UTI in a nutshell Typical clinical scenario · Dysuria, frequency Uranalysis BC Nitrite +ve Urine c&s Escherichia coli growth Resistant to all beta lactams and beta lactamase inhibitor e carbapenems Levofloxacin 500 mg ad po x 3d
UTI in a nutshell • Typical clinical scenario • Young female • Dysuria, frequency • Urianalysis • WBC +++ • Nitrite +ve • Urine C&S • Escherichia coli growth • Resistant to all beta lactams and beta lactamase inhibitor except carbapenems • Rx • Levofloxacin 500 mg qd po x 3d
Clinical Manifestation of utis Could be asymptomic in some chronic infections Abnormal urination: Vesical irritability: frequency urgency burning Difficulty of urination Abnormal urine Reddish urine, bloody urine, Hematuria Milky cloudy urine, pyauria, bacteriuria Pain: .ocal pain and referred pain e gl tract symptoms Nausea, vomitting, etc ● Systematic symptoms: Fever, chills, headache, etc Bacteremia, toxicemia sepsis infectious shock
Clinical Manifestation of UTIs: Could be asymptomic in some chronic infections. • Abnormal urination: Vesical irritability: frequency, urgency, burning Difficulty of urination • Abnormal urine: Reddish urine, Bloody urine, Hematouria Milky, cloudy urine, pyauria, bacteriuria • Pain: Local pain and referred pain • GI tract symptoms: Nausea, vomitting, etc. • Systematic symptoms: Fever, chills, headache, etc. Bacteremia, toxicemia, sepsis, infectious shock
Cystitis vs pyelonephritis manifestation Cystitis: localized Pyelonephritis: generalized · Bladder irritation · Fever, chills, nausea lower urinary tract and vomiting symptoms LUtS) Myalgia and malaise dysuria Risk of urosepsis ● Frequency, urgency Local: flank pain, Cva tenderness, dysuria and requency
Cystitis vs. pyelonephritis: manifestation Cystitis: localized • Bladder irritation/ lower urinary tract symptoms (LUTS) • Dysuria • Frequency, urgency Pyelonephritis: generalized • Fever, chills, nausea and vomiting • Myalgia and malaise • Risk of urosepsis • Local: flank pain, CVA tenderness, dysuria and frequency
LUTS VS bladder irritation symptoms Very similar LUTS: sphincter/detrusor Bladder irritation. dysfunction inflammation Core symptom difficult Core symptom: dysuria urination storage symptoms: frequency, urgency, dysuria voiding symptoms: hesitancy post-void dribbling other: suprapubic pain hematuria, foul-smelling urine
LUTS vs. bladder irritation symptoms: Very similar LUTS: sphincter/detrusor dysfunction • Core symptom: difficult urination Bladder irritation: inflammation • Core symptom: dysuria storage symptoms: frequency, urgency, dysuria voiding symptoms: hesitancy, post-void dribbling other: suprapubic pain, hematuria, foul-smelling urine
Clinical manifestations 3 components: symptoms, bacteriuria, pyuria Symptoms bacteriuria pyuria Symptomatic UT (location? Acute or chronic/recurrent? Bacteriuria only =Asymptomatic bacteriuria Pyuria only healthy or stone or cystitis or bladder cancer etc Symptom only interstitial cystitis etc
Clinical manifestations • 3 components: symptoms, bacteriuria, pyuria • Symptoms + bacteriuria + pyuria = Symptomatic UTI • (location? Acute or chronic/recurrent?) • Bacteriuria only = Asymptomatic bacteriuria • Pyuria only = healthy or stone or cystitis or bladder cancer etc. • Symptom only = interstitial cystitis etc