Contagious respiratory illness ranging from milt to

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Contagious respiratory illness ranging from milt to severe Abrupt onset of fever accompanied by chills, HA, myalgia, malaise, anorexia Non-productive cough, nasal discharge, sore throat 25% with pulmonary symptoms >65 y.o, asthma, diabetes, heart disease, pregnant females, young children Influenza associated pneumonia Typical symptoms then rapid respiratory decompensation Lung tissue defense impairment/dysregulation May be complicated by bacterial pneumoniae S. Pneumoniae, S. Aureus Considered in pts with severe disease, remain ill, worsen, or acute onset of high fever or respiratory distress after initial improvement
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Urinary Tract Infections UTI Presence of microbial pathogens w/i urinary tract 10^5 bacteria/ml Classification based by site of infection Urine- bacteriuria Bladder - cystitis (lower UTI) Non-systemic in symptomatology Kidney - pyelonephritis (upper UTI) Systemic infection Prostate - prostatitis Additional Classification Uncomplicated v complicated Most episodes of cystitis and pyelonephritis are uncomplicated Complicated UTI is associated with underlying condition that increases risk of infection or failing of therapy Mild, moderate, or severe illness Asymptomatic bacteriuria Routes of infection Ascending route Bacterial colonization of urethra —> bacteria multiply in bladder —> ascend to ureters Primarily from colonization of vaginal area by fecal flora Short length of female urethra and proximity to perinatal area predispose Hematogenous route (descending) Dissemination of microorganisms from distant sites of infection through blood or due to bacteremia (less common) Lymphatic route Bowel, blade, and kidney potentially connected by lymphatic pathways Clinical Presentation Signs and symptoms Lower UTI (cystitis) Dysuria Urgency and frequency Suprapubic heaviness Gross hematuria Upper UTI (pyelonephritis) May or may not have s/s of cystitis concurrently Flank pain or CVA tenderness Fever N/V Altered mental status Physical Examination
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Upper UTI: flank pain Lab tests Urinalysis Pyuria (WBC > 10 cells/mm) Nitrite-positive urine Leukocyte esterase positive urine Bacteriuria (>10^5 cfu/ml) Urine culture Reports bacterial speciation and drug sensitivities Pathogens E. Coli (75-90%) Proteus mirabilis Klebsiella pneumonia or oxytoca Staph saphrophyticus (more often in young women) Enterococcus sp Other gram negative rods (dependent on pt specific factors) Pseudomonas (especially in pts with recent healthcare contact) Enterobacter sp Citrobacter sp Others Question 1: Upper or lower UTI Important to determine for several reasons: Bacterial infection that has ascended past bladder has greater consequences if not treated properly Can enter blood
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  • Fall '19
  • Tetracycline, UTI, Ceftriaxone

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