Urinary Tract Infections

Question 1

What is micturition?

Answer 1

Urination

Question 2

What is cystitis?

Answer 2

Infection confined to the bladder

Question 3

What is pyelonephritis?

Answer 3

Kidney infection

Question 4

What is urethritis?

Answer 4

Inflammation of the urethra

Question 5

What is prostatitis?

Answer 5

Inflammation of the prostate

Question 6

What percentage of women have more than 1 UTI in their lifetime?

Answer 6

20 - 30%

Question 7

What age are men who usually get UTIs?

Answer 7

> 50 years

Question 8

How often are UTIs single or isolated attacks?

Answer 8

90%

Question 9

What can recurrent attacks (10%) be due to?

Answer 9

• Relapse (20%)
  Being infected with another pathogen
• Reinfection (80%)
  Being reinfected with the same infection

Question 10

What are the signs/symptoms of a lower UTI infection?

Answer 10

• Frequency of micturition
• Urgency to urinate
• Dysuria
• Suprapubic pain + tenderness
• Smelly/cloudy urine

Question 11

What are the signs/symptoms of an infection of pelvis and kidney (acute pyelonephritis)?

Answer 11

• Loin pain and kenderness
• High fever
• Systemic upset

Question 12

What investigation should you perform if their are complications with a UTI?

Answer 12

Excretion urography

CT urogram

Question 13

What can result in an abnormal Excretion urogram CT urogram?

Answer 13

• Stones
• Obstruction
• Polycystic kidneys
• Vesicoureteric reflux

Question 14

What associated diseases can cause complications with UTIs?

Answer 14

• Diabetes Melitus
• Sickle cell disease
• Analgesic abuse

Question 15

What is the Vesicoureteric reflux?

Answer 15

Condition in which urine flows retrograde, or backward, from the bladder into the ureters/kidneys.

Question 16

How do E.coli adhere to the bladder?

Answer 16

P. fimbriae adhere to the uroepithelium

Question 17

What is the most common cause of UTIs?

Answer 17

E. coli (80% of community acquired)

Question 18

What are the 2 different serotypes of UPEC E. coli?

Answer 18

• O (somatic)

- K (capsular)

Question 19

What are the virulence factors of E. coli?

Answer 19

• Fimbriae (adhesion)
• K antigen
• Haemolysin

Question 20

What are the 2 different types of fimbriae (pili) on E. coli?

Answer 20

• Type 1

- Type P

Question 21

What is iron acquisition machinary on E. coli activated via?

Answer 21

Siderophores

Question 22

What is the response of E.coli to adhesion?

Answer 22

• Iron acquisition machinery activated via siderphores
• Stimulates growth and reproduction
• Once a monolayer has formed a biofilm may develop
• Bacteria with type 1 fimbriae may become internalised in phagocytes and epithelial cells

Question 23

What are the features of the E. coli K antigen?

Answer 23

• Polysaccharide
• Forms a micro-capsule
• Confers resistance to phagocytosis

Question 24

What are the features of the E. coli Haemolysin?

Answer 24

• Cytolytic exo-protein
• Damages tissue membranes in vivo
• Causes kidney damage

Question 25

What are some of the main features of Proteus Mirabilis?

Answer 25

- Gram negative - Faculative anaerobe - Bacillus - Peritrichous flagellae - Produces urease - Swarming ability (produce surfactant)

Question 26

What does urease produced by proteus mirabilis do?

Answer 26

- Breaks down urea into ammonia making urine less acidic and more alkali - Can creat crystals of calcium carbonate which build up and creat kidney stones

Question 27

What are the gram negative bacteria which can cause UTIs?

Answer 27

- Escherichia coli - Proteus mirabilis - Klebsiella sp. - Enterobacter sp. - Serratia sp.

Question 28

What are some of the gram positive bacteria which can cause UTIs?

Answer 28

- Staphylococcus saprophyticus - Staphylococcus epidermidis - Enterococcus sp. - Corynebacteria - Lactobacillus

Question 29

Where can staphylococcus saprophyticus be found normally?

Answer 29

Female perineum and vagina

Question 30

WHat can increase the risk of staphylococcus saprophyticus?

Answer 30

Sexual activity

Question 31

What are the features of staphylococcus saprophyticus?

Answer 31

- Gram positive | - Coagulase negative

Question 32

What can be the non-bacterial causes of UTIs?

Answer 32

- Candida albicans - Trichomonas vaginalis - Schistosoma haematobium - Mycobacterium fortuitum - Histoplasma capsulatam - Polyomaviruses - CMV - Rubella

Question 33

When can a candida infection become serious?

Answer 33

- Opportunistic infection in immunocompromised individuals (can be deadly in HIV) - Usually commensal - Often associated with antibiotic use

Question 34

What is Trichomonas vaginalis?

Answer 34

- Protozoa which can cause UTIs - Pear-shaped flagellate - Causes trichomoniasis

Question 35

What is the pH at which trichomonas vaginalis prefers?

Answer 35

~6

Question 36

What kind of worm is Schistosoma haematobium?

Answer 36

Trematode worm

Question 37

What is schistosomiasis treated with?

Answer 37

Praziquantal

Question 38

Where can the entry points be for bacteria entering a catheter?

Answer 38

- Urethral meatus and aroun catheter - Junction between catheter and collection tube - Connetion to drainage bag and reflux from bag to tubing

Question 39

What is the bacteria content which deems urine to have significant bacteriuria?

Answer 39

- Mid stream specimen with >10^5 per ml | - Catheter specimen of urine will have lower number than MSU

Question 40

When is a suprapubic aspiration of bladder urine taken?

Answer 40

- Very rare occasions | - Can be for schistosoma haematobium

Question 41

What can bacteria cause nitrates to become?

Answer 41

Reduce to nitrites

Question 42

What can leukocytes produce which appear on a dipstick?

Answer 42

Leukocyte esterase

Question 43

What are the Urinary Tract host defenses?

Answer 43

- Urine - osmolality, pH - Sloughing of epithelial cells - Urine flow and micturition - Mucosal inhibitors of bacterial adherence - Complement activation - Inflmmatory response - Immune responses - Commensals

Question 44

What can cranberry/blueberry juice contain which can prevent UTIs?

Answer 44

Proanthrocyanidins | - Prevent E. coli from adhereing to the uroepithelium

Question 45

What oral antibiotics can be used to treat UTIs?

Answer 45

- Co-trimoxazole - Nitrofurantoin - Nalidixic acid - Co-amoxiclav - Trimethoprim - Ciprofloxacin