Elimination & Detox 2: Infections of the UT Flashcards
WHAT determines WHETHER a LOWER UT INFECTION will OCCUR?
what 2 FACTORS play a role in this? describe them?
the BACTERIAL GENE EXPRESSION determines whether BACTERIA can COLONIZE ON BLADDER & cause CLINICAL DZ
2 factors…
1. FITNESS FACTORS = promote COMMENSALISM
2. VIRULENCE FACTORS = dictate INFECTION SEVERITY
bacteria EVOLVE by INCREASING ___ or ___ to…
FITNESS, VIRULENCE to CONSTANTLY ADAPT to CHANGES within their MICROENVIRONMENT
bacteria with HIGH FITNESS are COMMONLY FOUND IN ___ infections that also have DECREASED ___ potential
CHRONIC, VIRLUENCE
ADHESION MOLECULES..
= definition in relation to UT
= produced by BACTERIA and allow them to BIND AFFINITIVELY to DIFFERENT AREAS OF URINARY TRACT
UROPATHOGENIC E. COLI (UPEC)
express __ ____ ____ which BIND TARGETS on _____
could ALSO express ____ ____ that BIND RECEPTORS in ____ ____ ___
can cause WHAT dz?
express TYPE I FIMBRIAE which BIND TARGETS on UROEPITHELIUM
could ALSO express P FIMBRIAE which BIND RECEPTORS in UPPER URINARY TRACT
can cause PYELONEPHRITIS
MOST GRAM-____ organisms express similar ___ molecules with HIGH AFFINITY for ___ ___
NEGATIVE, ADHESION, KIDNEY TISSUE
ASYMPTOMATIC or SUBCLINICAL BACTERIURIA…
this IS NOT A DEFINITION FOR… (2)
= definition
NOT A DEFINITION FOR UTI & DOES NOT MEAN that UTI WILL NOT OCCUR
= BACTIURIA WITHOUT LOWER URINARY TRACT SIGNS
6 LOWER URINARY TRACT SIGNS?
helps
- CAUDAL ABDOMINAL PAIN
- PERIURIA (urinating OUTSIDE litterbox)
- POLLAKIURIA
- DYSURIA
- HEMATURIA
- MALODOROUS URINE
UNCOMPLICATED or SIMPLE UTIs…
how OFTEN do these occur?
what 2 patients are EXCEPTIONS & why?
how OFTEN? = occurs NO MORE THAN ONCE every 6 MONTHS in an OTHERWISE HEALTHY DOG
2 EXCEPTIONS? –> DO NOT FOLLOW THIS RULE
- CATS –> COMMONLY DEVELOP TRUE UTIs with CONCURRENT SYSTEMIC DZ
- INTACT MALE DOGS –> can have RECURRENT PROSTATITIS
COMPLICATED UTIs…
3 types?
- PERSISTENT
- RELAPSE
- REINFECTION
PERSISTENT (REFRACTORY) COMPLICATED URINARY TRACT INFECTIONS
= basic definition?
what are 3 things this could POSSIBLY INDICATE?
overall, if we SUSPECT this dz, we should SCREEN FOR __ __, including… (3)
= with APPROPRIATE ANTIMICROBIAL THERAPY, we have FAILED TO STERILIZE URINE
indicates that…
1. BACTERIA has DEVELOPED RESISTANCE during TREATMENT
- PATIENT is IMMUNOCOMPROMISED so UNABLE TO CLEAR INFECTION
- we HAVE NOT ACHIEVE the URINARY CONCENTRATION of ANTIBIOTIC to INHIBIT BACTERIAL GROWTH
if we SUSPECT PERSISTENT (REFRACTORY) UTI, should SCREEN for SYSTEMIC DZ
1. GI DZ
2. FUNCTION of IMMUNE SYSTEM
3. HEPATIC/RENAL systems
give 4 reasons as to why ___ (___) URINARY TRACT INFECTIONS can occur due to INABILITY TO REACH URINARY CONCENTRATION of ANTIBIOTIC necessary to INHIBIT BACTERIAL GROWTH?
PERSISTENT (REFRACTORY)
- DECREASED INTESTINAL ABSORPTION from GI DZ
- ALTERED PERFUSION of INFECTED TISSUES, so ANTIBIOTIC CANNOT REACH CONCERNED AREA
- ALTERED DRUG METABOLISM from CONCURRENT DZ
- REDUCED URINARY CONCENTRATING DZ (such as TUBULAR DYSFUNCTION)
RELAPSE COMPLICATED URINARY TRACT INFECTION
= definition
what 5 AREAS of the UT can contribute to this?
alternatively, what TRAIT can CERTAIN BACTERIA have that can allow for this/how?
= urine is INITIALLY CLEARED of INFECTION but BACTERIAL RESERVOIRS REMAIN so that RECOLONIZATION w/ SAME ORGANISMS can occur in DAYS TO WEEKS after recovery
areas of UT that can HARBOR bacterial reservoirs…
1. KIDNEYS
2. PROSTATE
3. UROLITHS
4. VAGINA
5. UROTHELIUM
certain BACTERIA can MOVE INTRACELLULARLY during INFECTION & FORM QUIESCENT INTRACELLULAR RESERVOIRS (QIC) that can LATER RE-SEED THE BLADDER
REINFECTION COMPLICATED URINARY TRACT INFECTION…
= definition
this is DIFFICULT to DIFFERENTIATE from ____ infection, so we should perform a ____ ____, which includes.. (3)
= ALTERATION to HOST DEFENSES allow for NEW BACTERIAL STRAINS to COLONIZE BLADDER seen WEEKS to MONTHS after
this is DIFFICULT to DIFFERENTIATE from RELAPSE infection, so we should perform a SYSTEMIC EVALUATION…
- look at EXTERNAL GENITALIA (recessed vulva)
- look for URINE RETENTION
- DIAGNOSTIC IMAGING or CYSTOSCOPY to EVALUATE LOWER UT
what is the GOLD STANDARD DIAGNOSTIC for LOWER URINARY TRACT INFECTIONS?
this is a ____ ____ that is able to IDENTIFY the ____ ___ & ____ ___
however, this does NOT help distinguish between ____ & ___, so we can look to use ____ for SUPPORT
AEROBIC CULTURE
this is a QUANTITATIVE CULTURE that is able to IDENTIFY the INFECTING ORGANISM & COLONY COUNT
however, this does NOT help distinguish between SUBCLINICAL BACTERIURIA & TRUE UTI, so we can look to use SEDIMENT for SUPPORT (like INFLAMMATION)
URINE CULTURE & SEDIMENT are AFFECTED BY… (2)
give 2 examples of what can happen?
AFFECTED by…
1. URINE STORAGE
2. TIME TO PROCESSING
2 examples?
1. bacteria CAN OVERLY PROLIFERATE
2. bacteria can DIE if SAMPLES LEFT UN-REFRIGERATED
when DIFFERENTIATING between URINE CONTAMINATION with BACTERIA & COLONIZATION as result of UTI… (2)
- consider URINE COLLECTION & COLONY COUNT
- look on SEDIMENT for CONCURRENT PYRIA that’s SUGGESTIVE OF INFECTION even if NO CLINICAL SIGNS
AEROBIC CULTURE for UTI…
GROWTH is usually apparent within ___-____ __ of ____ GENERALLY
what 2 BACTERIA can TAKE LONGER? what’s the range?
GRAM-___ are MOST COMMONLY ISOLATED, such as ___ ____
18-24 hours of INCUBATION GENERALLY, some can take longer!
2 BACTERIA that TAKE LONGER?
1. C RENALE
2. MYCOPLASMA SPP
–> 4-7 DAYS
GRAM-NEGATIVE are MOST COMMONLY ISOLATED, such as E. COLI
SIGNIFICANT BACTERIURIA CUTOFF for…
–> CYSTOCENTESIS (1)
–> CATHETERIZED SAMPLE (2, one for males & females)
–> VOIDED SAMPLE (2, one for dogs & cats)
–> CYSTOCENTESIS = GREATER THAN or EQUAL TO 1,000 CFU/mL
–> CATHETERIZED SAMPLE
1. MALES = GREATER THAN or EQUAL TO 10,000 CFU/mL
2. FEMALES = GREATER THAN or EQUAL TO 100,000 CFU/mL
–> VOIDED SAMPLE (2, one for dogs & cats)
1. CATS = GREATER THAN or EQUAL TO 10,000 CFU/mL
2. DOGS = GREATER THAN or EQUAL TO 100,000 CFU/mL
TRUE/FALSE
if an animal has SUBCLINICAL BACTERIURIA, we are usually NOT using ANTIBIOTICS if NO LOWER UT SIGNS ARE PRESENT
TRUE
SIMPLE or UNCOMPLICATED UTI TREATMENT…
does it require URINE CULTURE?
GENERAL medication name & duration?
when is FURTHER INVESTIGATION required?
DOES NOT require URINE CULTURE, especially if IT’S ONLY THE FIRST TIME
GENERALLY, can give AMOXICILLIN/CLAVULANIC ACID or TMS for 3-5 DAYS
FURTHER INVESTIGATION needed if NO RESPONSE in 48 HOURS, so THEN TAKE CULTURE if not yet
TREATMENT for COMPLICATED RECURRENT UTIs…
FIRST, we should…
for RE-INFECTION?
for PERSISTENT or RELAPSING INFECTION?
after ____-____ ___ of TREATMENT or after ____ _____ ____, we should…
FIRST, we should ID & ADDRESS PREDISPOSING FACTORS!
for RE-INFECTION, do SHORT 3-5 DAY Tx
for PERSISTENT or RELAPSING INFECTION, do LONG 7-14 DAY tx
after 5-7 DAYS of TREATMENT or AFTER FINISHING ANTIMICROBIAL COURSE, we should REPEAT URINE CULTURE
what are 4 THERAPEUTIC options for UTI treatment?
efficacy?
- ADHERENCE BLOCKADE
- BACTERIAL INTERFERENCE
- ANTIMICROBIAL PREVENTATIVE THERAPY
- MISCELLANEOUS NON-ANTIMICROBIAL PREVENTATIVES
EFFICACY is NOT CONFIRMED, minimal evidence
ADHERENCE BLOCKADE
what KIND of treatment is this?
= how does it work?
give 3 examples/how they work?
THERAPEUTIC Tx for UTI
= BLOCK ability of BACTERIA to ADHERE TO UROTHELIUM so that HOST can FLUSH INVADING ORGANISMS FROM UT
3 examples?
1. CRANBERRIES/CRANBERRY EXTRACT
–> contain PACs that have ANTIBIOFILM PROPERTIES & prevent P FIMBRIAE from binding in UPPER UT
- D-MANNOSE
–> BLOCKS TYPE-1 FIMBRIAE - GLYCOSAMINOGLYCANS
–> normally GAG BARRIER over UROTHELIUM is DAMAGED BY BACTERIA, so giving CAN HELP REBUILD IT
BACTERIAL INTERFERENCE
what KIND of treatment is this?
= how does it work?
2 examples?
THERAPEUTIC Tx for UTI
= we IATROGENICALLY ESTABLISH COLONIES of NONVIRULENT ORGANISMS TO COLONIZE MICROENVIRONMENT & prevent PATHOGENIC bacteria from COLONIZING
2 examples?
1. INTRAVESICULAR NONPATHOGENIC E. COLI into BLADDER
- PROBIOTICS
MISCELLANOUS NON-ANTIMICROBIAL PREVENTATIVES
what KIND of treatment is this?
3 examples & how 2 of them work?
THERAPEUTIC UTI tx
3 examples?
1. ESTROGENS
- METHENAMINE SALTS can act as URINARY ANTISEPTICS
- VACCINATIONS & BACTERIOPHAGES to LYSE UROPATHOGENIC E. COLI
ANTIMICROBIAL PREVENTATIVE THERAPY..
what KIND of treatment is this?
= what is it?
how MUCH antibiotic is given?
WHEN is the antibiotic given DAILY?
DURATION of course?
THERAPEUTIC tx for UTI
= LONG-TERM, MODIFIED-DOSAGE ANTIBIOTIC PROPHYLAXIS
how MUCH antibiotic is given? = give 1/3 TO 1/2 of TOTAL DAILY DOSE
WHEN is the antibiotic given DAILY? = administered AT NIGHT AFTER LAST VOID OF THE DAY
DURATION of course? = for 6 MONTHS with REPEAT CULTURES EVERY MONTH to PROVE THAT PETS ARE NEGATIVE CONTINUOUSLY
ENCRUSTING CYSTITIS…
this is a ____ ____ infection, associated with ____-____ ____, such as what 2 organisms?
–> which is MOST COMMON IN DOGS?
causes WHAT pathologic finding?
can involve WHAT parts of the urinary system? (4)
often ___-____ ____, so we should use a ____ to GUIDE ____
can take HOW LONG to GROW ON URINE CULTURE?
BACTERIAL LUT INFECTION, associated with UREASE-PRODUCING BACTERIA, such as…
1. CORYNEBACTERIUM UREALYTICUM = MOST COMMON IN DOGS
2. STAPH PSEUDINTERMEDIUS
causes URINARY BLADDER WALL MINERALIZATION that is often INTRAMURAL
can INVOLVE…
1. URETHRA
2. BLADDER
3. URETERS
4. RENAL PELVIS
often MULTI-DRUG RESISTANT, so we should use a CULTURE to GUIDE TREATMENT
can take 48-72 HOURS to GROW ON URINE CULTURE
describe FINDING in CIRCLE (bladder)
what DZ is this?
CIRCLE = THICKENED BLADDER WALL
DZ = ENCRUSTING CYSTITIS (causes BLADDER WALL MINERALIZATION)
EMPHYSEMATOUS CYSTITIS…
commonly caused by GRAM-____ ____, such as… (2)
MAJORITY of DOGS/CATS also have WHAT DZ? (3, which is most common?)
TREATMENT is based on…
commonly caused by GRAM-NEGATIVE BACTERIA, such as…
1. E. COLI
2. CLOSTRIDIUM
MAJORITY of DOGS/CATS also have…
1. DIABETES MELLITUS (most common)
2. NEUROLOGIC DZ
3. ADRENAL DZ
TREATMENT based on URINE CULTURE & SUSCEPTIBILITY RESULTS to ENSURE INFECTION IS CLEARED
describe CIRCLE
DZ?
CIRCLE = GAS in BLADDER WALL
DZ? = EMPHYSEMATOUS CYSTITIS
CANDIDIASIS…
aka?
commonality?
CANDIDA are ___ that are USUALLY ___ & part of the ___ ___ of the ____ ___, ____ ___ & ____
what is the MOST COMMON PATHOGENIC STRAIN in DOGS/CATS?
4 risk factors?
aka FUNGAL UTI
NOT VERY COMMON
CANDIDA are YEASTS that are USUALLY BENIGN & part of the NORMAL FLORA of the GI TRACT, URINARY TRACT & SKIN
MOST COMMON PATHOGENIC STRAIN in DOGS/CATS? = CANDIDA ALBICANS
4 risk factors?
1. RECENT ANTIMICROBIAL ADMINISTRATION
2. IMMUNOSUPPRESSION
3. LOWER UT DZ
4. URINARY CATHETERIZATION
CANDIDIASIS..
diagnosis? (2)
treatment & duration?
what about for PERSISTENT UTI? & include FREQUENCY
diagnosis?
1. CYTOLOGIC EXAMINATION on URINE SEDIMENT to see FUNGAL ELEMENTS
2. BACTERIAL or FUNGAL CULTURE
treatment? = ORAL ANTIFUNGALS that achieve HIGH URINE CONCENTRATIONS like FLUCONAZOLE for 4-6 WEEKS
for PERSISTENT INFECTIONS, consider WEEKLY INTRAVESICULAR Tx with 1% CLOTRIMAZOLE
ID what you see & DZ
BUDDING elements of FUNGI
CANDIDIASIS
3 ROUTES to achieve PYELONEPHRITIS?
which is most common?
COLONIZATION usually requires a…
- ASCENDING from URETHRA (most common)
- HEMATOGENOUS
- LYMPHATIC SYSTEM
COLONIZATION usually requires a COMORBIDITY
3 PREDISPOSING FACTORS that can MAKE UPPER UTI more likely?
- COMPROMISED IMMUNE SYSTEM from ENDOCRINE or INFECTIOUS DZ
- IMPAIRED LOCAL DEFENSE MECHANISMS in KIDNEY, URETER & BLADDER
- BACTERIAL VIRULENCE PROPERTIES like ADHESION MOLECULES or BIOFILM FORMATION
4 CLINICAL SIGNS of UTI INFECTION/PYELONEPHRITIS?
SOME animals can present ___
5 signs…
1. ABDOMINAL PAIN
2. DYSURIA
3. POLYURIA or POLYDIPSIA
4. OCCASIONALLY malaise, V+, fever
SOME animals can present SUBCLINICALLY
DIAGNOSIS of UPPER UTI is best achieved with WHAT IMAGING TECHNIQUE?
what are 4 COMMON FINDINGS?
ABDOMINAL US
4 findings?
1. RETROPERITONEAL INFLAMMATION
2. ECHOGENIC EFFUSION
3. ENLARGED KIDNEYS
4. DILATION OF RENAL PELVIS
TREATMENT of PYELONEPHRITIS..
how SOON should we INITIATE TREATMENT?
if there’s no IMPROVEMENT after ____ ____ of STARTING ANTIMICROBIAL THERAPY, then…
treatment DURATION? and AFTER treatment…
initiate treatment IMMEDIATELY while AWAITING CULTURE RESULTS, such as…
–> FLUOROQUINOLONES or CEFPODOXIME
–> (antimicrobials that are effective against ENTEROBACTERIACEAE)
if there’s no IMPROVEMENT after 72 HOURS of STARTING ANTIMICROBIAL THERAPY, then CONSIDER OTHER DIAGNOSES
treatment DURATION should be 10-14 DAYS, and then FOLLOW-UP 1-2 WEEKS AFTER STOPPING MEDS
LEPTOSPIROSIS…
GRAM-____ bacteria that has an OUTER membrane of ___
list 5 DESCRIPTIVE traits
GRAM-NEGATIVE bacteria that has an OUTER membrane of LPS
5 DESCRIPTORS…
1. THIN
2. FLEXIBLE
3. MOTILE
4. SPIRAL-SHAPED
5. HOOK-SHAPED ENDS
LEPTOSPIROSIS..
has a ___ LIFE CYCLE
what are the MOST IMPORTANT HOSTS of LEPTO?
what are the 3 INCIDENTAL hosts? & list 3 ways THEY CAN BECOME INFECTED
OUTBREAKS tend to be in ___ & ___ environments & related to HEAVY ___
has a COMPLEX LIFE CYCLE
RODENTS are the MOST IMPORTANT HOSTS OF LEPTO WORLDWIDE
INCIDENTAL HOSTS = HUMANS, DOGS & CATS can be infected via…
1. DIRECT CONTACT WITH INFECTED URINE
2. INGESTION of RESERVOIR HOSTS
3. EXPOSURE to CONTAMINATED WATER or SOIL
OUTBREAKS tend to be in WARM & MOIST environments & related to HEAVY RAINFALL
LEPTO can PERSIST IN ____-____ SITES
IMMUNE-PRIVILEGED
LEPTO should be SUSPECTED in PATIENTS WITH WHAT 6 CLINICAL SIGNS?
- FEVER
- AKI
- LIVER INJURY
- UVEITIS
- PANCREATITIS
- PULMONARY HEMORRHAGE
list FINDINGS in LEFT & RIGHT circle?
what DZ is this?
LEFT = PROGRESSIVE BRONCHOINTERSTITIAL LUNG PATTERN in RIGHT LUNG LOBE
RIGHT = PATCHY ALVEOLAR PATTERN in LEFT CAUDAL LUNG LOBE from PULMONARY HEMORRHAGE
DZ = LEPTO
what is LEPTO LUNG?
PULMONARY HEMORRHAGE from SEVERE LEPTO INFECTION
DIAGNOSIS for LEPTO…
what 3 TESTS could we perform?
hint: which test is ONLY GOOD for patients that HAVE NOT RECEIVED ANTIBIOTIC Tx for LEPTO?
3 TEST?
1. SEROLOGY using MICROSCOPIC AGGLUTINATION TEST (MAT)
–> need to test PAIRED SAMPLES (10-14 days after FIRST)
- LATERAL FLOW ASSAYS for CANINE ANTI-LEPTOSPIRA ANTIBODIES
–> SNAP test (IgG)
–> WITNESS (IgM Abs ONLY) - PCR ASSAYS for DNA of LEPTOSPIRES in BLOOD/URINE
–> ONLY WORKS IF PATIENT HAS NOT BEEN ON ANTIBIOTICS BEFORE
what TEST for LEPTO could be CONTRAINDICATED in EARLY INFECTION or RIGHT AFTER VACCINATION?
SEROLOGY USING MICROSCOPIC AGGLUTINATION TEST (MAT)
general TREATMENT for LEPTO? & duration
what if they DO NOT FEEL WELL?
what PREVENTION should be used?
general = treat with DOXYCYCLINE for 2 WEEKS so long as EATING/FEELING OK
if NOT FEELING WELL like GI SIGNS = PARENTERAL AMPICILLIN OK
should use QUADRIVALENT VACCINE to help PREVENT DZ & REDUCE SHEDDING
BORRELIOSIS…
how is this disease TRANSMITTED? (2)
UNCOMMONLY, this DZ can lead to WHAT DZ?
TRANSMISSION? = B. BURGDORFERI transmitted via TICKS, like…
1. IXODES SCAPULARIS
2. IXODES PACIFICUS
UNCOMMONLY, this DZ can lead to PROTEIN-LOSING GLOMERULONEPHRITIS
FUNGAL PYELONEPHRITIS…
usually associated with… in WHAT SPECIES? such as… (2, which is more common?)
how can we DIAGNOSE this?
common TREATMENT? why can this be CONTRAINDICATED?
usually associated with SYSTEMIC FUNGAL DZ in DOGS, such as…
1. ASPERGILLOSIS (MORE COMMON)
2. CRYPTOCOCCUS
diagnosed from URINE CULTURE on ROUTINE LAB MEDIA
commonly TREATED WITH AMPHOTERICIN B for FUNGAL INFECTIONS, but this can be NEPHROTOXIC so NOT USED IF CONCURRENT PYELONEPHRITIS
LEISHMANIASIS..
caused by ___ ____ & give SPECIFIC GENUS & SPECIES
TRANSMITTED by ___ ____ ___
can cause WHAT concurrent DZ?
DIAGNOSIS via what 3 methods?
caused by DIPHASIC PROTOZOAN –> LEISHMANIA INFANTUM
TRANSMITTED by SAND FLY BITES
can cause PROTEIN-LOSING GLOMERULONEPHRITIS
DIAGNOSIS via…
1. SEROPOSITIVITY for ANTI-LEISHMANIA ABs
2. PCR TESTING on BONE MARROW, LN, SPLEEN, SKIN
3. RENAL BIOPSIES
LEISHMANIASIS..
3 Tx options & how they WORK?
which is used MOST COMMONLY?
- MEGLUMINE ANTIMONIATE
–> INHIBITS important PROTOZOAL ENZYMES to KEEP IT FROM REPLICATING - MILTEFOSINE
–> has DIRECT TOXIC EFFECT on LEISHMANIA PARASITES
–> USED MORE COMMONLY - ALLOPURINOL
–> PREVENTS REPLICATION
ID POTENTIAL PARASITIC DZ based on these 3 clinical signs:
- POOR COAT
- UNTHRIFTY/THIN
- MUSCLE-WASTED
LEISHMANIASIS
DIOCTOPHYMIASIS…
caused by WHAT etiologic agent? GIVE GENUS & SPECIES TOO
how are PATIENTS INFECTED? (3)
diagnosis? (2)
treatment of choice? what CAN be an alternative if we need it?
caused by GIANT KIDNEY WORM or DIOCTOPHYME RENALE
patients INFECTED via…
1. INGEST INFECTIVE LARVAE in FISH
- larvae EMERGE & PENETRATE DUODENAL WALL
- MIGRATE to RIGHT KIDNEY & cause DZ
diagnosis?
1. DETECTION of EGGS in URINE SEDIMENT
2. US VISUALIZATION of ADULT NEMATODES in KIDNEY
treatment of choice = NEPHRECTOMY
–> if BOTH KIDNEYS affected, then NEPHROTOMY can be done
