Patient 3: Maisy Wong

Case: Patient 3 -Maisy Wong

Diagnosis: Urinary Tract Infection

Complaints (Key words): Fever, Chills, Bladder distension. Patient is on indwelling catheter

In this entry, I will note down points on UTI in relation to the key words. I will then state down the possible microorganism(s) involved.

There are mainly 2 types of UTI – lower and upper. Hence we have to point out which of these 2 UTI is involved in this case. From here, we can then break down the possible microorganism(s) involved.

Bladder distension refers to the inability to urinate[1]. Catheterization is used to treat the bladder distension. Indwelling catheters avoid distension by emptying the bladder continuously into a bedside drainage collector[2].

One of the important keyword is that the patient is on indwelling catheter. As stated in the Jawetz, Melnick & Adelberg’s Medical Microbiology textbook (by G.Brooks, J.Butel and S.Morse), ‘Upper urinary tract infections routinely occur in patients with indwelling catheters even with optimal care and closed drainage systems’. Furthermore, fever and chills are the possible reactions after attachment of indwelling catheter. It was also mentioned in the textbook that ‘catherization carries a risk of introducing microorganism into the bladder, but it is sometimes unavoidable’.

The bladder wall is coated with various mannosylated proteins, which may interfere with the binding of bacteria to the uroepithelium[3]. The binding leads to establishment of pathogenicity for these organisms, its disruption results in reduced capacity for invasion of the tissues[3]. Furthermore, the unbound bacteria are more easily removed when voiding[3]. The use of physical trauma such as urine catheters may physically disturb this protective lining, thereby allowing bacteria to invade the exposed epithelium[3]. This paragraph explains how the introduction of indwelling catheter can lead to UTI.

From the above paragraphs, a possible diagnosis for the patient is upper urinary tract infection due to introduction of indwelling catheter. Hence the patient may have Pyelonephritis. The possible microorganism(s) involved are species of gram-negative rods. E. coli is however commonly found in UTI cases.

The next step in determining the possible microorganism(s) is to find out more about the gram-negative rods in relation to upper urinary tract infection. It is also important to find out more about the symptoms experienced by the patient and determine if the infection is due to before or after the catheter was introduced. Also, it is found that patient 5 also has the same complaints and diagnosis. However patient 3 is a female while patient 5 is a male. Hence, the difference have to be researched on.

Website References:
[1] http://www.wrongdiagnosis.com/medical/bladder_distension.htm
[2] http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/Atoz/ency/neurogenic_bladder.jsp
[3] http://en.wikipedia.org/wiki/Urinary_tract_infection