Urinary tract infection is a disease affecting the urinary tract from the urethra down to the ureter and may ascend towards the kidneys. It is an invasion of pyogenic bacteria in the lower urinary tract. It is common in women than in men.
The signs and symptoms of Urinary Tract Infection are usually nonspecific. They include frequent urination, vaginal burning, without other complications, such as fever, chills, and pain in the kidneys or flank pain. Nowadays, Urinary Tract Infection can be treated by over the counter medications and can even be diagnosed by over the counter dipsticks. A good response to antibiotic therapy usually eliminates the need for further tests. However, it is always recommended to consult a doctor when signs and symptoms of UTI are observed. Taking antibiotics in the wrong way and in wrong doses and time frame may lead to the severity of the disease and may cause adverse reactions. The classical treatment algorithm for UTI which is followed by most physicians is still the safest, the best and the most effective way to deal with such a disease.
The most common cause of UTI is the bacteria known as ESCHERICHIA coli. Other causes of UTI are fungus such as the Candida albicans, bacteria such as Chlamydia, and parasites such as Trichomonas.
Escherichia coli is a gram negative bacilli. It is a normal flora of the intestines. It gains access to the genitalia by the stools during defecation. It is also the used as the bacteriologic index of water. The higher the index, the less potable the water is.
The Candida species is not common to cause UTI in healthy individuals. Cases of Candida UTI usually affect the immunocompromised individuals. These are the people who have autoimmune diseases such as AIDS, HIV and those under Anti-Cancer Chemotherapy.
Chlamydia is a gram negative obligate intracellular organism that is usually transmitted through sexual intercourse. Most cases of Chlamydia UTI are documented from prostitutes and women with multiple sexual partners. The UTI caused by this organism comes with a purulent, foul-smelling vaginal discharge.
Another type of sexually transmitted UTI is caused by Trichomonas vaginalis. Usually, women with this type of UTI complain of vaginal pruritus and a fishy-odor vaginal discharge. Diagnosed cases are recommended to have a Papanicolov Smear by an OB-GYNE. Gardnerella vaginalis also present with a UTI similar to the Trichomonas but in the Papanicolov smear, the presence of "clue cells" is noted.
Symptoms of UTI are the following:
1. fever and chills
2. pyuria or painful urination
3. right lower quadrant pain
5. In UTI caused by organisms other than Escherichia, vaginal pruritus and vaginal discharge with a characteristic odor is noted.
6. In children, sudden chills or fever is enough to suspect UTI.
7. In babies, the most common and usually the only manifestation noted is vomiting, failure to feed and irritability.
Urinary Tract Infection is diagnosed by doing a Urinalysis. The Urine's physical characteristics alone may already indicate the presence of infection. Such as:
1. cloudiness of the urine sample
2. concentrated urine sample
3. foul-smelling urine sample
A positive exam reveals bacteria present, and commonly E. coli by more than 100,000 estimated colonies per milliliters of the urine sample. This has the same principle with the over the counter dipstick tests for UTI that are commonly used nowadays. Confirmatory test is a positive growth of the organism when cultured in the agar. Practically, by obtaining the positive estimated number of colonies in the urinalysis, a diagnosis can be made and the appropriate antimicrobial treatment may be started.
Treatment for UTI caused by either Escherichia coli is mainly the drug of choice which is Ciprofloxacin 500mg, 1 tab 3x a day for 1 week. Febrile patients with temperature >38 Celsius must be given Paracetamol every 4 hours. A chill is a compensatory reaction of the body to upcoming hyperthermia. This means that when ever chills occur, unless proven otherwise to be something else such as seizure or convulsions, it is only a signal of an upcoming fever and that no medications or relaxants must be given. Instead, a total sponge bath is rather helpful. UTI caused by Candida is usually treated with anti-fungal drugs and Trichomonas UTI is well treated with Metronidazole. Increasing oral fluid intake also helps in washing out bacteria. After finishing the treatment, a repeat urinalysis must be done to confirm success of the treatment.
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