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A 23 year old female came to the physician because of three days history of fever, nausea, and vomiting. Plus 4 days history of urgency and dysuria. PE showed suprapubic and flank tenderness. Urine exam showed 30WBC/hpf. Which of the following best describe the virulence factor of the most likely causal organism?

A- P pilli
B- M protein
C- Protein F
D- Lipoteichoic acid
E- Pyrogenic exotoxin
 

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I think it's Neisseria, causes Urthritus, and PID which would explain the flank pain and dysuria. It's a gram-ve so can't be B/D/E that leaves A or C, and to be honest I can't remember if there is even a protein F so i pick A:confused:
 

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i think the patient has pyelonephritis-associated pili. she has ascending infection to the renal pelvis due to E COLI infection ,ie vesicoureteral reflux of urine .the suprapubic pain is due to cystitis and the flank pain,fever wbc cast etc...is due to pyelonephritis.so the virulence factor for e coli adherence to the uroepithelium is the p-pili.
 
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