Urinary Tract Infection, UTI - Urethritis, Ureteritis, Cystitis, Asymptomatic Bacteriuria, Urosepsis, Pyelonephritis

Types of infection, clinical manifestations of Urinary Tract Infection (UTI)

There are several types, of clinical manifestations of Urinary Tract Infection (UTI) such as:

1. Urethritis

2. Ureteritis

3. Asymptomatic bacteriuria

4. Cystitis

5. Urethral syndrome

6. Pyelonephritis

Urinary Tract infections (UTIs) are classified as complicated and uncomplicated. Uncomplicated cases occur in otherwise healthy individuals and occasionally in male infants and adolescent and adult males most uncomplicated infections are susceptible to antibiotic treatment.

Urinary Tract Infection (UTI) in complicated cases has some risk factors:

• Underlying diseases that predispose the kidney to infection (eg. diabetes, sickle cell anemia)

• kidney stones

• structural or functional abnormalities of the urinary tract (eg. a tipped bladder)

• Indwelling urinary catheters

Complicated infections are more difficult to treat, and have greater morbidity (eg: kidney damage, bacteremia) and mortality compared with uncomplicated infections. The clinical presentation of UTI may vary, ranging from asymptomatic infection to pyelonephritis (infection of the kidney and its pelvis).

Some Urinary Tract Infection (UTI) symptoms are non-specific and symptoms may overlap in patients with lower UTIs and upper Urinary Tract Infection (UTIs).

Urethritis

• symptoms associated with urethritis (infection of the urethra), dysuria (painful or difficult urination), and frequently are similar to that of lower UTIs.

• common causative organisms of urethritis include Chlamydia trachomatis, Neisseria gonorrhea, and Trichomonas vaginalis

• as they are sexually transmitted, urethritis is considered an STI

Ureteritis

• inflammation of infection within ureters. Infection may combine with kidney infections

• Urethritis indicates the micro-organisms have begun or are in the process of ascending into the kidneys. This condition must be treated accordingly to prevent further infections

Asymptomatic bacteriuria/asymptomatic UTI

• it is the isolation of a specified quantitative count of bacteria in an appropriately collected urine sample from patients without any symptoms of UTI

• Asymptomatic bacteriuria/asymptomatic UTI is common but its prevalence varies widely with age, gender, and the presence of genitourinary abnormalities or underlying diseases

• After the screening, if asymptomatic bacteriuria can have adverse outcomes, then antimicrobial therapy is suggested

• Thus, screening and treatment of asymptomatic UTIs are recommended for pregnant women, males undergoing transurethral resection of the prostate, and individuals undergoing urologic procedures for which mucosal bleeding is anticipated.

• Screening for or treatment of asymptomatic UTI is not done for premenopausal, non-pregnant, diabetic women, older persons living in the community, older institutionalized subjects, persons with spinal cord injury, or catheterized patients while the catheter is in place.

Cystitis (infection of the bladder)

• Symptoms include dysuria, frequency, and urgency (compelling need to urinate). These symptoms of cystitis (infection of the bladder) are not only due to inflammation of the bladder but also due to the multiplication of bacteria in the urine and urethra.

• Often there is tenderness or pain over the area of the bladder. In some individuals, the urine is grossly bloody. The urine may also appear clouded and also may give off a bad odor. Because cystitis is a localized infection, fever and other signs of systemic illness are usually not present.

Acute urethral syndrome

• Patients are primarily young, sexually active women, who experience dysuria, frequency, and urgency but yield fewer organisms than 10⁵ colony-forming units of bacteria per milliliter (CFU/ml) urine on culture.

• About 50% of women suffering from acute cystitis fall into this group. Chlamydia trachomatis and N. gonorrhoea urethritis, anaerobic infection, genital herpes, vaginitis, etc account for some cases of acute urethral syndrome.

  But in most cases, these women are infected with organisms identical to those that cause cystitis but in numbers less than 10⁵ CFU/ml urine on culture. In such cases, 10² CFU/ml must be used as a cutoff and also must insist on concomitant pyuria (presence of 8 or more leukocytes/mm³ on microscopic examination of uncentrifuged urine).

• Almost 90% of women have pyuria.

Pyelonephritis

• Pyelonephritis refers to inflammation of the kidney parenchyma, calics (a cup-sized division of the renal pelvis), and pelvis (the upper end of the ureter that is located inside the kidney) and is usually caused by bacterial infection.

• The typical clinical presentation of an upper urinary tract infection includes fever and flank (lower back) pain and frequently, lower tract symptoms (frequency, urgency, and dysuria).

• Patients can also exhibit systemic signs of infection such as vomiting, diarrhea, chills, increased heart rate, and lower abdominal pain. 40% of patients with acute pyelonephritis are bacteremic.

Urosepsis

• Approximately 25% of septic cases are a result of urosepsis, a systemic infection that may develop from community or hospital-acquired UTIs. Early diagnosis and treatment of UTIs are essential in preventing urosepsis.