Infection Flashcards
Examples of GU infections
Pyelonephritis Cystitis Prostatitis Urethritis Epididymo-orchitis
What is pyelonephritis
Infection within the renal pelvis
What is cystitis
Infection causing inflammation of the bladder
What is prostatitis
Bacterial infection of the prostate gland
What is urethritis
Urethral inflammation
What is epididymis-orchitis
Pain, swelling and inflammation of the epididymis
Types of pyelonephritis
Acute
Chronic
Pathophysiology of acute pyelonephritis
Often, infection will rise from the bladder to the renal pelvis.
Haematogenous spread also possible.
Local infection will cause inflammation and damage.
Aetiology of acute or chronic pyelonephritis (and risk factors)
Infection by UTI organisms (Escherischia coli, Klebsiella, Proteus, Enterococcus)
RF: Calculi, catheterisation, pregnancy, diabetes
Clinical presentation of acute pyelonephritis
Rapid, loin, suprapubic or back pain.
Fever, malaise, nausea, anorexia.
Possibly lower UTI, with frequent dysuria, haematuria or hesitancy.
Epidemiology of acute pyelonephritis
Can occur at any age
Generally more frequent in females, except in neonates
Diagnosis of acute pyelonephritis
Urine dipstick
Urine is cloudy with an offensive smell
Midstream culture
Treatment of acute pyelonephritis
Support
Antibiotics, empirically
*Ciproflaxcin / Co-amoxiclav first line (at PEEK bacteria)
Complications of acute pyelonephritis
Septicaemia
Renal abscess
Pathophysiology of chronic pyelonephritis
Chronic infection can cause characteristic scarring of the kidney
Clinical presentation of chronic pyelonephritis
Failure to thrive Possibly hypertension Rapid, loin, suprapubic or back pain. Fever, malaise, nausea, anorexia. Possibly lower UTI, with frequent dysuria, haematuria or hesitancy.
Epidemiology of chronic pyelonephritis
4/100,000 asymptomatic adults
Diagnostic tests of chronic pyelonephritis
Urine dipstick
Midstream culture
Treatment of chronic pyelonephritis
Blood pressure control to slow progression of renal failure
Antibiotics (empirically) -> probs ciprofloxacin/co-amoxiclav
Complications of chronic pyelonephritis
Septicaemia
Progressive renal scarring
Secondary hypertension
Pathophysiology of cystitis (inflamed bladder from infection)
Infection of urine stored in the bladder.
Can be ‘washed out’ with frequent fluids.
Aetiology of cystitis
Can be caused from incomplete emptying
Clinical presentation of cystitis
Frequent urination Urgency Dysuria Abdominal tenderness Swollen bladder Confusion (elderly)
Epidemiology of cystitis
Very common
Diagnosis of cystitis
History
Midstream urine
Treatment of cystitis
Often resolves without treatment
Fluids and possibly antibiotics
Clinical presentation of Prostatitis (bacterial infection of prostate gland)
Macroscopic haematuria Fever Dysuria Pyrexia Sharp pelvic/penile/anal pain
Aetiology of prostatitis (name specific organisms)
Usually gram negative organisms; Escherichia coli, Enterobacter, Serratia. Sometimes STI: Neisseria gonorrhoeae and Chlamydia trachomatis
What sexually transmitted gram negative organisms can cause prostatitis
Neisseria gonorrhoeae
Chlamydia trachomatis
Epidemiology of prostatitis
15% of men experience symptoms at some point in their life
Diagnosis of prostatitis
DRE (digital rectal examination): Gland can feel nodular, ‘boggy’, tender and hot
Treatment of prostatitis (what is 1st line)
Antibiotics (empirically)
Quinolones (1st line!) e.g. Ciprofloxacin (A Quinalone)
Types of urethritis
Gonococcal
Non-gonococcal
Clinical presentation of gonococcal urethritis
May be asymptomatic. Usually is asymptomatic in women. Urethral discharge, more noticeable after holding urine overnight. Dysuria
What is the difference in presentation of non-gonococcal urethritis (compared to gonococcal)
Same except NO DISCHARGE in Non-gonococcal
Aetiology of Gonococcal Urethritis
Neisseria gonorrhoeae
As a result of STI
Aetiology of Non-gonococcal urethritis (2 most common causes)
Number of organisms can cause this.
*Chlamydia trachomatis, Mycoplasma genitalium most commonly
Epidemiology of urethritis
Non-gonococcal urethritis is most common condition diagnosed and treated in men in genitourinary
Diagnosis of urethritis
Urethral smear
Screen for STIs
Treatment of Gonococcal urethritis
Antibiotics (empirically)
Quinolones (1st line!) e.g. Ciprofloxacin (A Quinalone)
Treatment of Non-Gonococcal urethritis
Antibiotics Specifically Ceftriaxone (A Quinolone)
Complications of prostatitis
Chronic infection
Complications of urethritis
Non-Gonococcal = Epididymitis, Prostatitis Gonococcal = same but also risk of gonococcal arthritis; can remit spontaneously if untreated
Most common routes of infection leading to epididymo-orchitis infection
Most common route of infection is infection spreading from the urethra.
Second is from the bladder.
Clinical presentation of epididymo-orchitis
Unilateral scrotal pain and swelling.
In STI: urethral discharge also. Tenderness to palpation on affected side. Palpable swelling
Aetiology of epididymo-orchitis
Men <35 = most commonly STI
>35 = generally gram negative enteric organisms
Can also be viral
Epidemiology of epididymo-orchitis
25/10,000 (may have dropped)
Diagnosis of epididymo-orchitis
Culture urethral smear
Treatment of epididymo-orchitis
Check for torsion
STI advice
Empirical antibiotics if appropriate:
Doxycycine and Cefixime or Ciprofloxazin (Quinolone)
Complications of epididymo-orchitis
Reactive hydrocele
Abscess formation
Which 2 of these would you not treat with Ciprofloxacin: Pyelonephritis Cystitis Prostatitis Gonococcal urethritis Non-gonococcal urethritis Epididymo-orchitis
Cystitis = Trimethoprin
Non-gonococcal urethritis = Ceftriaxone
