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MEDI2003 Module 2 theory > Urinary Tract Infections > Flashcards

Urinary Tract Infections Flashcards

1
Q

What is cystitis? and what are the symptoms?

A 
Bladder infection.
Symptoms include:
- Dysuria (painful urination)
- Frequency and urgency of urination
- Suprapubic pain
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2
Q

What is pyelonephritis and what are the symptoms associated?

A

Kidney infection

- Cystitis symptoms plus: Flank (over kidney area) pain, back ache, fever, rigors (shaking, chills)

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3
Q

What does the presence of large numbers of epithelial cells in a urine specimen indicate?

A

Indicates that the sample is badly collected, possibly an FVU

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4
Q

What type of organisms would you expect to be present in an FVU? (list 4 types)

A

Normal flora:

  • CONS (Coagulase Negative Staphylococcus)
  • Corynebacteria (GPB)
  • Lactobacilli (GPB)
  • Enterobacteriaceae (from GIT/rectum)
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5
Q

How many colonies would you equate to >10^8 cfu/L using the calibrated loop method of determining bacterial numbers?

A

> 200 colonies

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6
Q

List two methods used in clinical labs to determine a urine colony count.

A
  • Filter paper foot

- Calibrated loop

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7
Q

List two parasites (genus and species) that might be detected in urine?

A
  • Schistosoma haematobium

- Trichomonas vaginalis

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8
Q

What does the presence of yeast in urine usually indicate?

A
  • in high number it means a yeast infection (thrush)

- usually it means a genital infection or a poorly collected specimen

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9
Q

What does the presence of uric acid crystals in urine usually indicate?

A
  • Possibly Leukaemia or lymphoma

- 16% of urine with uric acid crystals may be due to gout.

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10
Q

What does the presence of calcium oxalate crystals in urine usually indicate?

A
  • possibly due to kidney stone

- can be seen in normal urines as well

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11
Q

What urine WCC would normally be associated with a UTI?

A

> 100 x 10^6 WBC/L is consistent with a UTI

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12
Q

What does the presence of nitrites in a urine sample indicate?

A

bacterial infection in the urinary tract which could lead to a UTI

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13
Q

What does the presence of nitrites in a urine sample indicate?

A

Indicates the presence of bacteria (Enterobacteriaceae) which reduces nitrates to nitrites

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14
Q

If there were 7 PMN cells in one square mm of a disposable counting chamber from a urine sample, how many WBC would there be in 1L? (express your answer using scientific notation x10^6 WBC/L)

A 
Count = ~7 WBC in 1mm squared
7 x 10 = 70 WBC in 1mm squared (1 microlitre)
70  x 1000 = 70000 WBC in 1mL
70000 x 1000 = 70 x 10^6 WBC per Litre
Reported as: <100 x 10^6 WBC per Litre
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15
Q

True or false: UTIā€™s are one of the most common infections investigated in the clinical microbiology lab.

A

True

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16
Q

What is a UTI?

A

A UTI is an invasion of any tissues of the urinary tract extending from the renal cortex to the urethral opening

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17
Q

Are UTIā€™s more common in males or females?

A

Females by 30:1

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18
Q

What is Urethritis?

A

An inflammation of the urethra

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19
Q

What is Glomerular nephritis (GMN)?

A

An inflammation of the glomeruli

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20
Q

What can cause Glomerular Nephritis?

A

A variety of causes which can include:

  • Post bacterial infection
  • cancer of the lungs or bowel
  • IgA nephropathy
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21
Q

True or False: other than the distal urethra all other areas of the urinary system should be sterile.

A

True

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22
Q

What is the most common organism isolated from community acquired UTIā€™s in WA?

A

Escherichia coli (75%)

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23
Q

What is Urethritis?

A

An inflammation of the urethra

24
Q

what are the different types of specimens collected for UTI testing?

A
  • MSU
  • Supra pubic aspirates
  • Catheter specimens
  • Nephrostomy sample (via tube inserted into kidneys)
  • Paediatric bags
25
Q

If there will be a delay in processing the urine sample, at what temperature does the sample need to be stored at?

A

4 deg C

26
Q

When examining Urine Specimens what lab procedures are conducted for ALL samples?

A
  • Macroscopic examinations
  • Dipstrip/Dipstick test
  • Urine colony count
  • Microscopic examination (wet prep)
27
Q

When examining Urine Specimens what lab procedures are conducted for samples with significant WBC or RBC present?

A

Full culture

28
Q

For a full culture of a urine sample what is being looked at/tested?

A
  • Isolating organisms that can be ID with rapid tests
  • Biochemical reactions (Microgen, API)
  • Antibiotic susceptibility
29
Q

For macroscopic examinations of urine samples list the possible effects and what they may indicate.

A
  • Clear = Normal
  • Cloudy/turbid = possible infection
  • Green = diet or drugs
  • Blood in urine = Haematuria or menstruation
30
Q

What does the presence of increased protein found in a sample mean?

A

can indicate kidney damage or presence of organisms in the urine.

31
Q

What is the normal pH range for urine and how can this be effected?

A

pH in urine is normally 6 but can be affected by diet and sometimes bacteria

32
Q

What does the presence of blood in urine indicate?

A

Can indicate kidney/Urinary Tract damage, or menstrual blood contamination.

33
Q

What does the presence of glucose in urine indicate?

A

indication of diabetes or pre-diabetes.

34
Q

Urine colony counts are performed on all urine specimens. What are the two culture media used and what do they help determine?

A

MAC or CLED agar. These help to determine lactose fermenting bacteria which helps to ID the bacteria.

35
Q

When performing a streaking out for urine colonies how is the calibrated loop used to streak out the culture plate?

A
  1. dip into urine sample
  2. touch the loop to the culture plate, creating a line down the centre of the plate.
  3. Using the same loop (without flaming or re-dipping) draw the loop across the entire plate in a zig-zag fashion, crossing the centre line numerous times.
36
Q

What does CLED stand for? How does it work?

A

Cysteine Lactose Electrolyte Deficient agar.

  • Electrolyte deficiency prevents swarming by Proteus sp.
  • Differential for lactose fermenting pathogens.
  • Lactose fermenters turn the plate yellow, Non-Lactose Fermenters keep the plate blue/green
37
Q

Using the Calibrated Loop method for colony count, How do we calculate the CFU per ml of urine if there were exactly 200 colonies growing from 2 micro litres of urine?

A

200 bacteria x 500 (multiplication factor) = 100,000 bacteria per 1 ml (1000 micro litres) of urine

This is the same as 1 x 10^5 cfu/L or 10^5 cfu/L

38
Q

What is the significance of >200 colonies equal to?

A

> 10^5 orgs/ml (same as >10^8 orgs/L)

39
Q

What is the significance of 20 - 200 colonies equal to?

A

10^4 - 10^5 orgs/ml

40
Q

What is the significance of 0 - 20 colonies equal to?

A

<10^4 orgs/ml

41
Q

How do you calculate the indices when going from ml to L?

A

add the indices together

42
Q

How do you calculate the indices when going from L to ml?

A

subtract the indices by 3

43
Q

A pure colony count of >10^8 orgs/L AND a WCC of >100 x 10^6 WBC/L indicates what?

A

UTI

44
Q

<10^7 cfu/L (which is equal to <10^4 per ml) indicates what?

A

Normal urine

45
Q

A pure colony count of 10^7-10^8 orgs/L AND a WCC of >100 x 10^6 WBC/L indicates what?

A

Possible UTI

46
Q

What type of WBC would indicate a UTI?

A

Neutrophils (PMN)

47
Q

In a Wet Preparation if you were to see WBC or RBC under the microscope, what would this indicate?

A

WBC - usually associated with infection

RBC = may or may not be associated with infection

48
Q

In a Wet Preparation what are casts indicative of?

A 
acellular = possible dehydration
cellular = pyelonephritis (WBC) or GMN, glomerular damage if RBC as well.
49
Q

What does the presence of Tyrosine crystals indicate?

A

Possible liver damage

50
Q

How are WCC reported if there are less than 100 in the counting chamber?

A

the actual number of what was counted is reported

e.g. 30 x 10^6 WBC/L

51
Q

How are WCC reported if there are greater than 100 in the counting chamber?

A

> 100 x 10^6 WBC/L

52
Q

Other than microbes in the urine specimen, what other elements may be viewed in a wet prep?

A
  • spermatozoa

- artefacts (i.e. cotton fibres)

53
Q

In a wet preparation, if >10 x 10^6/L WBC are counted this is considered significant, what other testing does the sample require?

A
  • Direct sensitivity plate on Sensitest or MHA

- Purity plate on BA or similar

54
Q

How can the identity of a pathogen causing a UTI be determined?

A
  • Colony morphology
  • Gram stain
  • Catalase test
  • Oxidase test
  • Motility
  • Spot indole
  • API20E or MALDI-TOF (if required)
55
Q

If a GPC is identified in the Gram stain how do we proceed with identification of Genera and species?

A

By following the flow diagram in the lab manual

e.g. catalase/oxidase testing

56
Q

If a GNB/C are identified in the Gram stain how do we proceed with identification of Genera and species?

A

Begin using the systematics tables (Cowan and Steel) and then API or MALDI-TOF

57
Q

What does the ā€œEā€ stand for in the API 20E test strip?

A

Enterobacteriaceae

MEDI2003 Module 2 theory (5 decks)

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