Case studyInitial history27-year-old female comlaining of sympto.pdf

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Case study Initial history 27-year-old female comlaining of symptoms of urgency to urinate, frequent urination, and urethral burning during urination persisting for 48 hours Patient awoke from sleep with urgency and suprapubic discomfort 2 nights ago Urine now has strong odor and cloudy appearance Additional history Recurring urinary tract infections since she married at age 22 years Prior UTI associated with similar symptoms Denies history of febrile or hemorrhagic UTI Three episodes over past 2 years May be associated with strenuous physical exertion and sexual intercourse No other medical history She reports an allergy to penicillin which causes a “rush” and “trouble breathing” Physical examination Well-nourished female experiencing mild discomfort Tenderness on palpation of abdominal pelvic area; physical examination otherwise unremarkable T=98.6°C orally; BP=114/64 mmHg; P=68; RR=12 Laboratory results Dipstick urinalysis: Color: Dark yellow, specific gravity=1.030, pH=6.5 Protein: Negative, glucose: negative, Ketone: negative, bilirubin: negative Trace occult blood Leukocytes:large amount Nitrates: positive, urobilinogen:negative Microscopic examination: WBC: too numerous to count (TNTC)/HPF (high power field) Bacteria: TNTC RBC: 3 or 4/HPF Casts: negative Urine culture: E.Coli:> 104 CFU/mL Organism sensitive to ampicillin, nitrofutantoin, trimethoprim-sulfamethoxazole (TMP-SMX), ciprofloxacin, cephalexin What is the history of this patient? Solution The organism is sensitive to antibiotics like ampicillin, nitrofutantoin, trimethoprim- sulfamethoxazole (TMP-SMX), ciprofloxacin, cephalexin. The urine culture shows high number of E.coli present in the urine with 3-4 RBC. Also the WBC is too numerous to count . An initial increase in WBC is indicative of an infection and with such high amount of bacteria in urine , is indicative of a bacterial infection , specifically caused by E.Coli. Although, the urine analysis do not show anymore anomalies, except presence of nitrates. Nitrates in urine occur are also indicative of an urinary tract infection. The initial patient history is also suggestive of an Urinary tract infection, due to cloudy appearance of urine. The indication is of a Cystitis, which is generally caused by an E.coli in the urine . One of the reasons of the recurring urinary infections might be due to sexual intercourse or strenuous activities..

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Solution
The organism is sensitive to antibiotics like ampicillin, nitrofutantoin, trimethoprim-
sulfamethoxazole (TMP-SMX), ciprofloxacin, cephalexin. The urine culture shows high number
of E.coli present in the urine with 3-4 RBC. Also the WBC is too numerous to count . An initial
increase in WBC is indicative of an infection and with such high amount of bacteria in urine , is
indicative of a bacterial infection , specifically caused by E.Coli. Although, the urine analysis do
not show anymore anomalies, except presence of nitrates. Nitrates in urine occur are also
indicative of an urinary tract infection.
The initial patient history is also suggestive of an Urinary tract infection, due to cloudy
appearance of urine. The indication is of a Cystitis, which is generally caused by an E.coli in the
urine . One of the reasons of the recurring urinary infections might be due to sexual intercourse
or strenuous activities.

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