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Chapter 24 Lecture 1 (Structures of the Urinary and Reproductive Systems…
Chapter 24 Lecture 1
Structures of the Urinary and Reproductive Systems
Females have distinct urinary and reproductive systems.
Male urinary and reproductive systems share some components of each system
Structures of the Urinary System
Kidneys remove waste from the blood and excrete it in urine
Nephrons are the functional unit of the kidneys
Filter the blood to form urine
Ureters carry urine to the urinary bladder
The urinary bladder stores urine until it can be eliminated
Urine is excreted via the urethra
It is the urethra that can be the portal for the entrance of microorganism.
More so in females (4cm long, males 20 cm long)
Structures of the Reproductive System
Structures of the female reproductive system
Ovaries (2)
Uterine tubes(2)
Uterus
Vagina
External genitalia
Microorganisms enter through the vagina, through relations; however, the normal microbiome of the vagina helps to maintain a vaginal pH of 4.5
This helps to stop the growth of pathogens
Structures of the Reproductive System
Structures of the male reproductive system
Testes
Scrotum
System of ducts
Accessory glands like the prostrate which help to produce semen
Penis
Microorganisms enter through the urethra and skin of the penis, and this includes the foreskin
Microbiome of the Urinary and Reproductive Systems
Urinary system
Urethra supports colonization or the growth of some microbiota
Include Lactobacillus, Streptococcus and Staphylococcus
Occasionally there are others such as Mycobacterium Bacteroides, and Peptostreptococcus and Fusobacterium
The other urinary organs and the urine is considered axenic are sterile d/t the acidic pH of urine
When a person urinates the microbiota will contaminate the urine as it passes through the urethra but if you have a Foley…. It is typically sterile.
Male reproductive system
Regions above the prostate are sterile
The vagina is home to a wide variety of microorganisms that vary with the levels of hormones, particularly estrogen
When estrogen levels rise (like at puberty) cells that line the vagina make glycogen that lactobacilli convert into lactic acid.
Acidity stops the growth of many opportunistic infections
So if you are prepubescent and have little circulating estrogen you will be more susceptible to vaginal infections.
In fact, some women their estrogen levels fall and rise during their menstrual cycle some will cycle between period of infection and periods of health
Microbiome of the Urinary and Reproductive Systems
The microbiomes of the urethra and vagina serve to protect the body by outcompeting pathogens (microbial antagonism or microbial competition)
Microorganisms in the urethra can rarely move up to the bladder up the ureters, and infect kidneys But it can happen!
Opportunistic and sexually transmitted microbes can infect the reproductive system.
Bacterial Diseases of the Urinary Systems
Bacterial Urinary Tract Infections
Mild urethritis (urethra), cystitis (bladder), or pyelonephritis(kidneys)- when the pathogen enters the bloodstream bacteremia can occur (elderly)
Urinary bacteria can infect the prostate-- prostatits
Millions of females (girls and women) suffer from bacterial UTIs each year.
This includes 600,000 pts who acquire healthcare associated UTIs
Signs and symptoms
Slight fever, or no symptoms
Frequent, urgent, painful urination
Urine may be cloudy, bloody with foul odor
If pathogen in blood mental confusion
Pathogens and virulence factors
Enteric bacteria are the most common cause
Escherichia coli causes most cases 70%
Virulence factors include flagella and attachment fimbriae that will help the pathogen up the urethra
Bacterial Urinary Tract Infections
Pathogenesis and epidemiology
Often results when fecal bacteria are introduced into urethra
More common in females
Diabetics, nursing home pts and elderly men who have trouble emptying their bladders, women who use diaphragms for birth control and those who do not have adequate fluid intake
Diagnosis, treatment, and prevention
Diagnosis is based on urinalysis- what will we see in urine, RBC, WBC, and the bacterium
Many cases resolve without treatment
Some treated with antimicrobial drugs
Cephalosporin, sulfonamides and semisynthetic PCN
Prevented by limiting contamination by fecal microbes– wipe the correct way
Leptospirosis
Not all UTIs are from fecal contamination
Zoonotic disease seen primarily in animals that can spread to humans
Leptospira in urine-contaminated water enters the body through mucous membranes or kin abrasions
Signs and symptoms
Abrupt fever, myalgia, muscle stiffness, and headache
Rarely fatal but if so it is due to kidney and liver failure, meningitis, or respiratory distress
Half of pts will have N/V/D, 1/3 will have a dry cough
Pathogen
Over 200 strains of spirochete cause leptospirosis
Caused by Leptospira interrogans is the single species
Normally lives in many wild and domestic animals (rats, raccoons, foxes, dogs, horses, cattle and pigs)
Can survive in streams, rivers, and lakes
Virulent strains make adhesions that attach to cells, are motile, (move rapidly in a corkscrewing pattern) and can evade complement activity
Leptospirosis
Pathogenesis
Transmitted by contact with urine of infected animal or urine-contaminated water
It will take 2-26 days after you come into contact
Spirochete travels via the bloodstream through the body but will live in kidneys as disease gets worse spill in the urine
Epidemiology
Occurs throughout world but rare in the United States
Farmers, ranchers, vets, butchers, and people who go swimming in contaminated water are at risk
Diagnosis, treatment, and prevention
Diagnosis is based on antibody test
Treated with antimicrobial drugs, like IV PCN G
Prevented by avoiding contaminated water