8b Urinary tract infections Year 4 Internal Medicine Notes

8b Urinary tract infections Year 4 · Internal Medicine Collection: 4TH YEAR ALL NOTES / IMED / IMED 4.2 / Mogere -- Slide 1 Urinary tract infections Dr Alex Mogere Consultant Physician Slide 2 Anatomy of urinary tract Slide 3 Anatomy of urinary tract Slide 4 Introduction Uti –infection in any portion of urinary tract In health, bacterial colonisation is confined to the lower end of the urethra and the remainder of the urinary tract is sterile. C’m particularly in women, c’mly occurring a normal urinary tract, usu as cystitis Half of all women will experience uti in their lifetime Can occur in an uncomplicated setting-no structural anomalies or in complicated setting– structural anomalies Uncommon in men and children, when occurs,may be due to an abn urinary tract Slide 5 Ct. introduction Lower urinary tract uti- cystitis, urethritis Upper urinary tract uti- acute pyelonephritis Diagnosis- 10^5 organisms/ml from mid-stream clean catch urine samples In symptomatic pts a small no. of bacteria may also be diagnostic of uti Slide 6 Spectrum of presentations of uti Asymptomatic bacteriuria\nSymptomatic acute urethritis and cystitis\nAcute pyelonephritis\nAcute prostatitis\nSepticaemia (usually Gram-negative bacteria) Slide 7 Aetiology Tb, fungal infection, syphilis (bacteria causing granulomas) Non specific- E.coli, Klebsiella, proteus, enterobacter Parasitic- echinococcus G, schistosomiasis Helminths- enterobius, pin worms Protozoa- t. vaginalis Slide 8 In women, the ascent of organisms into the bladder is easier than in men; the urethra is shorter and the absence of bactericidal prostatic secretions may be relevant. Sexual intercourse\ninstrumentation Slide 9 Uncomplicated uti Cystitis, or pyelonephritis that occurs in premenopausal adult women who: Have no comorbidity No fxnal or structural anomaly of urinary tract Not pg Have no hx of instrumentation Slide 10 Complicated uti If pt is a child or pg Pt has structural/fxnal anomaly of urinary tract Comorbidity predisposing to uti Recent instrumentation/surgery of urinary tract Slide 11 Route of infection Hematogenous Ascending Lymphogenous Direct extension Iatrogenic Focis/foci in prostate /kidney Slide 12 Pathophysiology Slide 13 Innate host defenses Mucosal Mucopolysacch lining IgA In men prostatic secretions-bactericidal Zn/long urethra Urothelial secretions of cytokines urine Acidic pH Mechanical flushing of urine flow Urinary inhibitors of bacterial adherence Slide 15 Ct. other risk factors Behavioral-voiding dysfxn, recent sexual intercourse Genetic- familial, vaginal mucus properties Anatomic/physiologic-female, Pg Slide 16 urethritis Organisms access the numerous periurethral glands in the bulbous and pendulus portions of the male urethra and the entire female urethra—colonization acutely /chronic Pathogens may include: chlamydia, HSV, n. gonorrhea Slide 17 Cystitis Common in women “honeymoon cystitis”-preceded by sexual intercourse In men-complicated(ascending, prostatitis, instrumentation) Chronic bacterial prostatitis—most cm cause of recurrent cystitis in men Slide 18 Acute urethral syndrome (AUS) Occurs in women Dysuria, frequency, pyuria Routine urine cultures usu neg/lower colony counts Urethritis is a possible cause because causative agents include ureaplasma urealyticum, chlamydia trachomatis(neg on routine urine culture) intermittent or low-count bacteriuria,\nreaction to toiletries or disinfectants,\nsymptoms related to sexual intercourse, or\npost-menopausal atrophic vaginitis Slide 19 Asymptomatic bacteriuria This is defined as more than 10^5 organisms/mL in the urine of apparently healthy asymptomatic patients Treatment is required in infants, pregnant women and those with urinary tract abnormalities. Screening of pts for asymptomatic bacteriuria indicated for those likely to develop complications if left untreated eg. Pg—12-16 weeks Kidney transplant in last 6/12 Before certain invasive GU procedures Children with VUR Slide 20 Ct. asymptomatic bacteriuria Persistent asymptomatic bacteriuria-post menopausal women, pts with controlled DM, pts with stents, indwelling catheters etc If no symptoms- shouldn’t screen routinely Slide 21 Acute pyelonephritis acute pyelonephritis is suggested by prominent systemic symptoms with\nfever,\nrigors,\nvomiting,\nhypotension and\nloin pain,\nguarding or tenderness, and may be an indication for hospitalization Only about 30% of patients with acute pyelonephritis have associated symptoms of cystitis or urethritis. Uncm in men with normal urinary tract Cmner in pg and young girls after catheterization Mode of spread –mostly hematogenous Slide 22 Ct. acute pyelonephritis Papillary necrosis- dm, analgesic nephropathy, candida pyelonephritis,SCD, obstruction Slide 23 Complications Sepsis Recurrent infections Permanent renal damage- untreated uti Low birth wt delivery Slide 24 Renal TB Tuberculosis of the kidney and renal tract is secondary to tuberculosis elsewhere\nHaematogenous spread Initially, lesions develo