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HMB > Pathology - URINARY TRACT INFECTIONS > Flashcards

Pathology - URINARY TRACT INFECTIONS Flashcards

1
Q

What does “cystitis” mean?

A

Infection occurring in the bladder

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2
Q

What does “pyelonephritis” mean?

A

Infection occurring in the kidneys

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3
Q

What is the term used when there is an infection occurring in the urethra?

A

Urethritis

*Although its not really a UTI, more likely an STI

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4
Q

What is the clinical categorization of UTI, and identify the differences?

A

Uncomplicated:

  • Most common type
  • Affects healthy people
  • Mostly occur in adult, no pregnant women
  • Mostly e.coli (uropathogenic e.coli UPEC) (75%)

Complicated:

  • Less common
  • Affects people with anatomical and functional abnormalities
  • Increased risk of serious complication or treatment failure
  • Mostly: e.coli (uropathogenic e.coli UPEC) (65%)
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5
Q

What are come risk factors for cystitis?

A
  • Female
  • Sexual activity
  • Vaginal ifection
  • Prior UTI
  • Diabetes - “Glycosuria”
  • Obesity
  • Genetic susceptibility
  • Young children
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6
Q

What are the risk factors for complicated UTI?

A
  • Urinary obstruction
  • Urinary retention
  • Renal failure
  • Pregnancy
  • Diabetes
  • Renal transplant
  • Presence of foreign bodies e.g. renal calculi
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7
Q

What is renal calculi?

AKA Kidney stones

A

Formation of small mineral crystals present in the urine which stick together. Made up of 80% calcium, 5-10% uric acid, 10% struvite (Phosphate mineral). Can

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8
Q

What is urolithiasis?

A

Formation of renal calculi/kidney stones

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9
Q

Why are females are more at risk of contracting a UTI?

A

1 in 5 women are likely to get UTI in their lifetime

  • Shorter urethra
  • Shorter distance between anus + urethra
  • Vagina facilitating colonisation of uropathogens in periurethra
  • Source of urinary pathogens is from GIT - proximity to anus
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10
Q

Which host groups are more susceptible?

A

Women 20-40 age
- Increased sexual activity which enhances the entry of faecal bacteria into the urinary tract infections
Pregnant women
- Hormonal changes + increase in uterus which puts pressure on bladder and ureter.
Children
- Anatomic abnormalities of the urinary tract. Mostly uncircumcised male infants
Males >60
- Prostate hypertrophy which will block the urethral

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11
Q

Why do pregnant women have an increased risk of UTI’s?

A
  • Hormone changes: Increase levels of progesterone which induced ureteral dilation
  • Pressure of the expanding uterus against the ureters –> urinary retention
  • Early stage of infection may be asymptomatic –> increased risk of pyelonephritis

*UTI and pyelonephritis may lead to septicaemia –> may result in premature delivery

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12
Q

What are some mucosal host defences for the urinary tract?

A
  • Urethral secretion of cytokines and chemokines
  • Specific proteins, low molecular weight sugars, secretory IgA act as anti-adherence factors
  • Mucopolysaccharide lining of bladder
  • Prostatic secretions (men) contain bacteridal zinc and men’s urethra is longer.
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13
Q

What are some urine host defences for the urinary tract?

A
  • Mechanical flushing effect (more peeing)
  • High osmolarity
  • Salts, urea and organic acids in urine can reduce bacterial survival
  • Competitive inhibitors of attachment
  • Urinary inhibitors of bacterial adherence
  • Lactoferrin in urine can savage essential iron away from incoming microbes
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14
Q

What are the signs and symptoms of “cystitis”?

A
  • Dysuria (pain when urinating)
  • Frequency (passing many times)
  • Urgency (Unable to control urination)
  • Possible subpubic pain
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15
Q

What are the signs and symptoms of “pyelonephritis”?

A
  • Fever chills, nausea, vomiting
  • Flank pain: (stabbing pain or dull ache in upper below ribs. Kidney pain may also be felt in upper abdominal area OR pain can radiate to the back as well as the groin region)
  • Smelly urine (rare)
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16
Q

What are the signs and symptoms of “urethral syndrome - asymptomatic bacteriuria”?

A
  • Similar to cystitis (Frequency, dysuria, subpubic discomfort)
  • Difficult starting urination - slow stream
  • feeling incomplete emptying the bladder
  • No bacteria present in urine
17
Q

How does cauterization increase the risk of a UTI?

A
  • During the insertion of catheter, bacteria maybe carried directly into the bladder
  • Once in catheter facilitates bacterial access to bladder (straight access)
  • Increases change of infection the longer the catheter is left in (>5 days –> 50% chance of infection)

*Biofilm formabtion: communities of bacteria in a polysaccharide covering

18
Q

Give examples of organisms which cause COMPLICATED UTI’s

A
  • E.coli (Uropathogenic E.coli (UPEC)) (65%)
  • Enterococcus (11%)
  • Klebsiella (K.) pneumoniae (8%)
  • Candia species (7%)
  • Staphylococcus aureus (3%)
19
Q

Give examples of organisms which cause UNCOMPICATED UTI’s

A
  • E.coli (Uropathogenic E.coli (UPEC)) (75%)
  • Klebsiella (K.) pneumonia (6%)
  • S. Saprophyticus (6%)
  • Enterococcus (5%)
  • Group B streptococcal infection (3%)
20
Q

What are the virulence factors of uropathogenic escherica coli (e.coli) (UPEC) ?

A

Type 1 pili

  • A structure on the bacteria surface that interacts which the host cells
  • Essential for colonization invasion and persistence
  • FimH adhesion at the type 1 pili which binds to the mannosylated uroplakins and integrins on the surface umbrella cells –> bindings leads to actin rearrangement and internalisation of the UPEC in the host cells
  • UPEC multiples and forms intracellular communities. (Biofilms - early stage). Inside the host - UPEC is protected from antibiotics and host defences.
  • Overtime, UPEC multiplies + changes shapes (middle stage), before moving to the surface (late stage) and re-entering the bladder lumen –> further invasion and cycle repeat
21
Q

Describe the pathogenesis of UTI

A
  1. Contamination of periurethral are –> colonization of urethra and migration to the bladder
    a. Colonization and invasion of the bladder medicated by pili and adhesions
    b. Inflammatory response in the bladder, fibrinogen accumulation and cytokine accumulation (IL-6, IL-8)
  2. Neutrophil infiltration via IL-8
  3. Bacterial multiplication and immune system subversion
  4. Biofilm formation
  5. Epithelial damage by bacterial toxins and proteases - mediated by HyalA: haemolysin and CNF1
  6. Ascension to kidneys –> colonization of the kidneys –> host tissue damage by bacterial toxins
  7. Bacteraemia (bacteria entering blood)
22
Q

What type of clinical procedure would need to be used to test if a adult patient has an UTI? and why is the steps in the procure important for preventing contamination?

A

Mid-stream urine

  • It is a collection of urine after 1-2 seconds of the first pass urine
  • It is important to wash hands and clean around the genital area and not touch the inside of the sample jar
  • Reduced contamination of urine with bacterial + epithelial cells present in the urethra + skin epithelial cells
23
Q

What types of clinical procedures could be used to test babies/young children if they have a UTI? Identify, some cons making it difficult to undergo.

A
  • Urine bag: Very high rate of contamination (less used)
  • Suprapubic aspirate: Avoids contamination. Detection of ay bacteria is clinically significant
  • Catherization: Urine drawn from a catheter port with sterile syringe
  • Clean catch urine (MSU): Time consuming (parents need to watch) + high rates of contamination
24
Q

What types of examinations/analysis are used on a urine sample?

A

Urine analysis using Bili-labstix “Dip - sticks”
- Leukocytes, nitrite, glucose, bilirubin, ketone, specific gravity, blood, pH, protein and urobilinogen

Macroscopic:
- Foamy? red? blood? cloudy? particles floating in it?

Microscopic:

  • PMNs (white blood cells)
  • RBCs:
  • Bacteria
  • Epithelial cells

Cultural samples

  • MacConkey agar: Determine the number of bacterial allowed to culrure –> colonies counted
  • Chromogenic agar: Identification can be used on colour of the colony formed
  • Urostrip: It determines the quantity (#) of bacteria + colonies are counted
25
Q

What factors which could result in RBC’s being present in the urine?

A
  • UTI
  • Catheterization
  • Instrumentation
  • Menstruation
  • Aspirin
  • Calculi
  • Renal trauma
  • Thrombocytopaenia
26
Q

Identify the colour present on a chromogenic agar for the following causative agent?

  1. Enterococcus faesalis
  2. Escherichia coli
  3. Proteus mirabilis
  4. Klebsiella pneumoniae
A
  1. Enterococcus faesalis
    - Green/teal
  2. Escherichia coli
    - Red
  3. Proteus mirabilis
    - Yellow
  4. Klebsiella pneumoniae
    - Blue
27
Q

What is the treatment medication for cystitis?

A
  • Trimethoprim - NOT for pregnant women
  • Cephalexin
    Augmentin
  • Nitrofurantoin

If resistant –> nitrofurantoin

28
Q

What is the definition of a reoccurring UTI? What are some predisposing factors for reoccurring UTI?

A
  • 2 UTI in 6 months
    OR
  • 3 UTI in a year

Most recurrences are thought to represent reinfection rather an relapse

Predisposing factors

  • UTI history in the mother
  • Frequent intercourse
  • Use of spermicides
  • Age at first urinary tract infection <15
  • New sexual partner during the past year
29
Q

What are the likely findings of a UTI in a mid-stream urine test?

A

Consistent with UTI

  • WBC > 100 x 10 (6)/L
  • Bacteria > 10 (8)/L of one bacterial species

Likely UTI

  • WBC > 100 x 10 (6)L
  • 2 Bacterial species with at least 1 > 10 (8)/L

Children

  • WBC (PMN) > 1-5 x 10 (4)/ml
  • CFU > 1-5 x 10 (4) cfu/ml
30
Q

What is the treatment medication for Pyelonephritis?

A

Mild infection:

  • Trimethoprim
  • Cephalexin
  • Augmentin
  • Resistance use ciprofloxacin or norfloxacin

Sever infection - vomiting, sepsis, fever

  • Immediate empiric therapy required - gentamicin IV plus amoxycillin/ampicillin IV
  • Cefriaxone or cefotaxime IV - hypersensitive to penicillins
31
Q

What is a treatment/management with a catheter associated UTI?

A
  • Treat systemic symptoms
  • Remove catheter ASAP
  • Change an infected catheter immediately
  • Encourage an increase in fluid intake (to flush out - part of a host defence)
32
Q

A 30 year old woman presents with a 2 day history of frequency, dysuria, light haematuria and suprapubic pain. She has no vaginal discharge or any other relevant history

  1. What factors in this case history suggest UTI?
  2. What specimens would you collect?
  3. What laboratory tests would you carry out?
  4. How would you determine if there is more than 1 type of bacterium?
  5. How would you determine the actual number of bacteria?
A
  1. What factors in this case history suggest UTI?
    - Frequency, suprapubic pain and dysuria
  2. What specimens would you collect?
    - Mid stream urine
  3. What laboratory tests would you carry out?
    - Microscopy, culture and sensitive testing
  4. How would you determine if there is more than 1 type of bacterium?
    - MacConkey agar plate
  5. How would you determine the actual number of bacteria?
    - Urostrip (use it to count the # of colonies)

HMB (34 decks)

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