What is a urinary tract infection?
This diagnosis is determined by a combination of a number of processes that are localized in the urinary system. This is due to the presence in the urine of microorganisms, usually bacteria, and their number in certain proportions. This article describes the clinical manifestations of a number of diseases, the material is strictly exploratory in nature. Recall that the diagnosis and treatment of various types of urinary tract infections is carried out under control. your doctor (make an appointment).
Confirmation of a urinary tract infection is the presence of a certain number of microorganisms present in the urine. It is the analysis of urine and its bacteriological analysis that indicates the presence of colony-forming units, and the subsequent antibiogram shows the resistance of bacteria to antibiotics.
Diagnosis of urinary infections. Analysis to confirm cystitis.
Tests and procedures used to diagnose urinary tract infections include the following: Analysis of a urine sample. The doctor may request a urine sample to check for white blood cells, red blood cells, or bacteria using laboratory tests. To avoid possible contamination of the specimen, you may be instructed to first clean the genital area with an antiseptic swab and collect the urine halfway through.
Culture of bacteria from the urinary tract in the laboratory. After laboratory tests, a urine culture is sometimes done. This test tells the doctor which bacteria are causing the infection and which medications will be most effective.
Visualization of the urinary tract. If your doctor thinks your frequent infections may be due to an abnormality in the urinary tract, he or she may order an ultrasound, CT scan, or MRI. He or she may also use contrast dye to highlight structures in the urinary tract.
In the urinary system, we must distinguish between two elements with different immunological behaviors:
- Cortical and medulla of the kidneys, prostate gland, testicles and epididymis - parenchyma
- The urinary tract, which begins in the renal calyces, continues with the renal pelvis, then comes the ureter, bladder, and ends with the urethra.
Using an endoscope to examine the bladder. If you have recurring urinary tract infections, your doctor may do a cystoscopy using a long thin tube with a lens (cystoscope) to look inside your urethra and bladder. The cystoscope is inserted into the urethra and passed to the bladder. The use of hyaluronic acid in the treatment of chronic cystitis.
What types of cystitis exist?
With uncomplicated infections (simple cystitis, for example), on the contrary, with modern diagnostic methods, we cannot detect any type of disorder, except for bacteriuria. However, there are infections occurring both in the parenchyma and in the urinary tract, which can be complicated if there is an organic or functional change in the urinary system.
[su_highlight]Any of the urinary infections, with or without clinical symptoms, depends on the specific bacterium itself, the presence of which can only be detected by a positive urine culture. There is also asymptomatic bacteriuria, which also needs to be treated.[/su_highlight]
- Some patients ask the question: if I feel well and have an asymptomatic urinary infection, do I need to treat it? Answer: Yes!
Finally, there are forms of just a single outbreak (single case) and repeated frequent outbreaks of urinary infections caused either by the same microorganism (recurrent bacteriuria) or by different microorganisms (bacteriuria due to reinfection).
Despite the differences and complexity of these processes associated with bacteriuria, there is always a need to establish the correct relationship between laboratory data, symptoms and other additional tests in order to achieve a correct diagnosis. Therefore, self-medication is not recommended and self-diagnosis is not desirable.
Therefore, patients (almost always women) who visit a pharmacy for a urinary tract infection who may have the same cystitis or another urinary infection should clearly understand how it is important to consult a doctor. It is very important to take a urine test before taking antibiotics and after a course of treatment.
Bacteriuria is considered truly significant if more than 100,000 cfu/ml is detected in at least two cultures. When this occurs in a patient without any symptoms, we speak of asymptomatic bacteriuria. Often there is a so-called overdiagnosed disease (before 10%) because it is assessed with a single positive culture.
Most often, asymptomatic cystitis occurs in people of older age groups. On an outpatient basis, it is detected in 6% men and 18% women. In bedridden people, the percentage is higher, it can reach 23% and even up to 32% in hospitalized patients. Note that in pregnant women, the percentage of asymptomatic bacteriuria can be 4-7%. The highest percentage is observed in patients who undergo permanent bladder catheterization, and reaches 100% (such patients are even prescribed a course of preventive antibiotic)
Bacteriuria is usually well tolerated by adults and the elderly. However, it should be studied in children due to the possibility of complications due to the presence of organic changes.
[su_highlight]Always treat asymptomatic bacteriuria in pregnant women, as if left untreated, they may develop pyelonephritis in up to 30% cases.[/su_highlight]
Violation of urination (syndrome miccional)
The typical triad of symptoms of urination syndrome consists of the appearance of dysuria (disuria) - painful urination, pollakiuria (polaquiuria) - frequent urination in small volumes and imperative urinary incontinence (urgencia miccional) - arbitrary and uncontrolled periodic urination.
Bacterial acute cystitis.
It is characterized by the presence of bacteriuria (from 100 to 100,000 CFU/ml) and urination syndrome. The frequency during the year reaches up to 25% in women. Symptoms are sudden and intense, characterized by the presence of dysuria (pain when urinating), frequent and urgent urge to urinate. Often the appearance of microscopic or macroscopic hematuria. This is sometimes accompanied by general symptoms or fever (inflammation of the ureters and kidneys).
In children, this can be manifested by bedwetting. The most common microbes that most commonly cause cystitis are E. coli and S. saprophyticus. Laboratory studies reveal bacteriuria and pyuria in the urinary sediment, and in the blood the same leukocytosis is usually not detected, unless, of course, this is an advanced sepsis.
Acute urethral syndrome.
A more inconspicuous and less intense onset of symptoms is distinctive. Sometimes this is accompanied by pain. The most commonly involved microbes are C. trachomatis and coliforms. During cultivation, bacteriuria is determined to be less than 100 CFU/ml. When analyzed in the urinary sediment, pyuria (leukocytes) is usually detected, very rarely the presence of hematuria (blood). If a suprapubic puncture had been performed in these patients, then bacteriuria would have been detected in 44% of them.
It is characterized by the presence of deep and dull pain in the lower abdomen, itching of the vulva and external dysuria. In the urine sediment, bacteriuria of less than 100 CFU / ml is detected. The appearance of pyuria or hematuria is rare. Usually this is a consequence of infections caused by Candida spp (candida / thrush) and Trichomonas. See also Gardenella vaginalis. This type of disease is more related to sexually transmitted infections.
Acute bacterial pyelonephritis
Pyelonephritis is a serious infectious disease, which is the most serious form of urinary tract infection. In the case of a diagnosis, even hospitalization is required, because with pyelonephritis, kidney function is already affected. It is characterized by infection of the renal parenchyma and collecting system. Manifested by urination syndrome, accompanied by high temperature, chills, tachycardia and vomiting.
Physical examination reveals fossa pain (which worsens with fist percussion) and abdominal tenderness. There may be incomplete or subclinical forms in which some characteristic clinical and/or investigative findings are not evident. In the elderly, this may be expressed in a deterioration in the general condition or urinary incontinence.
The incidence is higher in women and is usually the result of an upsurge of microorganisms from the lower urinary tract. Therefore, the bacteria responsible are similar to those that cause cystitis, with E. coli stands out for its frequency.
In the blood test, the presence of leukocytosis (a sign of acute bacterial inflammation) is isolated, bacteriuria, pyuria and leukocyte cylinders are found in the urine sediment. The risk of bacteremia (spread of bacteria throughout the body) in patients with acute pyelonephritis can reach 30%. In this case need to use multiple antibiotics, one of them intravenously, to prevent bacterial sepsis, the risk of which is quite high in this case.
The material was created in collaboration with practicing urologists (Association of Urologists of Spain). When using the article, a reference to VALINTERMED is required.