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MMID_UTI_10 - Infections of the Urinary Tract Denise Schain...

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Infections of the Urinary Tract Denise Schain MD Division of Infectious Diseases November 18, 2010
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A 19 yo UF student presented to the Emergency Department Chief Complaint: fever x 2 days associated right back pain with severe nausea and vomiting She has no medical problems and was feeling well until 7 days PTA when she began experiencing burning on urination. She had to urinate more frequently to relieve suprapubic pain. She was studying for exams and didn’t have time to go to student health. 2 days PTA she noted the onset of fevers to 103°F as well as right sided sharp CVA pain that was made worse by taking a deep breath. She began having nausea and vomited several times. On the day of admission she felt light headed and decided to seek medical attention. PE Temp 104°F P120 BP 80/50 RR 25 Toxic appearing. Dry mucous membranes. Marked CVA tenderness; abdominal exam: diffuse tenderness; pelvic exam: normal Lab: WBC 14,000 (40% PMN 30% bands) U/A spG 1025 WBCs 300 RBCs 5
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Infections of the Urinary Tract The most common infection seen by physicians in their outpatient practice . >8 million office visits/year >100,000 hospital admissions for pyelonephritis/year Common problem in hospitalized patients with urinary catheters The clinician needs to   understand the anatomy of the urinary tract in order to correctly identify and treat these infections.
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Anatomy of the Urinary Tract
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Anatomy of the Urinary Tract
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Anatomy of the Urinary Tract
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Anatomy of the Urinary Tract
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Anatomy of the Urinary Tract
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Anatomic Relationship of the Urethra to the surrounding GI/GU Structures
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Anatomic Relationship of the Kidneys to the Diaphragm and Lungs ?
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Bacterial Virulence Factors 1. Increased ability to adhere to urethroepithelial cells Adhere by fimbria - mannose sensitive receptors (mannose) mannose resistant receptors (glycolipid) Trimethoprim -sulfa reduces fimbria adhesion molecules
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More Bacterial Virulence Factors 2. Increased resistance to serum cidal activity 3. Hemolysin production 4. Urease production (Proteus spp) 5. Bacterial motility (can ascend ureter against urine flow) 6. Endotoxin production
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E.Coli Virulence factors Condition Pyelonephritis Cystitis Asymptomatic bacteruria Fecal Flora %Mannose R % +Hem >76 60 23 27 18 17 16 10
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Host Factors Preventing Infection of the Urinary Tract Urine High concentrations of urea & low pH  inhibit bacterial growth.
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