Document 6431769

Nonspecific Infections of the
Genitourinary Tract
Uriner Sistemin Özgün olmıyan
Enfeksiyonları
Doç.Dr. Hamdi Özkara
Nonspecific Infections of the
Genitourinary Tract
The “Nonspecific Infections of the Genitourinary
Tract” are infections with Similar manifestation
that are caused by different bacteria (mainly aerobic
gram-negative rods.
Routes of infection in the genitourinary tract:
„
„
„
„
Ascending Infection ( urethra to bladder)
Descending Infection (Kidney to bladder)-hematogenous
Direct extension ( bowel to bladder)
Lymphatogenous Spread (rectal & colonic lymphatıcs)
Nonspecific Infections of the
Genitourinary Tract
Important Observations Concerning UTI
„
„
UTI are most common bacterial infection of
humans of all ages.
Prevalence of urinary tract infection according to
age and sex.
Š Age Group
neonatal
Preschool
Scholl
Adult
Elderly
Prevalence
%1
%3
%2
%2.5
%30
Sex Ratio
(m)1,5:1 (fem)
1:10
1:30
1:50
1:10
Nonspecific Infections of the
Genitourinary Tract
Susceptibility factors/mechanisms in
UTI:
„
„
„
Bacterial Virulence
Host Defense mechanism
Urethral factors
Nonspecific Infections of the
Genitourinary Tract
Acute Pyelonepfritis: An infectious
inflammatory disease that involves both
the parenchyma and the pelvis of the
kidney.
Aerobic gram-negative bacteria are the
principal causative agents (e-coli are
the predominant causative agent)
Acute Pyelonephritis
Pathology:
„
Gross:
The kidney is usually enlarged due to edema. On cut
section the abscess appear mainly in the cortex as small
rounded areas with a wedge- shaped configuration in
focal distribution.
„
Microscopic:
In the cortex the parenchyma shows extensive tissue
destruction. PML, lymphocytes, plasma
cells eosinophils is
common. Renal pelvis and calceal system shows also
inflammation.
Acute Pyelonephritis
Acute Pyelonephritis
Pathogenesis:
„
Hematogenous spread is the main way for
bacterial (e-coli) inflammation.
Acute Pyelonephritis
Clinical Finding:
„
Symptoms:
Š CVA pain, shaking chills, fever, malaise, cystitis, nausea-
vomiting,
„
Signs:
Š ill general apperance, fever (40 C), abdominal
discomfort, tenderness, muscle pain…
„
Laboratory Findings:
Š Leucocytosis, pyuria, hematuria, urinary culture (+)
„
Radiologic Findings:
Š Edema of the kidney, enlarged kidney
Acute Pyelonephritis
Differential Diagnosis:
„
„
„
„
Pancreatitis
Basal Pneumonia
Acute intra-abdominal Disease
PID (women)
Acute Pyelonephritis
Treatment:
„
„
„
„
Hospitalization
Antibiotic therapy (aminoglycosides;
ampiciline)
Medication for fever, pain, vomiting
Hydration
Nonspecific Infections of the
Genitourinary Tract
Chronic Pyelonephritis: Acute
uncomplicated UTI do not commonly lead to
renal scarring and progressive renal disease.
It is mainly a radiological definition.
Chronic Pyelonephritis
Chronic Pyelonephritis
Pathology: The kidney shows atrophy
of variable degree depending on the
severity and uniformity of the
involvement.
Histological examination shows diffuse
infiltration of the parenchyma with
plasma cells and lymphocytes.
Chronic Pyelonephritis
Clinical Findings:
„
„
„
„
Symptoms: When bilateral and advanced,
anemia; azotemia and hypertension
Signs:Usually associated with hypertension
Laboratory Findings: Azotemia, proteinuria,
BUN and creatinine elevation
Radiological Findings: Kidney small and
irregular, urolithiasis may be evident
(shows typical renal scarring on IVP)
Chronic Pyelonephritis
Treatment:
„
„
„
„
Prevention: In childhood VUR
Prevention of UTI
Surgical Measures: nephrectomy
General Measures: HT, azotemia
Nonspecific Infections of the
Genitourinary Tract
Renal Abscess:
„
Renal Cortical Abscess (Renal Carbuncule):
Š Mainly caused by Staph. Aureus spread by
descending way. Predisposing conditions are
DM and hemodialysis.
„
Renal Corticomedullary Abscess:
Š most often caused by e-coli due an underlying
urinary tract abnormality (VUR, obstruction…)
Renal Abscess
Renal Abscess
Clinical Finding:
„
Symptoms and Signs: Abrupt onset of fever
and chill, CVA tenderness and edema, flank mass
and loin bulge
„
„
Laboratory Finding: leukocytosis,
Imaging Studies: renal US can confirm abscess,
diagnosis is made by CT
Renal Abscess
Treatment:
„
„
Antimicrobial Agents:
Surgical drainage
Nonspecific Infections of the
Genitourinary Tract
Perinephric Abscess: it develops
mainly from rupture of intrarenal
abscess into the perinephric space.
Gerota’s fascia usually confines the
abscess formation to the perinephritic
space, it can extend widely throughout
the retroperitoneum to affect
surrounding structures.
Perinephric Abscess
Clinical Findings:
„
„
„
Symptoms and Signs: spasm of the psoas
muscle, peritoneal irritation, scoliosis
Laboratory Findings: mild/moderate
Leucocytosis, elevated ESR, pyuria…
Radiological Findings: Renal US/ CT
Perinephric Abscess
Perinephric Abscess
Treatment:
„
„
Antimicrobial Agents
Surgical drainage
Nonspecific Infections of the
Genitourinary Tract
Acute Cystitis: is an infection of the
urinary bladder caused mainly by
coliform bacteria (E-coli). The infection
usally ascend to the bladder from the
urethra.
Acute cystitis is much common in girls
and women than in boys or men.
Acute Cystitis
Pathology: The bladder mucosa
typically shows hypermia, edema and
infiltration by neutrophils.
Symptoms: frequency, urgency,nocturia
dysuria, low back pain, suprapubic
disconfort, hematuria. Significant fever
is unusual.
Acute Cystitis
Signs: No specific physical sign is
characteristic.
Laboratory findings: Urinalysis typically
shows pyuria and bacteriuria. The
infecting pathogen is found on urine
culture.
Acute Cystitis
Complication: is the possibility that
infection can ascend to the kidney
which is prone especially in children
with VUR and pregnant women.
Prognosis: usually resolve rapidly in
response to the therapy.
Acute Cystitis
Treatment:
„
„
Antibiotherapy
Urinary analgesics ( phenazopyridine HCl)
Nonspecific Infections of the
Genitourinary Tract
Acute Bacterial Prostatitis: mainly
caused by aerobic gram-negative rods.
Pathogenesis & Pathology:
„
„
„
„
Ascent from urethra
Reflux of infected urine into the pr. duct
Direct extention from rectum
Hematogenous spread
Acute Bacterial Prostatitis
Clinical Findings: Acute b. Prostatitis
is an acute febrile illness characterized
by chills, low back and perineal pain,
urinary urgency and frequency, dysuria
and urinary outlet obstruction. Both
myalgia and arthralgia are common.
Acute Bacterial Prostatitis
Signs: Moderate or high grade fever,
rectal palpation typically discloses an
exquisitely tender, swollen prostate
gland and warm to the touch.
Laboratory findings: leukocytosis with
shift to the left, urinalysis shows pyuria,
hematuria
Acute Bacterial Prostatitis
Complication: may lead to acute
urinary retantion; bacteremia may lead
to septiz shock.
Prevention: Urethral instrumentation
should never be done if urine is known
to be infected.
Acute Bacterial Prostatitis
Treatment:
„
„
„
„
Bed rest/ hospitalization
Antibio therapy ( fluoroquinolone,
cephalosporine, penicile, aminoglyceride..)
Antipiretics / analgesics
Parenteral nutrition
Nonspecific Infections of the
Genitourinary Tract
Other Infections:
„
„
„
„
„
„
Acute Epididymitis
Acute Orchitis
Prostatic abcsess
Acute urethral syndrome in women
Papillary necrosis of kidney
Xanthogranulomatous pyelonephritis