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3002 > 48 Urinary tract infections > Flashcards

48 Urinary tract infections Flashcards

1
Q

What is micturition?

A

Urination

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2
Q

What is dysuria?

A

Pain on urination

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3
Q

What is bacteriuria?

A

Presence of bacteria in urine

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4
Q

What is haematuria?

A

Presence of blood in urine

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5
Q

What is pyelonephritis?

A

Kidney infection

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6
Q

What is cystitis?

A

Infection confined to bladder

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7
Q

What is urethritis?

A

Inflammation of urethra

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8
Q

What is prostatitis?

A

Prostate infection

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9
Q

What is the aetiology of UTIs?

A
  • Women > men
  • 20-30% women have ≥ 1 UTI in lifetime
  • In men primarily >50 years of age
  • Occurs in normal urinary tract
  • Incidence 50, 000 per million persons per year
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10
Q

What type of attacks are UTIs?

A
  1. Single or isolated attack (90%)
  2. Recurrent attacks (10%)
    - relapse (20%)
    - reinfection (80%)
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11
Q

Outline the signs and symptoms of UTIs:
Lower?
Infection of pelvis and kidney (acute pyelonephritis)?

A 
• Lower UTIs:
– Frequency of micturition
– Urgency to urinate
– Dysuria
– Suprapubic pain & tenderness – Haematuria
– Smelly / cloudy urine

• Infection of pelvis and kidney (acute pyelonephritis):
– Loin pain & tenderness
– High fever
– Systemic upset

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12
Q

What are the factors favouring UTIs:

Bacterial attributes?

A
  • capsular antigens
  • hemolysins
  • urease
  • adhesion to uroepithelium (e.g.P. fimbriae in E.coli)
  • introital colonisation
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13
Q

What are the factors favouring UTIs:

Host factors?

A
  • renal calculi
  • ureteric reflux
  • tumours in and adjacent to urinary tract
  • pregnancy, bladder stones
  • neurologic problems: incomplete bladder emptying; large volume of residual urine; loss of sphincter control
  • prostatic hypertrophy
  • short urethra in women
  • catherisation
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14
Q

What are the common causes of UTIs:

Common acquired?

A
  • E.coli
  • coagulase-negative staphylococci
  • other gram-positives e.g. Staphylococcus epidermis, Staphylococcus aureus, Enterococcus faecalis
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15
Q

What are the common causes of UTIs:

Hospital (nosocomially) acquired?

A
  • candida
  • proteus mirabilis
  • other gram-negatives e.g. Klebsiella, Enterobacter, Serratia, Pseudomonas aeruginosa
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16
Q

What are the gram negative bacteria UTIs?

A
  • Escherichia coli
  • Proteus mirabilis
  • Klebsiella sp.
  • Enterobacter sp.
  • Serratia sp.
17
Q

Which virulence factors are expressed by uropathogenic E.coli (UPEC)?

A
  1. Fimbriae (For adhesion, Type 1 and Type P)
  2. K antigen
    - Polysaccharide
    - Forms a micro-capsule
    - Confers resistance to phagocytosis
  3. Haemolysin
    - Cytolytic exo-protein
    - Damages tissues membranes in vivo
    - Causes kidney damage
18
Q

What serogroups are in uropathogenic E.coli (UPEC)?

A

Certain serogroups of O and K serotypes
• O (somatic) - O1, O2, O4, O6, O7, O75
• K (capsular) K1, K2, K3, K5, K12, K13

19
Q

What does E.coli adhere to and what are the 2 types of fimbriae (pili)?

A
  • Specific adhesion to uroepithelial cells
  • Fimbriae types:
  • Type 1 fimbriae
  • Type P fimbriae
20
Q

What is the bacterial response to adhesion?

A
  • Iron acquisition machinery activated via siderophores
  • Stimulates growth and reproduction
  • Once a monolayer has formed a biofilm may develop
  • Bacteria with type 1 fimbriae may become internalised in phagocytes and epithelial cells
21
Q

Features of proteus mirabilis as a causative agent of UTIs?

A
  • Gram negative
  • Facultative anaerobe
  • Bacillus
  • Peritrichous flagellae
  • Produces urease
  • Swarming ability
22
Q

What are the gram positive bacteria in UTIs?

A
  • Staphylococcus saprophyticus
  • Staphylococcus epidermis
  • Enterococcus sp.
  • Corynebacteria
  • Lactobacillus
23
Q

Features of Staphylococcus saprophyticus as a causative agent for UTIs?

A
  • Gram positive
  • Coagulase negative
  • Normal microbiota of female perineum & vagina
  • Sexual activity increases risk of UTI
  • Commonly causes community acquired UTIs
  • Symptomatic cystitis
24
Q

What other organisms (fungi/yeast/protozoal) involved in UTIs?

A
  • Candida albicans
  • Trichomonas vaginalis
  • Schistosoma heamatobium
  • Myobacterium fortuitum
  • Histoplasma capsulatum
  • Polyomaviruses
  • CMV
  • Rubella
25
Q

Features of Trichomonas vaginalis as a causative agent for UTIs?

A
  • Protozoan: Most common protozoal cause of UTIs
  • Pear-shaped flagellate
  • T. vaginalis is pathogenic
  • Other species are commensal
  • Prefers pH ~6.0
  • Trichomoniasis
  • Less common in males
26
Q

Features of Trichomonas vaginalis as a causative agent for UTIs?

A
  • Protozoan: Most common protozoal cause of UTIs
  • Pear-shaped flagellate
  • T. vaginalis is pathogenic
  • Other species are commensal
  • Prefers pH ~6.0
  • Trichomoniasis
  • Less common in males
27
Q

What are the 3 different types of urine specimens for lab analysis?

A
  1. MSU (Mid-stream Specimen of Urine)
    - Significant bacteriuria
    - >10^5 per ml
  2. CSU (Catheter Specimen of Urine)
    - Significant bacteriuria
    - Loer number of micro-organisms than MSU
  3. Suprapubic aspiration of bladder urine
    - For schistosome haematobium and other rare occasions

Specimens used to perform urine dipstick test. (Nitrites present = infection)

28
Q

What are the 3 different types of urine specimens for lab analysis?

A
  1. MSU (Mid-stream Specimen of Urine)
    - Significant bacteriuria
    - >10^5 per ml
  2. CSU (Catheter Specimen of Urine)
    - Significant bacteriuria
    - Loer number of micro-organisms than MSU
  3. Suprapubic aspiration of bladder urine
    - For schistosome haematobium and other rare occasions
29
Q

What shows there’s infection in urine dipstick test?

A

Nitrites present

Increased leukocyte esterase

30
Q

Urinary tract host defences?

A
  • Urine - osmolality, pH
  • Sloughing of epithelial cells
  • Urine flow and micturition
  • Mucosal inhibitors of bacterial adherence
  • Complement activation
  • Inflammatory response
  • Immune responses
  • Commensals
31
Q

What chemical is found in cranberry juice that helps to prevent E.coli adherence that leads to UTIs?

A

Proanthrocyanidins

32
Q

Oral Antibiotics for UTIs?

A
  • Co-trimoxazole
  • Nitrofurantoin
  • Nalidixic acid
  • Co-amoxiclav
  • Trimethoprim
  • Ciprofloxacin
33
Q

Identify which pathogens commonly cause UTIs

A

*E.coli (gram neg)
*Proteus mirabilis (gram neg)
*S. saprophyticus (gram pos)
Candida albicans
Schistosoma haematobium
T. vaginalis

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