Infections of the Urinary Tract Flashcards
(25 cards)
What is a UTI?
Umbrella term for infection of the urinary tract (KUBU) characterised by dysuria, polyuria, Nocturia and suprapubic pain
How may UTIs be differentiated or categorised?
Types: Complications or Chronicity
- Uncomplicated: UTI in healthy individual
- Complicated: UTI with functional or structural impairments e.g. GU tract abnormalities or drug-resistant pathogens
- Acute: Infected urine = infection Sx
- > E.g. Urethritis; Cystitis
- Recurrent: Two separate culture-proven episodes of UTIs within 6/12
- > E.g. Pyelonephritis; Epididymo-orchitis
Give 3 risk factors for a UTI.
- Renal tract obstruction (BPH, stones, stricture)
- Previous UTI
- Age ≥ 50 years
- Instrumentation of renal tract e.g. Catheterisation, Urological surgery
Give the most common pathogens causing UTIs.
- E. coli (70%)*
- S. saprophyticus
- P. mirabilis
- Klebsiella spp.
A 52 year old man presents with painful urination, increased urge and frequency to urinate. O/E you palpation elicits suprapubic pain.
A urinalysis is positive for leukocytes and nitrites. CT-KUB shows no abnormalities. On MSU + Microscopy, a pathogen is identified.
What is the most likely pathogen causing this condition?
What is your DDx?
Give the Tx.
E. coli/ Proteus/ Klebsiella
UTI (uncomplicated)
Ciprofloxacin/Levofloxacin
What is pyelonephritis?
inflammation of the kidney due to a bacterial infection
State 3 risk factors for pyelonephritis.
- Acute pyelonephritis
- Vesicoureteral reflux
- Obstruction
- Renal calculi
- Diabetes Mellitus
How may pyelonephritis be classified?
- Uncomplicated Acute Pyelonephritis -> Infection of kidney in immunocompetent patient
- Complicated Acute Pyelonephritis -> Infection of kidney in immunocompromised individual
A 47 year old male presents with painful urination, fever and nausea. He reports a sudden onset of excruciating pain. The pain is located on his side and radiates towards his groin, described as a 7/10. He has no significant medical history other than Type 2 Diabetes and previous UTIs.
O/E you notice offensive urine with a fishy smell.
Urinalysis shows leukocytes. His urine culture is positive. A CT-KUB shows no abnormalities other than echogenic parenchyma and peri-renal fluid collections.
What is your Ddx?
Which pathogen is most likely to have caused this?
Give your Tx.
Uncomplicated pyelonephritis
E. coli/ Proteus/ Klebsiella
Ciprofloxacin (500mg PO BDS 14/7) + Ceftriaxone (1g IV)
What is urethritis?
Infection of the urethra characterised by dysuria, urethral discharge and pruritus
What are the types of urethritis?
- Gonococcal (GU): N. gonorrhea
- Non-Gonococcal (NGU): C. trachomatis, M. genitalium, U. urealyticum
- Post-traumatic (instrumentation)
State 3 risk factors for urethritis.
- Age: 15-24 (adolescents)
- Female
- Low socioeconomic class
- Multiple sex partners
- STD
- Unprotected sex
State 3 common pathogens which may cause urethritis.
- N. gonorrhoeae
- C. trachomatis
- U. urealyticum
- M. genitalium
A 22 year old male presents with urethral discharge, itching at the tip of his penis and painful urination. O/E there is erythema present at the head of his penis, epididymal tenderness is absent.
From MSU + NAAT, a gram-negative diplococci is found.
What is your DDx?
State the most likely pathogen to be present.
Outline your Tx.
Urethritis (GU) 2º to N. gonorrhoea
N. gonorrhoea
ABX: Ceftriaxone (250mg IM) + Azithromycin (1g PO) \+ Notify partner - 2/52 symptomatic - 3/12 asymptomatic - Test if > 14 days after exposure \+ NAAT (test of cure): Negative
A 22 year old male presents with urethral discharge, itching at the tip of his penis and painful urination. O/E there is erythema present at the head of his penis, epididymal tenderness is absent.
From MSU + NAAT, a gram-negative rod is found.
What is your DDx?
State the most likely pathogen to be present.
Outline your Tx.
Urethritis (NGU) - 2º to C. trachomatis
C. trachomatis
ABX: Ceftriaxone (250mg IM) + Azithromycin (1g PO)
What is acute epididymitis?
Inflammation of epididymis due to infection characterised by scrotal pain, unilateral swelling and symptoms ≤ 6 weeks.
State the types of Epididymitis.
- Bacterial
- Viral
- Fungal
- Drug-Induced
- Vasculitis
- Idiopathic
State 3 risk factors for developing acute epididymitis.
- Unprotected sex
- Bladder outflow obstruction
- Instrumentation
- Amiodarone use
- Vasculitis
State common aetiological factors which cause acute epididymitis.
- C. trachomatis
- N. gonorrhea
- M. genitalium
- E. coli (anal sex)
- Proteus spp. (older men urine stasis + outflow obstruction)
- Mumps (Viral epididymitis)
- Candida spp. (Fungal epididymitis)
- Amiodarone (reversible, sterile epididymitis)
- Vasculitides (Behcet’s; HSP)
• Idiopathic
A 35 year old man presents with unilateral scrotal pain and painful urination. He has no significant medical history other than an arrhythmia which is treated with Amiodarone. He has no significant family history. He has previously had a catheter in following an outflow obstruction 6 months ago.
O/E the scrotum is hot and erythematous with urethral secretions present. The testes are not enlarged.
Urinalysis shows leukocytes raised and a urine culture is positive for a diplococci, gram-negative bacterium.
What is your DDx?
State the causative pathogen.
Outline your management.
Acute epididymitis
N. gonorrhoea OR Amiodarone
Ceftriaxone (250mg IM) + Azithromycin (1mg PO)
AND
Reduce/Stop Amiodarone
A 37 year old man presents with unilateral scrotal pain and painful urination. He has no significant medical history other than an arrhythmia which is treated with Amiodarone. He has no significant family history. He has previously had a catheter in following an outflow obstruction 6 months ago.
O/E the scrotum is hot and erythematous with urethral secretions present. The testes are not enlarged.
Urinalysis shows leukocytes raised and a urine culture is positive for a rod, gram-negative bacterium.
What is your DDx?
State the causative pathogen.
Outline your management.
• Ceftriaxone (250 IM) + Doxycycline (100mg PO 14/7)
–> Doxycycline for C. trachomatis but could still be N. gonorrhoea
AND
Stop Amiodarone
What is Prostatitis?
Inflammation of prostate caused by infection, characterised by dysuria, polyuria, tender prostate, fever, chills and malaise.
State 3 types of Prostatitis.
- Acute Bacterial Prostatitis
- Chronic Bacterial Prostatitis
- Non-bacterial prostatitis
- Prostatodynia (Idiopathic Prostate pain)
State 3 common pathogens which may cause prostatitis.
- E. coli (80%)*
- Klebsiella Spp.
- Proteus Spp.
- N. gonorrhea
- C. trachomatis
- M. genitalium
- Candida
