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a) What specimens would you take from this patient and what organisms would you look for? (2 marks).
As this was a home test given for the patient to take at home and send to the lab, the correct answer is Self Taken Vaginal Swab. (1 mark). If the student just mentions ‘vaginal swab; as the specimen to take, then they can get ½ mark (in the clinical setting, cervical swabs would be taken and not vaginal swabs)
As the sample was bacterial culture negative (ruling out gonorrhoea which has similar symptoms), the correct answer for this is Chlamydia trachomatis. (1 mark)
b) What type of test would the lab perform on this sample? (1 mark).
The lab would perform a Nucleic Acid Amplification Technique test (NAAT). (1 mark).
c) Why would this organism not have been grown on routine bacterial culture? (1 mark).
Because the organism is an Obligate Intracellular bacterium. (1 mark).
d) What type of antibiotics could be used to treat this infection? (5 marks) – 1 for each correct antibiotic named).
azithromycin or doxycycline are drugs of choice (95% sensitivity). (2 marks – one for each named). Amoxycillin, erythromycin and levofloxacin can also be used. (3 marks – one for each named.) Antibiotic resistance is rare.
e) What are the names for the infective but metabolically inactive stage and actively replicating stages of this organism lifecycle? (2 marks).
Infectious and metabolically inactive stage = Elementary body (1 mark).
Actively replicating stage = Reticulate body (1 mark).
f) Name up to 4 complications associated with this infection? (2 marks) - ½ mark per correct complication listed.)
Pelvic inflammatory disease. (½ mark)
Infertility. (½ mark)
Ectopic pregnancy. (½ mark)
Chronic pelvic pain. (½ mark)
a) What specimens would you take from this patient and what organism would you look for? (2 marks).
Main organism to look for would be HIV (1 mark).
For new diagnosis, would take Serum (1/2 mark) and plasma (1/2 mark) samples.
b) What tests would you perform and what elements would they look to identify when looking for this organism? (3 marks) - ½ mark for giving correct technology used for screening test, ½ mark for naming what 2 elements in the blood the screening test looks for, ½ mark for correct identification of the generation of test used and ½ mark given for naming each of the two confirmatory tests used on a positive screening test.
The initial test for HIV is an ELISA(1/2 mark) looking for HIV antibodies (1/2 mark) and p24 antigen (1/2 mark)(4th Generation test)(1/2 mark). Better answers will indicate that, if positive, and first diagnosis, then serum sample would be re-tested using another technique and the plasma sample would have genotype to distinguish between HIV1 and HIV2 (1/2 mark) and a viral load (to determine levels of virus in the blood (1/2 mark) performed on it.
c) What natural factors and drug inhibitors could be used to treat this organism and what are their modes of action? (7 marks).
Half a mark for each cellular factor/drug inhibitor and correct mode of action(upto a maximum of 7 marks).
Natural cellular factors
TRIM5 = tripartite motif containing protein 5. Its a retrovirus restriction factor blocking retrovirus infection – detects proteins in viral coat and prevents virus uncoating.
SAMHD1 = SAM and HD domain containing proteins. Blocks replication. Converts deoxyribonucleotide triphosphates (dNTP’s) to inorganic phosphate and 2’ deoxynucleoside without phosphate – depletes availability of dNTP’s available to reverse transcriptase to prevent replication
Tetherin = produced by cell to prevent virus budding by forming dimers, one in the viral membrane and one in the host membrane.
CCR5 = C chemokine receptor type 5 blocks CCR5 receptor and prevents entry.
Fusion Inhibitors = Binds to envelope protein on virus and blocks structural changes needed for the virus to fuse with the host cell.
NRTI and NNRTI = Non and nucleoside reverse transcriptase inhibitors – Analogues of deoxynucleotides lacking 3’ hydroxyl group so next nucleotide to come along the growing chain can not form bond and nucleic acid growth halted.
INSTI’s = Integrase inhibitors prevents integration of viral genetic material into host genetic material.
Protease Inhibitors – blocks viral proteases and prevents cleavage of protein precursors in proviral cell thus preventing the cell from becoming infective.
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