Patient 1: Khong fay fay (2nd entry)
Reasons why cystitis was chosen for the diagnosis
1. Nausea and vomiting are signs and symptoms of pyelonephritis
a. Nausea and vomiting were not observed in this patient [1]
2. Causes of pyelonephritis include [1]
a. Urinary catherization[Kidney Infection (Pyelonephritis)
b. Surgery on urinary tract
c. Physical obstruction to the flow of urine due to a prostate enlargement or kidney stone or the backflow of urine from the bladder into the ureters increases the risk of pyelonephritis
However,
à Urinary catherization was not performed in this patient
à No history of surgery was indicated
à Patient is a female, hence physical obstruction to the flow of urine due to prostate enlargment is unlikely
3. Pyelonephritis is usually a spread of bacterial infection from the bladder [2]
à Risk of infection increases if there is a history of cystitis
à Hence even if pyelonephritis was present, cystitis is still the primary diagnosis
4. Pyelonephritis occurs less commonly in comparison to cystits. [3]
Complicated and Uncomplicated Cystitis
Cystitis is a common female problem. About 90% of UTIs in women are uncomplicated but recurrent. [4]
Cystitis is referred to as complicated if there are urologic abnormalities such as urinary retention, urinary stones and post surgery [5]
Bacteria found in cystitis
Uncomplicated cystitis
1. E. coli is the most commonly isolated microorganism in 80 - 90% of cystitis in young women followed by
2. Staphylococcus saprophyticus
3. Enterococci
Bacteria such as
1. Klebsiella
2. Proteus
3. Pseudomonads
constitute a lower percentage of infecting agents in uncomplicated cystits
Complicated cystitis
The spectrum of infecting bacteria in complicated cystitis is broader. Common infecting agents include
1. E. coli
2. Klebsiella
3. Proteus
4. Enterobacter
5. Enterococci
6. Pseudomonads
7. Staphylococci
Conclusion
Since uncomplicated cystitis is more common, the most probable bacteria that can be isolated from the bladder of this patient includes E. coli, Staphylococcus saprophyticus and Enterococci. Now that the common microorganisms have been identified, the next step is to find out ways to isolate the following bacteria and the biochemical tests that can be used for the identification of these bacteria.
References
1. http://www.merck.com/mmhe/sec11/ch149/ch149e.html
2. http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/10227.html
3. http://www.nlm.nih.gov/medlineplus/ency/article/000522.htm
4. http://www.faqs.org/health/Sick-V1/Cystitis.html
5. http://www.touchbriefings.com/pdf/1134/riedl.pdf
6. G.Brooks, J.Butel and S.Morse. (2004). Jawetz, Melnick & Adelberg’s Medical Microbiology
1. Nausea and vomiting are signs and symptoms of pyelonephritis
a. Nausea and vomiting were not observed in this patient [1]
2. Causes of pyelonephritis include [1]
a. Urinary catherization[Kidney Infection (Pyelonephritis)
b. Surgery on urinary tract
c. Physical obstruction to the flow of urine due to a prostate enlargement or kidney stone or the backflow of urine from the bladder into the ureters increases the risk of pyelonephritis
However,
à Urinary catherization was not performed in this patient
à No history of surgery was indicated
à Patient is a female, hence physical obstruction to the flow of urine due to prostate enlargment is unlikely
3. Pyelonephritis is usually a spread of bacterial infection from the bladder [2]
à Risk of infection increases if there is a history of cystitis
à Hence even if pyelonephritis was present, cystitis is still the primary diagnosis
4. Pyelonephritis occurs less commonly in comparison to cystits. [3]
Complicated and Uncomplicated Cystitis
Cystitis is a common female problem. About 90% of UTIs in women are uncomplicated but recurrent. [4]
Cystitis is referred to as complicated if there are urologic abnormalities such as urinary retention, urinary stones and post surgery [5]
Bacteria found in cystitis
Uncomplicated cystitis
1. E. coli is the most commonly isolated microorganism in 80 - 90% of cystitis in young women followed by
2. Staphylococcus saprophyticus
3. Enterococci
Bacteria such as
1. Klebsiella
2. Proteus
3. Pseudomonads
constitute a lower percentage of infecting agents in uncomplicated cystits
Complicated cystitis
The spectrum of infecting bacteria in complicated cystitis is broader. Common infecting agents include
1. E. coli
2. Klebsiella
3. Proteus
4. Enterobacter
5. Enterococci
6. Pseudomonads
7. Staphylococci
Conclusion
Since uncomplicated cystitis is more common, the most probable bacteria that can be isolated from the bladder of this patient includes E. coli, Staphylococcus saprophyticus and Enterococci. Now that the common microorganisms have been identified, the next step is to find out ways to isolate the following bacteria and the biochemical tests that can be used for the identification of these bacteria.
References
1. http://www.merck.com/mmhe/sec11/ch149/ch149e.html
2. http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/10227.html
3. http://www.nlm.nih.gov/medlineplus/ency/article/000522.htm
4. http://www.faqs.org/health/Sick-V1/Cystitis.html
5. http://www.touchbriefings.com/pdf/1134/riedl.pdf
6. G.Brooks, J.Butel and S.Morse. (2004). Jawetz, Melnick & Adelberg’s Medical Microbiology
posted by Samantha @ 11:37 AM
7 Comments:
At 7:02 PM,
Ruud said…
(All the questions have been discussed by all group members)
1. The main symptoms of pyelonephritis is not only nausea and vomiting. It also include fever, chills and dysuria. And the patient doesn't show any symptoms of nausea and vomiting. Isn't it abit unfair to rule out pyelonephritis just because of nausea and vomiting? (symptoms which patient do not have)
2. Cystitis might be the starting point of acute pyelonephritis. However, pyelonephritis might also develop on its own due to the past history of cystitis. Maybe this patient develops pyelonephritis is due to the history of cystitis she had before, which resulted in increased risk she is exposed to acute pyelonephritis?
Eling
At 1:36 AM,
Samantha said…
Hi Eling!
Thanks for the questions.
Yes, there is a possibility that acute pyelonephritis could have resulted due to underlying cystits. However, the type of microorganism found should be the same as that found in cystits. This is because pyelonephritis, in this case is caused by the spread of bacteria from the bladder to the kidneys. But, once again, i'd like to stress that acute uncomplicated pyelonephritis is less frequent in women than is cystitis. [http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=dcp2.section.5066]
In acute pyelonephritis, symptoms may be the same as those of cystitis; 1⁄3 of patients have increased urinary frequency and dysuria. However, with acute uncomplicated pyelonephritis, nausea and vomiting are typical symptoms. [http://www.merck.com/mmpe/sec17/ch231/ch231b.html]
I feel that such symptoms are all-or-none symptoms (either you have it or don't) and since it wasn't reported, I feel that it is fair to say that acute uncomplicated pyelonephritis is not the cause of UTI.
At 1:54 AM,
Samantha said…
This comment has been removed by a blog administrator.
At 1:55 AM,
Samantha said…
oh yes, i'd also like to add that if the type of UTI was acute pyelonephritis, we should not see a broad spectrum of bacteria in this form of kidney infection as mixed infection is only found in complicated pyelonephritis which is caused by an obstruction to the normal flow of urine.
At 8:27 PM,
Samantha said…
so, whether if it's cystitis or acute pyelonephritis, the type of microorganism that is expected to be seen should be more or less the same. the only exception is that staphylococcus saprophyticus is rare in pyelonephritis. http://www.ampath.co.za/AntiBiotGuide/chapter18.htm
At 7:12 PM,
Mark said…
Hi. As dicussed, I would like to know what happends when two different type of Proteus species swarms a plate. What steps can u take to isolate the both of them.
Mark Tinyfootz
At 1:55 AM,
Dose Pharmacy said…
Thank you for providing such a piece of valuable information.
Post a Comment
<< Home