UT7 - Infeções do Trato Urinário (3) Flashcards
Urosepsis?
◆ Patients with urosepsis should be diagnosed at an early stage, especially in the case of a cUTI.
◆ Systemic inflammatory response syndrome (SIRS), characterized by fever or hypothermia, hyperleukocytosis or leukopenia, tachycardia, and tachypnoea, is recognized as the first event in a cascade leading to multi-organ failure
◆ The treatment of urosepsis involves adequate life-supporting care, appropriate and prompt antimicrobial therapy, adjunctive measures, and the optimal management of urinary tract disorders.
◆ The decompression of any obstruction and drainage of larger infectious abscess in the urinary tract is essential as first-line focus control.
◆ It is important to note that a patient can move from an almost harmless state to severe sepsis in a very short time.
◆ Patients who are more likely to develop urosepsis include elderly patients, diabetics, immunosuppressed patients, such as transplant recipients and patients receiving cancer chemotherapy or corticosteroids.
Urosepsis - Etiologia e Alvos em estado agudo?
◆ E. coli remains the most prevalent microorganism.
◆ During the first six hours of resuscitation, the goals of initial resuscitation of sepsis-induced hypoperfusion should include all of the following:
– central venous pressure (CVP) 8-12 mmHg;
– mean arterial pressure (MAP) 65-90 mmHg;
– central venous oxygen (CVO2) > 70%;
– haematocrit (HKT) > 30 %;
– urine output > 0.5 mL/kg/hr.
Urethritis?
◆ Inflammation of the urethra presents usually with symptoms of the LUT and must be distinguished from other infections of the LUT.
◆ From a therapeutic and clinical point of view, gonorrhoeal urethritis (GU) must be differentiated from non-gonococcal urethritis (NGU).
◆ Infection is spread by sexual contact.
◆ Causative pathogens include Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Trichomonas vaginalis (TV), and Ureaplasma urealyticum (UU)
◆ Persons who have been diagnosed with a new STD should receive testing for other STDs, including syphilis and HIV.
Urethritis – Tratamento?
◆ Causative agents either remain extracellularly on the epithelial layer or penetrate into the epithelium (N. gonorrhea and C. trachomatis) and cause pyogenic infection.
◆ Although arising from urethritis, chlamydiae and gonococci can spread further through the urogenital tract to cause epididymitis in men or cervicitis, endometritis, and salpingitis in women.
◆ Mucopurulent or purulent discharge, alguria, dysuria, and urethral pruritus are symptoms of urethritis.
◆ However, many infections of the urethra are asymptomatic.
◆ Quando tratamos uma uretrite, devemos tratar a gonocócica e a não gonocócica simultaneamente.
Bacterial Prostatitis?
◆ A causative pathogen is detected by routine methods in only 5-10% of cases
◆ Enterobacteriaceae, especially E. coli, are the predominant pathogens in acute bacterial prostatitis.
◆ In chronic bacterial prostatitis, the spectrum of strains is wider
◆ Chronic bacterial prostatitis is the most frequent cause of rUTI in men
Bacterial Prostatitis - Clinica e Considerações?
◆ In acute prostatitis, the prostate may be swollen and tender on DRE.
◆ Prostatic massage is contraindicated.
◆ In case of lasting symptoms (“chronic prostatitis” symptoms), CPPS as well as other urogenital and anorectal disorders must be taken into consideration.
◆ Symptoms of chronic prostatitis or CPPS can mask prostate tuberculosis.
◆ Pyospermia and haematospermia in men in endemic regions or with a history of tuberculosis should prompt investigation for urogenital tuberculosis
◆ O toque retal é muito característico havendo uma dor muito intensa com a próstata quente, amolecida e congestionada.
◆ Na palpação da próstata devemos verificar se existem zonas de flutuação, uma vez que a PBA pode evoluir para abcesso prostático.
◆ In chronic bacterial prostatitis, quantitative bacteriological localization cultures and microscopy of the segmented urine and of expressed prostatic secretion (EPS), as described by Meares and Stamey are important investigations.
Bacterial Prostatitis - Prognostic?
◆ Approximately 10% of men with acute prostatitis will experience urinary retention.
◆ Teoricamente a algaliação está contraindicada numa situação de prostatite aguda.
◆ Suprapubic cystostomy placement is generally recommended.
◆ In the case of a prostatic abscess, both drainage and conservative treatment strategies appear feasible.
◆ The size may matter. In one study conservative treatment was successful if the abscess cavities were < 1 cm in diameter, while larger abscesses were better treated by single aspiration or continuous drainage
◆ In asymptomatic post-treatment patients routine urinalysis and/or urine culture is not mandatory.
Acute Infective Epididymitis?
◆ Acute epididymitis is clinically characterized by pain, swelling, and increased temperature of the epididymis, which may involve the testis and scrotal skin.
◆ It is generally caused by the migration of pathogens from the urethra or bladder.
◆ Torsion of the spermatic cord (testicular torsion) is the most important differential diagnosis in boys and young men.
◆ The predominant pathogens isolated are C. trachomatis, Enterobacteriaceae (typically E. coli), and N. gonorrhoeae.
◆ Men who have anal intercourse and those with abnormalities of the urinary tract resulting in bacteriuria are at higher risk of epididymitis caused by Enterobacteriaceae.
◆ The mumps virus should be considered if there are viral prodromal symptoms and salivary gland enlargement.
Acute Infective Epididymitis - Treatment?
◆ O tratamento de eleição na epididimite aguda passa por elevação escrotal e tratamento antibiótico adequado.
◆ Quando há torsão do cordão espermático, a clínica é o fator mais relevante (é completamente diferente o aparecimento de uma torsão comparado à de uma orquiepididimite), sendo uma dor aguda e muito intensa logo desde o início.
◆ Podemos utilizar o EcoDoppler para nos auxiliar e fazer o diagnóstico diferencial.
