Urinary Tract Infections: MBCHB Vi

URINARY TRACT INFECTIONS
MBChB VI
Dr. Bernard B. O. Awuonda
http://ecampus.maseno.ac.ke Slide 1 of 5
Topic outline
Introduction
Epidemiology
Classification of UTI
Presentation
Investigations
Management
Complications
Introduction
Urinary Tract consists of kidneys,ureters bladder and

urethra
Urinary tract is supposed to be sterile.
Urinary tract has mucosal defence
Factors which limit multiplication of organisms
High rate of urine flow
Regular complete bladder emptying
Urinary glycosaminoglycans(Tamm-Horsfall
mucoprotein)
Mucosal defences-secretions of IgA and IgG
Goals of treatment
The goals of treatment for UTI include :
 Elimination of infection and prevention of urosepsis
 Prevention of recurrence and long-term complications
including hypertension, renal scarring, and impaired renal
growth and function
 Relief of acute symptoms (eg, fever, dysuria, frequency)
Urethriris
 Definition
◦ Inflammation of the urethra
 Etiology
a) Gonococcal urethritis
◦ N.gonorrhea
b) Non gonococcal urethritis
◦ C.Trachomatis
◦ Ureaplasma urealyticum
◦ Trichomonas vaginalis
◦ Herpes simples virus
Decision to hospitalise
 Most infants older than two months with UTI can be safely managed
as outpatients as long as close follow-up is possible .
 Usual indications for hospitalization include :

◦ Age <2 months
◦ Clinical urosepsis or potential bacteremia
◦ Immunocompromised patient
◦ Vomiting or inability to tolerate oral medication
◦ Lack of adequate outpatient follow-up (eg, no telephone, live far from hospital,
etc.)
◦ Failure to respond to outpatient therapy
Gonococcal urethritis
 Etiology- N.gonorrhea
 Pathogenesis:
◦ The bacteria infects the columnar epithelium of he
urethra but can also infect the rectum, pharynx and
the eye
Clinical features
 Burning sensation of urine
 Urethral discharge in 90-95% of men
 60% of women with this infection are
asymptomatic.
 In women the symptoms are dysuria and
vaginal discharge
Investigations
 Urethral swab
◦ gram stain-Gram negative diplococci
 Culture
◦ growth of gram negative diplococci
Treatment
Antibiotics
Penicillins
Quinolones
Complications of gonorrhea
 Epididymo-orchitis
 Pelvic inflammatory disease
 Acute gonococcal arthritis
 septiceamia
 Ophthalmia neonatorum
Prevention
 Use of condoms
 Treatment of infected partner
Non gonococcal urethritis
 Etiology
◦ Chlaymidia trachomatis- accounts for 50%
◦ Ureaplasma urealyticum
◦ Trichomonas vaginalis
◦ Herpes simplex virus
Clinical presentation
In men:
 Features resembles those of gonococcal
urethritis but milder
 The causative ogarnism is T.vaginalis
In women:
 50% are due to C. trachomatis and
 50% -no causes have been identified
Investigations
In men:
 Urethral swab
 wet preparation-T.vaginalis
In women:
 Serology-antigen detection for C. trachomatis
 Culture of C. trachomatis
Management
 Antibiotics
◦ Tetracycline- oxytetracycline, doxycycline
◦ Erythromycin
Cystitis/Prostitis
 Inflammation of the prostate
 Etiology
◦ E.coli
◦ Proteus
◦ Klebsiela

 Dysuria
 Frequent micturation
 Lower abdominal pains
 Perineal pains
Investigations
 Urine culture
 Urethral discharge
Management
 Antibiotics
◦ Quinolones
◦ Erythromycin
Asymptomatic Bacteriuria
 Defined as more than 10 5 /ml organisms in the
mid stream urine of apparently health
asymptomatic patients.
 1% of children under 1 yr of age
 1% of school girls
 0.03% of school boys and men
 3% of adult non pregnant women
 5% of pregnant women
Pyelonephritis
 Inflammation of the kidney parenchyma and
the renal pelvis
 May be:
◦ Acute pylonephritis
◦ Chronic pylonephritis
Pathogenesis of acute pyelonephritis
Etiology:
 75% is caused E.coli
 25% is caused by
◦ Protues
◦ Klebsiela
◦ Staphylococci
◦ Streptococci
 Pyelonephritis usually follows ascending infection and a few
cases are blood borne.
 Causes Inflammation of the renal pelvis
 Abdominal pain
 Dysuria
 Strangury
 Frequent micturation
 Tendernesss on the lumber region
Investigations
 Urine microscopy
 Urine culture
 Full haemogram
 U/E/C
 IVU
 Abdominal ultrasound
Management
 Antibiotics
◦ Quinolones
◦ Cephalosporins
◦ Penicilins
Chronic pyelonephritis
 Chronic inflammation of the kidney
parenchyma.
 Predisposing factor:
oVesico-ureteric reflux (VUR) in early life
 In many cases no symptoms arise directly from
the renal disease
 Vague ill-health
 Symptoms of uraemia
 Hypertension
Investigations
 Urine culture
 Full haemogram
 U/E/C
 Micturating cystourethragram (MCU)
Management
 Chronic infection is difficult to eradicate
 Attempt should be made to correct
abnormalities of the urinary tract
 Antibiotics sensitive to the organism isolated
given for at least 7 days.
 Treat hypertension
Renal tuberculosis
 Etiology
◦ M.tuberculosis.
 Occurs as secondary infection through
haematogenous spread
Pathogenesis
 Initial lesion develops in the renal cortex,
 if untreated may involve the renal pelvis then
the bladder, epididymis, seminal vesicles and
then the prostate
 Malaise
 Fever
 Weight loss
 Haematuria
 Dysuria
Investigations
 Urine microscopy
 Urine culture
 Full blood count.
 U/E/C
 IVU
 Abdominal ultrasound
Management
 Antituberculosis drugs
◦ INH
◦ Rifampicin
◦ Pyrazinamide
◦ Ethambutol

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URINARY TRACT INFECTIONS

Urinary Tract consists of kidneys,ureters bladder and

 Usual indications for hospitalization include :

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