utis-definition infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney)...
TRANSCRIPT
![Page 1: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/1.jpg)
UTIs-Definition
Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)
![Page 2: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/2.jpg)
Etiology Usually Acute Majority due to a single pathogen Usually an Enterobacteriaceae
90% of all UTI gram negative bacilli common intestinal flora
Escherichia coli most commonly isolated pathogen ~80% of all UTI
![Page 3: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/3.jpg)
Gram staining
Gram –ve E. coli Gram +ve S. aureus
![Page 4: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/4.jpg)
Organisms: Gram -ve
Cause 90-95% of UTI’s most often, E. coli. Others include:
• Proteus mirabilis and Klebsiella.
Gram +ve pathogens include:
• Staph saprophyticus, • Staph aureus, • group A beta hemolytic streptococci and
enterococci.
![Page 5: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/5.jpg)
Features of UTI
Common affliction to seek medical attention.
Infancy to old age Bacturia:
bacteria in urine• does not necessarily
imply infection
![Page 6: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/6.jpg)
Features of UTI Pyuria
Presence of WBCs in urine Evidence of inflammatory response to
infection.
![Page 7: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/7.jpg)
Epidemiology
Populations with increased incidences: School age girls Young women>men
• >50% have a UTI during their lifetime• >10% per year have a UTI • Pregnant women
Elderly of both sexes Diabetes Abnormal urine flow
![Page 8: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/8.jpg)
Who to screen for UTI? Children with recurrent infection Monitoring antibiotic therapy High risk individual
![Page 9: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/9.jpg)
How do we screen for UTIs?
Collect midstream urine use fresh or refrigerate.
Pour about 10 ml in tube and dipstick.
Microscopy Culture
![Page 10: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/10.jpg)
Chemical Analysis Dip-stick testing
Quick Efficient Inexpensive Large number of substances
![Page 11: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/11.jpg)
Chemical Analysis
![Page 12: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/12.jpg)
Chemical Analysis
![Page 13: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/13.jpg)
Chemical Analysis
![Page 14: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/14.jpg)
Urinalysis Dipstick findings:
leukocyte esterase + with pyuria nitrite + with Enterobacteriaceae alkaline pH with urea splitting
bacteria, e.g., Proteus mirabilis high specific gravity if patient is
volume depleted protein often + blood may be +
![Page 15: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/15.jpg)
What are the most useful test? Leukocyte Esterase
Enzyme found WBCs More reliable than microscopic analysis for
WBCs Positive results indicate inflammation in the
path taken by urine.• Includes urethra, prostate, cervix and vagina• Occur in 90 to 95% of symptomatic UTI• Less sensitive asymptomatic UTI in elderly and
pregnancy Significant result: positive
![Page 16: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/16.jpg)
What are the most useful test? Nitrite
Some bacteria will convert Nitrate to Nitrite Good indicator of contact of urine with
bacteria Detects 2/3 to ¾ of all UTIs But…
• Gram +ve bacteria do not cause a positive result• Negative results do not rule out infection
Significant Result: Positive
![Page 17: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/17.jpg)
Microscopic Urinalysis
![Page 18: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/18.jpg)
Urinalysis
Centrifuge for 5 min at 2000 rpm, pour off supernatant; examine sediment with microscope using high power objective.
Microscopic findings: <5 leukocytes per high power field (hpf)
• more = pyuria 1 bacterium per hpf correlates with >100,000
per ml; • 1 bacterium = 1 colony forming unit (cfu)
hematuria
![Page 19: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/19.jpg)
Urine Culture
Quantitative: uncentrifuged urine inoculated on an agar plate to do a colony count.
Appropriate agars: 5% sheep blood and eosin-methylene blue or MacConkey.
Incubate: at 35-37o C for 24 hours.
![Page 20: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/20.jpg)
E. Coli in Urine Culture
![Page 21: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/21.jpg)
Urine Culture Significant bacteriuria:
by 24 hour colony count cystitis: >100 cfu per ml pyelonephritis: >100,000 cfu/ml
Species identification. Susceptibility testing
urine for C&S.
![Page 22: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/22.jpg)
A secure diagnosis of UTI requires a urine culture
![Page 23: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/23.jpg)
How the test is done
![Page 24: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/24.jpg)
Urinary Bacteria Detection Kits Two Uses
Patients susceptible to UTI Monitor effectiveness of Treatment
Detect urinary nitrites associated with gram-negative bacterial infections.
![Page 25: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/25.jpg)
How the Test Works: Nitrites
Gram -ve Pathogen
Nitrite
Diazonium CompoundPink ColorPink Color
N-(1-naphthyl)-ethylenediamine
P-Arsanilic AcidMeat, Fish & Eggs
Nitrate in Acidic Urine
![Page 26: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/26.jpg)
How the Test Works: Leukocytes
Pyrrole Ester Compound
Diazo ReagentColorColor
Leukocyte esterase
INFECTION/INFLAMMATORYRESPONSE
White Blood Cells in Urinary Tract White Blood Cells in Urine
Pyrrole
![Page 27: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/27.jpg)
Sampling precautions Clean Dry Container First Morning Urine or in Bladder >4
hrs Fresh sample Follow-up: Regardless of result. Test Sensitivity
90% - 3 consecutive mornings 10% - False negative rate
![Page 28: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/28.jpg)
Factors Affecting Test Concentration of Gram -ve Bacteria
> 100,000/mL of urine Time in the Bladder Contamination Blood Adequate Dietary Nitrates
Most people Consume sufficient Quantities Drug interference
Alkaline Urine Ascorbic Acid (Vitamin C)>250 mg Antibiotics and Drugs that turn urine red
![Page 29: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/29.jpg)
Home Cholesterol Tests
Two Uses Monitor progress on Lipid lowering drugs and diet Save Time and Costs of Physician Visits
Err on the side of false positives Multiple measurements should be
evaluated Measurement errors and day to day
biological and behavioral changes contribute to variations in cholesterol levels
![Page 30: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/30.jpg)
![Page 31: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/31.jpg)
How the Test Works
Filter
Few Drops of Blood
Plasma (Cholesterol & Cholesterol esters)
Cholest-4-ene-3-one H2O2 Colored Dye
Step 1
Step 2a1. Wick Flow of Plasma2. Cholesterol Oxidase/Esterase
Step 2b
Peroxidase
10
3.2
![Page 32: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/32.jpg)
Factors Affecting TestFactors Affecting Test
Finger Pricking Technique Hanging Drops Squeezing and Milking
Time to Collect Low results if > 5 min.
Blood Volume
![Page 33: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/33.jpg)
?Usefulness Test only measures Total Cholesterol Laboratories measure LDL, HDL,
triglyceride, and cholesterol. All are required. You cannot make a judgement on
cardiovascular risk on Cholesterol alone. If values >5.2 : Discuss with physician If values<5.2: Check Cholesterol again at next
visit with a physician
![Page 34: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/34.jpg)
Other kits Drugs of Abuse
• Cannabinoids• Cocaine• Amphetamines• Benzodiazepines• Barbiturates• Opiates• Combinations
Home tests for STDs Home tests for monitoring DM
complications
![Page 35: UTIs-Definition Infectious diseases of the urinary tract: cystitis (bladder) pyelonephritis (kidney) prostatitis (prostate)](https://reader036.vdocuments.mx/reader036/viewer/2022062321/56649da15503460f94a8d5bf/html5/thumbnails/35.jpg)
This new product measures cholesterol plus other things using a test strip
Predict in as greatest detail you can how it might works…
What factors do you think could affect the reliability of the test results?