References:
- Global Infectious Diseases and Epidemiology Online Network: Infectious Diseases of the Philippines, 2013 eBook Edition, ISBN 978-1-61755-582-4, by Stephen Berger. Accessed here.
| Agent | BACTERIUM OR FUNGUS. Escherichia coli, other facultative gram negative bacilli, enterococci, et al. |
| Reservoir | Human |
| Vector | None |
| Vehicle | Endogenous |
| Incubation Period | Variable |
| Diagnostic Tests | Urine culture and leucocyte count |
| Typical Adult Therapy | Antimicrobial agent(s) directed at known or likely pathogen |
| Typical Pediatric Therapy | As for adult |
| Clinical Hints | Fever, dysuria, frequency, flank pain and vomiting; infection in children or men and infection which relapses in women may warrant radiological studies to rule out underlying obstruction or calculus. |
| Synonyms | Cistite, Cistitis, Cystite, Cystitis, Pielite, Pielitis, Pielonefrite, Pielonefritis, Prostatite, Pyelitis, Pyelonephrite, Pyelonephritis, Trigonitis, Tubulointerstitial nephritis, Urethritis, Uretrite, Zystitis |
Young children often exhibit nonspecific signs such as fever, poor feeding and vomiting.
- Abdominal pain may be present.
- After early childhood, dysuria, urgency, and frequency are generally present in UTI.
- Adult women with cystitis have frequent and urgency, often with lower abdominal or lower back pain.
- The urine may be foul smelling or turbid and is often bloody.
- Onset of symptoms is usually abrupt.
- Some infections progress to upper tract involvement, with fever, rigors, nausea, vomiting, abdominal and flank pain.
- Classical signs of ‘upper’ vs. ‘lower’ UTI are often misleading and do not necessarily point to the location of infection.
In the elderly, UTIs are often asymptomatic or manifest by nonspecific signs.
- Frequency, urgency, nocturia, and incontinence in this age group may also mimic other disorders in this age group.
- Infection associated with neurogenic bladders and indwelling catheters may not necessarily present with localizing symptoms.
Acute uncomplicated cystitis is most common in young women but may also be seen in men, children or the elderly.
- Typical symptoms include dysuria, frequency, urgency, and suprapubic or pelvic pain.
- Suprapubic tenderness is present in 10 to 20 percent, and gross hematuria in 20 to 30 percent.
- Approximately ten percent of patients with symptoms of acute cystitis will be found to have occult infection of the upper urinary tract.
- Bacterial vaginosis may predispose to urinary tract infection.
Acute pyelonephritis presents with flank, low back, or abdominal pain, in addition to fever, rigors, sweats, headache, nausea, vomiting, malaise, and prostration.
- Antecedent or concomitant symptoms of cystitis may or may not be present.
- Fever and flank pain are relatively specific indicators of renal infection.
- A minority of patients with pyelonephritis develop septicemia, or necrotizing renal or perinephric abscesses.
All urinary infections in males should be considered complicated until proven otherwise, and prompt a careful search for anatomical or functional abnormality of the urinary tract.