Elimination & Detox 2: Infections of the UT

Question 1

WHAT determines WHETHER a LOWER UT INFECTION will OCCUR?

what 2 FACTORS play a role in this? describe them?

Answer 1

the BACTERIAL GENE EXPRESSION determines whether BACTERIA can COLONIZE ON BLADDER & cause CLINICAL DZ

2 factors…
1. FITNESS FACTORS = promote COMMENSALISM
2. VIRULENCE FACTORS = dictate INFECTION SEVERITY

Question 2

bacteria EVOLVE by INCREASING ___ or ___ to…

Answer 2

FITNESS, VIRULENCE to CONSTANTLY ADAPT to CHANGES within their MICROENVIRONMENT

Question 3

bacteria with HIGH FITNESS are COMMONLY FOUND IN ___ infections that also have DECREASED ___ potential

Answer 3

CHRONIC, VIRLUENCE

Question 4

ADHESION MOLECULES..

= definition in relation to UT

Answer 4

= produced by BACTERIA and allow them to BIND AFFINITIVELY to DIFFERENT AREAS OF URINARY TRACT

Question 5

UROPATHOGENIC E. COLI (UPEC)

express __ ____ ____ which BIND TARGETS on _____

could ALSO express ____ ____ that BIND RECEPTORS in ____ ____ ___

can cause WHAT dz?

Answer 5

express TYPE I FIMBRIAE which BIND TARGETS on UROEPITHELIUM

could ALSO express P FIMBRIAE which BIND RECEPTORS in UPPER URINARY TRACT

can cause PYELONEPHRITIS

Question 6

MOST GRAM-____ organisms express similar ___ molecules with HIGH AFFINITY for ___ ___

Answer 6

NEGATIVE, ADHESION, KIDNEY TISSUE

Question 7

ASYMPTOMATIC or SUBCLINICAL BACTERIURIA…

this IS NOT A DEFINITION FOR… (2)

= definition

Answer 7

NOT A DEFINITION FOR UTI & DOES NOT MEAN that UTI WILL NOT OCCUR

= BACTIURIA WITHOUT LOWER URINARY TRACT SIGNS

Question 8

6 LOWER URINARY TRACT SIGNS?

helps

Answer 8

1. CAUDAL ABDOMINAL PAIN
2. PERIURIA (urinating OUTSIDE litterbox)
3. POLLAKIURIA
4. DYSURIA
5. HEMATURIA
6. MALODOROUS URINE

Question 9

UNCOMPLICATED or SIMPLE UTIs…

how OFTEN do these occur?

what 2 patients are EXCEPTIONS & why?

Answer 9

how OFTEN? = occurs NO MORE THAN ONCE every 6 MONTHS in an OTHERWISE HEALTHY DOG

2 EXCEPTIONS? –> DO NOT FOLLOW THIS RULE

1. CATS –> COMMONLY DEVELOP TRUE UTIs with CONCURRENT SYSTEMIC DZ
2. INTACT MALE DOGS –> can have RECURRENT PROSTATITIS

Question 10

COMPLICATED UTIs…

3 types?

Answer 10

1. PERSISTENT
2. RELAPSE
3. REINFECTION

Question 11

PERSISTENT (REFRACTORY) COMPLICATED URINARY TRACT INFECTIONS

= basic definition?

what are 3 things this could POSSIBLY INDICATE?

overall, if we SUSPECT this dz, we should SCREEN FOR __ __, including… (3)

Answer 11

= with APPROPRIATE ANTIMICROBIAL THERAPY, we have FAILED TO STERILIZE URINE

indicates that…
1. BACTERIA has DEVELOPED RESISTANCE during TREATMENT

2. PATIENT is IMMUNOCOMPROMISED so UNABLE TO CLEAR INFECTION
3. we HAVE NOT ACHIEVE the URINARY CONCENTRATION of ANTIBIOTIC to INHIBIT BACTERIAL GROWTH

if we SUSPECT PERSISTENT (REFRACTORY) UTI, should SCREEN for SYSTEMIC DZ
1. GI DZ
2. FUNCTION of IMMUNE SYSTEM
3. HEPATIC/RENAL systems

Question 12

give 4 reasons as to why ___ (___) URINARY TRACT INFECTIONS can occur due to INABILITY TO REACH URINARY CONCENTRATION of ANTIBIOTIC necessary to INHIBIT BACTERIAL GROWTH?

Answer 12

PERSISTENT (REFRACTORY)

1. DECREASED INTESTINAL ABSORPTION from GI DZ
2. ALTERED PERFUSION of INFECTED TISSUES, so ANTIBIOTIC CANNOT REACH CONCERNED AREA
3. ALTERED DRUG METABOLISM from CONCURRENT DZ
4. REDUCED URINARY CONCENTRATING DZ (such as TUBULAR DYSFUNCTION)

Question 13

RELAPSE COMPLICATED URINARY TRACT INFECTION

= definition

what 5 AREAS of the UT can contribute to this?

alternatively, what TRAIT can CERTAIN BACTERIA have that can allow for this/how?

Answer 13

= urine is INITIALLY CLEARED of INFECTION but BACTERIAL RESERVOIRS REMAIN so that RECOLONIZATION w/ SAME ORGANISMS can occur in DAYS TO WEEKS after recovery

areas of UT that can HARBOR bacterial reservoirs…
1. KIDNEYS
2. PROSTATE
3. UROLITHS
4. VAGINA
5. UROTHELIUM

certain BACTERIA can MOVE INTRACELLULARLY during INFECTION & FORM QUIESCENT INTRACELLULAR RESERVOIRS (QIC) that can LATER RE-SEED THE BLADDER

Question 14

REINFECTION COMPLICATED URINARY TRACT INFECTION…

= definition

this is DIFFICULT to DIFFERENTIATE from ____ infection, so we should perform a ____ ____, which includes.. (3)

Answer 14

= ALTERATION to HOST DEFENSES allow for NEW BACTERIAL STRAINS to COLONIZE BLADDER seen WEEKS to MONTHS after

this is DIFFICULT to DIFFERENTIATE from RELAPSE infection, so we should perform a SYSTEMIC EVALUATION…

1. look at EXTERNAL GENITALIA (recessed vulva)
2. look for URINE RETENTION
3. DIAGNOSTIC IMAGING or CYSTOSCOPY to EVALUATE LOWER UT

Question 15

what is the GOLD STANDARD DIAGNOSTIC for LOWER URINARY TRACT INFECTIONS?

this is a ____ ____ that is able to IDENTIFY the ____ ___ & ____ ___

however, this does NOT help distinguish between ____ & ___, so we can look to use ____ for SUPPORT

Answer 15

AEROBIC CULTURE

this is a QUANTITATIVE CULTURE that is able to IDENTIFY the INFECTING ORGANISM & COLONY COUNT

however, this does NOT help distinguish between SUBCLINICAL BACTERIURIA & TRUE UTI, so we can look to use SEDIMENT for SUPPORT (like INFLAMMATION)

Question 16

URINE CULTURE & SEDIMENT are AFFECTED BY… (2)

give 2 examples of what can happen?

Answer 16

AFFECTED by…
1. URINE STORAGE
2. TIME TO PROCESSING

2 examples?
1. bacteria CAN OVERLY PROLIFERATE
2. bacteria can DIE if SAMPLES LEFT UN-REFRIGERATED

Question 17

when DIFFERENTIATING between URINE CONTAMINATION with BACTERIA & COLONIZATION as result of UTI… (2)

Answer 17

1. consider URINE COLLECTION & COLONY COUNT
2. look on SEDIMENT for CONCURRENT PYRIA that’s SUGGESTIVE OF INFECTION even if NO CLINICAL SIGNS

Question 17

AEROBIC CULTURE for UTI…

GROWTH is usually apparent within ___-____ __ of ____ GENERALLY

what 2 BACTERIA can TAKE LONGER? what’s the range?

GRAM-___ are MOST COMMONLY ISOLATED, such as ___ ____

Answer 17

18-24 hours of INCUBATION GENERALLY, some can take longer!

2 BACTERIA that TAKE LONGER?
1. C RENALE
2. MYCOPLASMA SPP
–> 4-7 DAYS

GRAM-NEGATIVE are MOST COMMONLY ISOLATED, such as E. COLI

Question 18

SIGNIFICANT BACTERIURIA CUTOFF for…

–> CYSTOCENTESIS (1)

–> CATHETERIZED SAMPLE (2, one for males & females)

–> VOIDED SAMPLE (2, one for dogs & cats)

Answer 18

–> CYSTOCENTESIS = GREATER THAN or EQUAL TO 1,000 CFU/mL

–> CATHETERIZED SAMPLE
1. MALES = GREATER THAN or EQUAL TO 10,000 CFU/mL
2. FEMALES = GREATER THAN or EQUAL TO 100,000 CFU/mL

–> VOIDED SAMPLE (2, one for dogs & cats)
1. CATS = GREATER THAN or EQUAL TO 10,000 CFU/mL
2. DOGS = GREATER THAN or EQUAL TO 100,000 CFU/mL

Question 19

TRUE/FALSE

if an animal has SUBCLINICAL BACTERIURIA, we are usually NOT using ANTIBIOTICS if NO LOWER UT SIGNS ARE PRESENT

Answer 19

TRUE

Question 20

SIMPLE or UNCOMPLICATED UTI TREATMENT…

does it require URINE CULTURE?

GENERAL medication name & duration?

when is FURTHER INVESTIGATION required?

Answer 20

DOES NOT require URINE CULTURE, especially if IT’S ONLY THE FIRST TIME

GENERALLY, can give AMOXICILLIN/CLAVULANIC ACID or TMS for 3-5 DAYS

FURTHER INVESTIGATION needed if NO RESPONSE in 48 HOURS, so THEN TAKE CULTURE if not yet

Question 21

TREATMENT for COMPLICATED RECURRENT UTIs…

FIRST, we should…

for RE-INFECTION?

for PERSISTENT or RELAPSING INFECTION?

after ____-____ ___ of TREATMENT or after ____ _____ ____, we should…

Answer 21

FIRST, we should ID & ADDRESS PREDISPOSING FACTORS!

for RE-INFECTION, do SHORT 3-5 DAY Tx

for PERSISTENT or RELAPSING INFECTION, do LONG 7-14 DAY tx

after 5-7 DAYS of TREATMENT or AFTER FINISHING ANTIMICROBIAL COURSE, we should REPEAT URINE CULTURE

Question 22

what are 4 THERAPEUTIC options for UTI treatment?

efficacy?

Answer 22

1. ADHERENCE BLOCKADE
2. BACTERIAL INTERFERENCE
3. ANTIMICROBIAL PREVENTATIVE THERAPY
4. MISCELLANEOUS NON-ANTIMICROBIAL PREVENTATIVES

EFFICACY is NOT CONFIRMED, minimal evidence

Question 23

ADHERENCE BLOCKADE

what KIND of treatment is this?

= how does it work?

give 3 examples/how they work?

Answer 23

THERAPEUTIC Tx for UTI

= BLOCK ability of BACTERIA to ADHERE TO UROTHELIUM so that HOST can FLUSH INVADING ORGANISMS FROM UT

3 examples?
1. CRANBERRIES/CRANBERRY EXTRACT
–> contain PACs that have ANTIBIOFILM PROPERTIES & prevent P FIMBRIAE from binding in UPPER UT

2. D-MANNOSE
   –> BLOCKS TYPE-1 FIMBRIAE
3. GLYCOSAMINOGLYCANS
   –> normally GAG BARRIER over UROTHELIUM is DAMAGED BY BACTERIA, so giving CAN HELP REBUILD IT

Question 24

BACTERIAL INTERFERENCE what KIND of treatment is this? = how does it work? 2 examples?

Answer 24

THERAPEUTIC Tx for UTI = we IATROGENICALLY ESTABLISH COLONIES of NONVIRULENT ORGANISMS TO COLONIZE MICROENVIRONMENT & prevent PATHOGENIC bacteria from COLONIZING 2 examples? 1. INTRAVESICULAR NONPATHOGENIC E. COLI into BLADDER 2. PROBIOTICS

Question 25

MISCELLANOUS NON-ANTIMICROBIAL PREVENTATIVES what KIND of treatment is this? 3 examples & how 2 of them work?

Answer 25

THERAPEUTIC UTI tx 3 examples? 1. ESTROGENS 2. METHENAMINE SALTS can act as URINARY ANTISEPTICS 3. VACCINATIONS & BACTERIOPHAGES to LYSE UROPATHOGENIC E. COLI

Question 26

ANTIMICROBIAL PREVENTATIVE THERAPY.. what KIND of treatment is this? = what is it? how MUCH antibiotic is given? WHEN is the antibiotic given DAILY? DURATION of course?

Answer 26

THERAPEUTIC tx for UTI = LONG-TERM, MODIFIED-DOSAGE ANTIBIOTIC PROPHYLAXIS how MUCH antibiotic is given? = give 1/3 TO 1/2 of TOTAL DAILY DOSE WHEN is the antibiotic given DAILY? = administered AT NIGHT AFTER LAST VOID OF THE DAY DURATION of course? = for 6 MONTHS with REPEAT CULTURES EVERY MONTH to PROVE THAT PETS ARE NEGATIVE CONTINUOUSLY

Question 27

ENCRUSTING CYSTITIS... this is a ____ ____ infection, associated with ____-____ ____, such as what 2 organisms? --> which is MOST COMMON IN DOGS? causes WHAT pathologic finding? can involve WHAT parts of the urinary system? (4) often ___-____ ____, so we should use a ____ to GUIDE ____ can take HOW LONG to GROW ON URINE CULTURE?

Answer 27

BACTERIAL LUT INFECTION, associated with UREASE-PRODUCING BACTERIA, such as... 1. CORYNEBACTERIUM UREALYTICUM = MOST COMMON IN DOGS 2. STAPH PSEUDINTERMEDIUS causes URINARY BLADDER WALL MINERALIZATION that is often INTRAMURAL can INVOLVE... 1. URETHRA 2. BLADDER 3. URETERS 4. RENAL PELVIS often MULTI-DRUG RESISTANT, so we should use a CULTURE to GUIDE TREATMENT can take 48-72 HOURS to GROW ON URINE CULTURE

Question 28

describe FINDING in CIRCLE (bladder) what DZ is this?

Answer 28

CIRCLE = THICKENED BLADDER WALL DZ = ENCRUSTING CYSTITIS (causes BLADDER WALL MINERALIZATION)

Question 29

EMPHYSEMATOUS CYSTITIS... commonly caused by GRAM-____ ____, such as... (2) MAJORITY of DOGS/CATS also have WHAT DZ? (3, which is most common?) TREATMENT is based on...

Answer 29

commonly caused by GRAM-NEGATIVE BACTERIA, such as... 1. E. COLI 2. CLOSTRIDIUM MAJORITY of DOGS/CATS also have... 1. DIABETES MELLITUS (most common) 2. NEUROLOGIC DZ 3. ADRENAL DZ TREATMENT based on URINE CULTURE & SUSCEPTIBILITY RESULTS to ENSURE INFECTION IS CLEARED

Question 30

describe CIRCLE DZ?

Answer 30

CIRCLE = GAS in BLADDER WALL DZ? = EMPHYSEMATOUS CYSTITIS

Question 31

CANDIDIASIS... aka? commonality? CANDIDA are ___ that are USUALLY ___ & part of the ___ ___ of the ____ ___, ____ ___ & ____ what is the MOST COMMON PATHOGENIC STRAIN in DOGS/CATS? 4 risk factors?

Answer 31

aka FUNGAL UTI NOT VERY COMMON CANDIDA are YEASTS that are USUALLY BENIGN & part of the NORMAL FLORA of the GI TRACT, URINARY TRACT & SKIN MOST COMMON PATHOGENIC STRAIN in DOGS/CATS? = CANDIDA ALBICANS 4 risk factors? 1. RECENT ANTIMICROBIAL ADMINISTRATION 2. IMMUNOSUPPRESSION 3. LOWER UT DZ 4. URINARY CATHETERIZATION

Question 32

CANDIDIASIS.. diagnosis? (2) treatment & duration? what about for PERSISTENT UTI? & include FREQUENCY

Answer 32

diagnosis? 1. CYTOLOGIC EXAMINATION on URINE SEDIMENT to see FUNGAL ELEMENTS 2. BACTERIAL or FUNGAL CULTURE treatment? = ORAL ANTIFUNGALS that achieve HIGH URINE CONCENTRATIONS like FLUCONAZOLE for 4-6 WEEKS for PERSISTENT INFECTIONS, consider WEEKLY INTRAVESICULAR Tx with 1% CLOTRIMAZOLE

Question 33

ID what you see & DZ

Answer 33

BUDDING elements of FUNGI CANDIDIASIS

Question 34

3 ROUTES to achieve PYELONEPHRITIS? which is most common? COLONIZATION usually requires a...

Answer 34

1. ASCENDING from URETHRA (most common) 2. HEMATOGENOUS 3. LYMPHATIC SYSTEM COLONIZATION usually requires a COMORBIDITY

Question 35

3 PREDISPOSING FACTORS that can MAKE UPPER UTI more likely?

Answer 35

1. COMPROMISED IMMUNE SYSTEM from ENDOCRINE or INFECTIOUS DZ 2. IMPAIRED LOCAL DEFENSE MECHANISMS in KIDNEY, URETER & BLADDER 3. BACTERIAL VIRULENCE PROPERTIES like ADHESION MOLECULES or BIOFILM FORMATION

Question 36

4 CLINICAL SIGNS of UTI INFECTION/PYELONEPHRITIS? SOME animals can present ___

Answer 36

5 signs... 1. ABDOMINAL PAIN 2. DYSURIA 3. POLYURIA or POLYDIPSIA 4. OCCASIONALLY malaise, V+, fever SOME animals can present SUBCLINICALLY

Question 37

DIAGNOSIS of UPPER UTI is best achieved with WHAT IMAGING TECHNIQUE? what are 4 COMMON FINDINGS?

Answer 37

ABDOMINAL US 4 findings? 1. RETROPERITONEAL INFLAMMATION 2. ECHOGENIC EFFUSION 3. ENLARGED KIDNEYS 4. DILATION OF RENAL PELVIS

Question 38

TREATMENT of PYELONEPHRITIS.. how SOON should we INITIATE TREATMENT? if there's no IMPROVEMENT after ____ ____ of STARTING ANTIMICROBIAL THERAPY, then... treatment DURATION? and AFTER treatment...

Answer 38

initiate treatment IMMEDIATELY while AWAITING CULTURE RESULTS, such as... --> FLUOROQUINOLONES or CEFPODOXIME --> (antimicrobials that are effective against ENTEROBACTERIACEAE) if there's no IMPROVEMENT after 72 HOURS of STARTING ANTIMICROBIAL THERAPY, then CONSIDER OTHER DIAGNOSES treatment DURATION should be 10-14 DAYS, and then FOLLOW-UP 1-2 WEEKS AFTER STOPPING MEDS

Question 39

LEPTOSPIROSIS... GRAM-____ bacteria that has an OUTER membrane of ___ list 5 DESCRIPTIVE traits

Answer 39

GRAM-NEGATIVE bacteria that has an OUTER membrane of LPS 5 DESCRIPTORS... 1. THIN 2. FLEXIBLE 3. MOTILE 4. SPIRAL-SHAPED 5. HOOK-SHAPED ENDS

Question 40

LEPTOSPIROSIS.. has a ___ LIFE CYCLE what are the MOST IMPORTANT HOSTS of LEPTO? what are the 3 INCIDENTAL hosts? & list 3 ways THEY CAN BECOME INFECTED OUTBREAKS tend to be in ___ & ___ environments & related to HEAVY ___

Answer 40

has a COMPLEX LIFE CYCLE RODENTS are the MOST IMPORTANT HOSTS OF LEPTO WORLDWIDE INCIDENTAL HOSTS = HUMANS, DOGS & CATS can be infected via... 1. DIRECT CONTACT WITH INFECTED URINE 2. INGESTION of RESERVOIR HOSTS 3. EXPOSURE to CONTAMINATED WATER or SOIL OUTBREAKS tend to be in WARM & MOIST environments & related to HEAVY RAINFALL

Question 41

LEPTO can PERSIST IN ____-____ SITES

Answer 41

IMMUNE-PRIVILEGED

Question 42

LEPTO should be SUSPECTED in PATIENTS WITH WHAT 6 CLINICAL SIGNS?

Answer 42

1. FEVER 2. AKI 3. LIVER INJURY 4. UVEITIS 5. PANCREATITIS 6. PULMONARY HEMORRHAGE

Question 43

list FINDINGS in LEFT & RIGHT circle? what DZ is this?

Answer 43

LEFT = PROGRESSIVE BRONCHOINTERSTITIAL LUNG PATTERN in RIGHT LUNG LOBE RIGHT = PATCHY ALVEOLAR PATTERN in LEFT CAUDAL LUNG LOBE from PULMONARY HEMORRHAGE DZ = LEPTO

Question 44

what is LEPTO LUNG?

Answer 44

PULMONARY HEMORRHAGE from SEVERE LEPTO INFECTION

Question 45

DIAGNOSIS for LEPTO... what 3 TESTS could we perform? hint: which test is ONLY GOOD for patients that HAVE NOT RECEIVED ANTIBIOTIC Tx for LEPTO?

Answer 45

3 TEST? 1. SEROLOGY using MICROSCOPIC AGGLUTINATION TEST (MAT) --> need to test PAIRED SAMPLES (10-14 days after FIRST) 2. LATERAL FLOW ASSAYS for CANINE ANTI-LEPTOSPIRA ANTIBODIES --> SNAP test (IgG) --> WITNESS (IgM Abs ONLY) 3. PCR ASSAYS for DNA of LEPTOSPIRES in BLOOD/URINE --> ONLY WORKS IF PATIENT HAS NOT BEEN ON ANTIBIOTICS BEFORE

Question 46

what TEST for LEPTO could be CONTRAINDICATED in EARLY INFECTION or RIGHT AFTER VACCINATION?

Answer 46

SEROLOGY USING MICROSCOPIC AGGLUTINATION TEST (MAT)

Question 47

general TREATMENT for LEPTO? & duration what if they DO NOT FEEL WELL? what PREVENTION should be used?

Answer 47

general = treat with DOXYCYCLINE for 2 WEEKS so long as EATING/FEELING OK if NOT FEELING WELL like GI SIGNS = PARENTERAL AMPICILLIN OK should use QUADRIVALENT VACCINE to help PREVENT DZ & REDUCE SHEDDING

Question 48

BORRELIOSIS... how is this disease TRANSMITTED? (2) UNCOMMONLY, this DZ can lead to WHAT DZ?

Answer 48

TRANSMISSION? = B. BURGDORFERI transmitted via TICKS, like... 1. IXODES SCAPULARIS 2. IXODES PACIFICUS UNCOMMONLY, this DZ can lead to PROTEIN-LOSING GLOMERULONEPHRITIS

Question 49

FUNGAL PYELONEPHRITIS... usually associated with... in WHAT SPECIES? such as... (2, which is more common?) how can we DIAGNOSE this? common TREATMENT? why can this be CONTRAINDICATED?

Answer 49

usually associated with SYSTEMIC FUNGAL DZ in DOGS, such as... 1. ASPERGILLOSIS (MORE COMMON) 2. CRYPTOCOCCUS diagnosed from URINE CULTURE on ROUTINE LAB MEDIA commonly TREATED WITH AMPHOTERICIN B for FUNGAL INFECTIONS, but this can be NEPHROTOXIC so NOT USED IF CONCURRENT PYELONEPHRITIS

Question 50

LEISHMANIASIS.. caused by ___ ____ & give SPECIFIC GENUS & SPECIES TRANSMITTED by ___ ____ ___ can cause WHAT concurrent DZ? DIAGNOSIS via what 3 methods?

Answer 50

caused by DIPHASIC PROTOZOAN --> LEISHMANIA INFANTUM TRANSMITTED by SAND FLY BITES can cause PROTEIN-LOSING GLOMERULONEPHRITIS DIAGNOSIS via... 1. SEROPOSITIVITY for ANTI-LEISHMANIA ABs 2. PCR TESTING on BONE MARROW, LN, SPLEEN, SKIN 3. RENAL BIOPSIES

Question 51

LEISHMANIASIS.. 3 Tx options & how they WORK? which is used MOST COMMONLY?

Answer 51

1. MEGLUMINE ANTIMONIATE --> INHIBITS important PROTOZOAL ENZYMES to KEEP IT FROM REPLICATING 2. MILTEFOSINE --> has DIRECT TOXIC EFFECT on LEISHMANIA PARASITES --> USED MORE COMMONLY 3. ALLOPURINOL --> PREVENTS REPLICATION

Question 52

ID POTENTIAL PARASITIC DZ based on these 3 clinical signs: 1. POOR COAT 2. UNTHRIFTY/THIN 3. MUSCLE-WASTED

Answer 52

LEISHMANIASIS

Question 53

DIOCTOPHYMIASIS... caused by WHAT etiologic agent? GIVE GENUS & SPECIES TOO how are PATIENTS INFECTED? (3) diagnosis? (2) treatment of choice? what CAN be an alternative if we need it?

Answer 53

caused by GIANT KIDNEY WORM or DIOCTOPHYME RENALE patients INFECTED via... 1. INGEST INFECTIVE LARVAE in FISH 2. larvae EMERGE & PENETRATE DUODENAL WALL 3. MIGRATE to RIGHT KIDNEY & cause DZ diagnosis? 1. DETECTION of EGGS in URINE SEDIMENT 2. US VISUALIZATION of ADULT NEMATODES in KIDNEY treatment of choice = NEPHRECTOMY --> if BOTH KIDNEYS affected, then NEPHROTOMY can be done