma cells).
2) CV disease (proximal aorta)
3) CNS disease (Neurosyphilis-Tabes dorsalis) |
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Term
| What epidemiological features define Treponema pallidum infection? |
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Definition
1) Sexual contact and rarely by close contact, as well as congenital.
2) Relatively rare in US, but has been increasing over the past 8 years, presumably from male:male sex
3) Disproportionately high in African Americans. |
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Term
| Explain the general timeline of Syphilis infection |
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Definition
1) Incubation of 3 weeks
2) Primary (2-6 weeks)- CHANCRE/local ulceration on genetalia
3) Asymptotic (2-24 weeks)
4) Secondary (2-6 weeks)- disseminated organisms cause lesions in skin (rash), mucous membranes, LN, CNS, ect
5) Latent (3-30 years)- residual organisms in spleen, LN
6) Tertiary (gummas in skin and bone, CV and CNS) |
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Term
| How does primary syphilis infection present? |
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Definition
1) Hard painless ulcer (chancre) at site of invasion within 3 weeks of infection
2) Painless enlargement of local LN
Infectious treponemes in primary lesions disseminate into blood. |
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Term
| How does secondary syphilis present? |
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Definition
1) Infectious treponemes in primary lesions disseminate into blood vessels and spread to skin, liver, joints, LN, muscles and brain over 3-6 weeks (50-75% remain asymptomatic)
2) Mucocutanous lesions are most common
3) Raised, broad, flat papules (CONDYLOMA LATA) in 10% of patients in warm, moist areas. |
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Term
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Definition
| Raised, enlarged, broad papules that develop in warm, moist areas during 10% of Secondary syphilis infections. |
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Term
| How does Latent syphilis occur? |
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Definition
Treat within 1st year for most effective outcome!
1) Etiological agent resides in local LN and spleen (3-30 years)
2) Asymptomatic, but CSF abnormalities are correlated with subsequent symptomatic tertiary neurosyphilis (reactivation) |
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Term
| How does Tertiary Syphilis present? |
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Definition
T. pallidum "reactivates" and penetrates various body tissues.
1) Granulomatous lesions or GUMMA on skin, bone, liver and other tissues
or
2) Degenerative CNS disease or Neurosyphilis (cranial nerve palsies, sensorineural deafness and hydrocephalus).
- Can see "Tabes dorsalis" (demyelination of posterior column and roots of spinal chord). Also 8th CN lesion.
3) CV lesions and HF |
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Term
| What is "Congenital Syphilis"? |
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Definition
Can cause stillbirth, death soon after, or physical deformity and neuro complications (STARTS at secondary stage)
1) Typically premature, with hepatosplenomegaly, skeletal involvement and pneumonia/skin leasions.
2) CSF abnormal 50% of time (10% infants asymptomatic)
3) Late-onset disease is seen after 2 years and is not considered "contagious" |
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Term
| How do you diagnose Syphilis? |
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Definition
In vitro culturing is ineffective!
1) PE for chancre on genitals as indicator of primary infection
2) Silver stain and dark field microscopy of chancre or secondary lesions
3) Serology is MOST important |
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Term
| What type of preventative measures/treatment are available for Syphilis? |
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Definition
1) Primary and Secondary lesions are self-resolving, but antibiotic treatment necessary to prevent tertiary spread (PCN)
2) Increased risk in AIDS (maybe ART therapy will help?) |
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