Evaluation of Infection In Pregnancy
- Some infections can be transmitted from mother to fetus and cause serious issues. Rarely, serious maternal illness can impact the fetus as well.
- Intra-amniotic infections from bacteria in the vaginal flora can cause infections like sepsis and meningitis in newborns.
- Common organisms that cause neonatal sepsis include Streptococcus agalactiae (group B strep), E. coli, coagulase-negative staphylococci, and Staphylococcus aureus. Screening and treatment is recommended for some high risk infections.
Parvovirus B-19 in Pregnancy Parvovirus is a member of the family Parvoviridae. The virus contains a single-stranded DNA. It can only infect humans. 50% of all adults have been infected sometime during childhood or adolescence.
Parvovirus B-19 in Pregnancy Epidemiology Congenital infection rates vary depending on the prevalence in the community. Approximately 50 to 75% of adult women are immune. 20% to 30% of susceptible adults in school settings will become infected. Day-care workers have a 20% to 50% risk of seroconversion. The risk of infection among susceptible adults following household exposure to an infected person is approximately 50%.
If someone says the word “Herpes”, everyone cringes. Surprisingly, about 2/3 of you reading
this now, may have had HSV 1 (the type that causes cold sores), and about 20% of you may
have had the genital type of Herpes (HSV2).
*I hope its help you all for preparation part 1 exam for MRCOG & MOG and your daily job.Good Luck May ALLAH bless our work and study,Good luck to all.dont forget to pray to ALLAH.if i wrong please correct me..process of learning..
Recurrent pregnancy loss (RPL), also referred to as recurrent miscarriage or habitual abortion, is historically defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period.
This Presentation is made by Dr.Laxmi Shrikhande
Parvovirus B-19 in Pregnancy Parvovirus is a member of the family Parvoviridae. The virus contains a single-stranded DNA. It can only infect humans. 50% of all adults have been infected sometime during childhood or adolescence.
Parvovirus B-19 in Pregnancy Epidemiology Congenital infection rates vary depending on the prevalence in the community. Approximately 50 to 75% of adult women are immune. 20% to 30% of susceptible adults in school settings will become infected. Day-care workers have a 20% to 50% risk of seroconversion. The risk of infection among susceptible adults following household exposure to an infected person is approximately 50%.
If someone says the word “Herpes”, everyone cringes. Surprisingly, about 2/3 of you reading
this now, may have had HSV 1 (the type that causes cold sores), and about 20% of you may
have had the genital type of Herpes (HSV2).
*I hope its help you all for preparation part 1 exam for MRCOG & MOG and your daily job.Good Luck May ALLAH bless our work and study,Good luck to all.dont forget to pray to ALLAH.if i wrong please correct me..process of learning..
Recurrent pregnancy loss (RPL), also referred to as recurrent miscarriage or habitual abortion, is historically defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period.
This Presentation is made by Dr.Laxmi Shrikhande
Sexually transmitted disease in pregnancyDR MUKESH SAH
An STI during pregnancy can pose serious health risks for you and your baby. As a result, screening for STIs , such as human immunodeficiency virus (HIV), hepatitis B, chlamydia and syphilis, generally takes place at the first prenatal visit for all pregnant women.
TORCH syndrome is a group of symptoms caused by Toxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex, and other organisms including syphilis, Varicella zoster, and parvovirus.
There are nearly 100 viruses of the herpes group that infect many different animal species.
Official name of herpesviruses that commonly infect human is Humans herpesvirus (HHV)
herpes simplex virus types 1 (HHV 1)
Herpes simplex virus type 2 (HHV 2)
Varicella-zoster virus (HHV 3)
Epstein-Barr virus, (HHV 4)
Cytomegalovirus (HHV 5)
Human herpesvirus 6 (HHV 6)
Human herpesvirus 7 (HHV 7)
Human herpesvirus 8 (HHV 8) (Kaposi's sarcoma-associated herpesvirus).
Herpes B virus of monkeys can also infect humans
hELMINTHS#corona virus#Aspergillosis#BUGANDO#CUHAS#CUHAS#CUHAS
Hearing the word “tumor” may naturally cause fear or panic. But a tumor is simply an abnormal buildup of tissue that occurs when cells divide too quickly or don’t die off as they normally should. A lung tumor is a tumor that occurs in the lung tissue itself or in the airways that lead to the lungs. Your airways include your:
Nose.
The inside of your nose (nasal cavity).
Throat (pharynx).
Voice box (larynx).
Windpipe (trachea).
The large tubes that carry air from your windpipe to your lungs (bronchi).
Lungs.
Lung tumors can either be cancerous (malignant) or noncancerous (benign).
If a healthcare provider tells you that you have a lung tumor and it “looks like it’s benign,” what does that mean? Should you have concerns?
When compared to malignant tumors, benign lung tumors:
Aren’t cancerous, so they won’t spread to other parts of your body.
Grow slowly or might even stop growing or shrink.
Aren’t usually life-threatening.
Usually don’t require removal.
Can expand and push against nearby tissues but won’t invade, destroy or replace other tissues.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. • IN pregnant women, most infections are no more serious than
in non- pregnant women of similar age
some infections can be transmitted to the fetus in utero or to the infant
during or immediately after delivery, with potentially serious sequale.
Uncommonly, serious infectious illness in the mother can have non- specific
fetal or obstetric effects and lead to miscarriage, premature labour or fetal
death, these infections must be treated as any other serious illness.
more common and a source of anxiety is mild illness or suggestive
laboratory findings in the absence of symptoms.
Intra amniotic infection due to bacteria in the vaginal flora
not only initiate labor but can also cause infections such as
septicemias and meningitis in the new born.
Several host defense mechanisms operate against
ascending infections:
»Vaginal acidity
»Cervical mucus
»Intact membranes
»Antibacterial activity of amniotic fluid
3. • Organisms causing neonatal sepsis
Early onset sepsis ( 24 hours to 7 days postpartum):
Streptocococcus B- haemolyticus (GBS)
E. coli
Late onset sepsis ( later than 7 days postpartum):
Coagulase negative staphylococcus (CONS)
Streptococcus B- haemolyticus (GBS)
Staphylococcus aureus
4. Streptococcus B- haemolyticus of group B of lanncefield
(SGB) or streptococcus agalactiae
The prevalence of SGB colonization among pregnant women
ranges from 10 to 30 %
SGB disease can occur in three clinical forms:
Early onset disease,, defined by the development of disease in newborn
infants up to the 7 th day of llife
Late onset disease, charaterized by occurense between the 8 th day and
3rd month of life.
Very late onset disease, occurring after the 3 rd month of life
Prevention: SGB culture for women at between 35 and 37
weeks of gestation – antibiotic therapy if culture is positive
5. • Infection jeopardizing the fetus with no serious
maternal consequences.
o Cytomegalovirus
o Toxoplasmosis
o Parvovirus B19
Infections jeopardizing the fetus with possible
maternal complications
o Rubella
o Varicella
o Sexually transmitted infections
o malaria
6. cytomegalovirus
Cytomegalovirus is the leading cause of congenital viral
infection
Typical clinical syndromes : intrauterine growth restriction,
microcephaly, hepato splenomegaly, petechiae, jaundice,
thrombocytopenia, anemia, chorioretinitis
Long term neurodevelopmental sequale include: mental
retardation, motor impairment, sensorineural hearing loss and/
or visual impairment
Primary maternal CMV infection during gestation poses a 40 %
risk of intrauterine transmission
7. Toxoplasmosis
Detection of T. gondii –specific IgM antibodies has been used
as an aid in determining the time of infection: a negative IgM
test result with a positive IgG result usually indicates infection at
least six months previously.
When a pregnant women is found to be infected with T. gondii,
the next step is to determine whether the fetus is infected: PCR
testing of amniotic fluid is used to diagnose congenital
toxoplasmosis.
8. Parvovirus B19
• Most persons ( usually children: erythema infectiosum or fifth
disease) with parvovirus B19 infection are asymptomatic or
have mild, nonspecific, cold like symptoms.
• The virus is highly infectious and spreads mainly through
respiratory droplets.
• The infection can trigger an acute cessation of RBC production,
causing transient aplastic crisis, chronic red cell aplasia,
hydrops fetalis, or congenital anemia.
• Although the virus can be contracted in any trimester, the
second trimester seems to carry the highest risk of fetal loss
9. To test a fetus for possible infection , a PCR is performed on
amniotic fluid.
Fetal cord blood is not widely used because of the associated 1
% fetal loss rate, and also because the IgM does not often
appear in the fetal circulation until after 22 weeks gestation.
Routine prenatal screening for parvovirus B19 is not advised. If
the fetus shows evidence of hydrops, the only treatment option
is intrauterine blood transfusion to correct the assosciated
anemia.
10. Rubella infection
The earlier in gestation the maternal infection occurs,, the more
severe is the damage to the fetus.
Maternal infection during the first 8 weeks after the last
menstrual period results in nearly all fetus becoming infected
and upto 100% of infected fetus developing congenital defects:
Congenital heart diseases
Congenital cataract
Deafness
Microcephaly
Mental retardation
The risk of fetal infection and the severity of congenital
abnormalities decreases after the 1st trimester, after 17 weeks
gestation, the risk of developing any defect is low
11. Varicella – zooster virus
VZV is spread by respiratory transmission or direct contact with
infectious lesion.
At any stage during pregnancy, severe maternal chickenpox
may cause intrauterine death.
Varicella infection in the first and second trimesters may lead to
the congenital varicella syndrome
The symptoms include:
Skin lesion in dermatomal distribution
Neurological defects
Eye diseases
Skeletal anomalies
About 30% of infants born with these lesion die in the 1st
trimester of life
13. Ureaplasma urealyticum
Ureaplasmal colonization of the lower genital tract is not
assosciated with adverse pregnancy outcome.
Ureaplasmal infection of the chorioamnion have been
implicated in :
o Infertility
o Spontaneous abortion
o Still birth
o Premature birth
o LBW
o Increased perinatal morbidity and mortality
U. urealyticum is the single most common mos. Isolated from
the CNS and LRT of newborn infants
14. Malaria in pregnancy
• Women living in endemic areas are considered to have some
immunity and malarial infections are usually asymptomatic.
• The disease is almost always symptomatic, and potentially
lethal, in non immune patients particularly gravid females.
• Possible pregnancy complications.
Preterm delivery
IUGR
Spontaneous abortion
Still birth
Postpartum haemorrhage
Puerperal fever
Maternal / fetal death
15. Screening of infections
Universal screening of pregnant women should be
recommended for the following :
Syphilis
Chlamydia, ureaplasmal infection and gonorrhea or bacterial
vaginosis
SGB culture for women at between 35 and 37 weeks of gestation
HIV Testing
history of genital and orolabial herpes simplex V virus infection
rubella
history of chickenpox vaccination
Routine screening for toxoplasmosis, cytomegalovirus or
parvovirus infection is not recommended.
16. CHANGES IN PREGNANCY
• Increased renal parenchymal volume due to intrarenal
fluid accumulation, hence…
• massive dilatation of renal calyces and ureter.
[approximately 90 % of pregnant women develop
ureteral dilatation, which will remain until delivery, and
up to 12th – 16th postpartum week.]
• By 2nd trimester, there is increased renal blood flow up
to 70-80 % and also GFR by 45-50%.
17. • Diagnosing intra amniotic infection
intra amniotic infection is difficult to diagnose on the basis of any single criterion
and so diagnosis depends on a set of criteria, the most important clinically being
maternal fever and tachycardia and fetal tachycardia.
Increased maternal leukocyte count , fetal biophysical profile examination using
ultrasound are also used in diagnosis.
Detection and estimation of surrogate markers:
• C- reactive protein
• Cytokines
• Fetal fibronectin
The infection may be polymicrobial, but collecting amniotic fluid samples without
contamination with normal vaginal flora is cumbersome and may require invasive
procedures.
After membrane rupture many bacteria may enter the amniotic cavity without
having caused the rupture
18. UTI
• An urinary tract infection (UTI): Bacteriuria:
i] presence of at least 100,000 organisms/mL of urine in an
asymptomatic patient
ii] as more than 100 organisms/mL of urine with accompanying
pyuria (>7 WBCs/mL) in a symptomatic patient
can be lower/upper UTI
• Pregnant women are at increased risk for UTI's starting in
week 6 through week 24.
19. Essential Elements of Urine Cultures
• Pathophysiology of urinary tract infection
• Microbiology of urinary tract infection
• Clinical signs and symptoms of urinary tract infection
Technical variables in specimen collection and transport
• Interpretation of urine cultures
• Quality management
20. Pathophysiology of urinary tract infection
• Ascending route of infection most common
• Colonization of urethra and periurethral tissue by uropathogens
the initial event in urinary tract infection
• Urinary tract infection more common in women than men due to
short female urethra with distention and turbulent flow that
washes urethral organisms into the bladder during micturition
and in close proximity to perianal areas
• Hospital infection associated with lower urinary tract
instrumentation (catheterization, cystoscopy)
• Once in the bladder uropathogens multiply, then pass up the
ureters (especially if vesicoureteral reflux present) to the renal
pelvis and parenchyma
• Source of uropathogens: enteric bacteria
21. Pathophysiology of urinary tract infection
• Cystitis: localized infection of the bladder with superficial
neutrophilic inflammation of the mucosa (lower urinary tract
infection)
• Pyelonephritis: infection of the kidney with acute suppurative
inflammation of the pelvis, medullary and cortical tubules, and
corticomedullary intersititum (upper urinary tract infection)
• Urosepsis: bacteremia due to pyelonephritis
• Papillary necrosis: complication of pyelonephritis in diabetes and
urinary tract obstruction with coagulative necrosis of renal
pyramids and an intense inflammatory response between preserved
and necrotic tissue
• Sloughing of necrotic pyramids: complication of papillary necrosis
that can cause urinary tract obstruction (in some instances
sloughed portions voided and recovered in urine)
• Perinephric abscess: associated with obstruction of an infected
kidney with abscess formation in the pernephric space due to
extension of bacterial infection across the renal capsule
22. Pathophysiology contd……
• Uncomplicated urinary tract infection:
Bacterial or yeast infection in a structurally
and neurologically normal urinary tract
• Complicated urinary tract infection: Bacterial
or yeast infection in a urinary tract with
functional or structural abnormalities
24. Bacterial virulence factors in urinary tract infection
• Escherichia coli strains expressing O-antigens O1, O2,
O4, O6, O7, O8, O75, O150, and O18ab cause high
proportion of infections
• Capsular K1, K5, and K12 antigens of E. coli associated
with clinical severity (antiphagocytic)
• P-fimbriae enhance mannose-resistant attachment of E.
coli to globoseries glycosphingolipid receptors (gal-gal)
of uroepithelial cells (P-fimbriated E. coli dominant as
cause of pyelonephritis and urosepsis)
• Type 1 fimbriae enhance mannose-susceptible
adherence of E. coli to uroepithelial cells (virtually all
cystitis-producing E. coli strains express type 1 fimbriae)
• Motile bacteria ascend the ureter against urine flow
25. Bacterial virulence factors in urinary tract infection
• Bacterial urease (Proteus, Corynebacterium urealyticum)
splits urinary urea with generation of ammonium ion that
alkalinizes urine with loss of acid pH as natural defense
barrier against infection, stone formation with ureteral
obstruction and survivial of bacteria deep within stones
resisting eradication by antibiotic, and alkaline-
encrusted cystitis
• Gram-negative endotoxin decreases ureteral peristalsis
• Hemolysin produced by many uropathogens damages
renal tubular epithelium and promotes invasive infection
• Aerobactin (a siderophore) present at increased
frequency in uropathogenic strains of E. coli promoting
intracellular iron accumulation for bacterial replication
26. Host protective factors in urinary tract infection
• Flushing mechanism of micturition a major protective
factor
• Low vaginal pH (3.5-4.5) (due to lactic acid produced by
action of Lactobacilli on glycogen of sloughed vaginal
epithelial cells) suppresses colonization by
uropathogens
• Normal acid pH of urine (4.6-6) anti-bacterial
• Urinary Tamm-Horsefall protein (secreted by ascending
loop of Henle) binds to mannose-sensitive fimbriae and
blocks E. coli attachment to uroepithelial cells
• Chemotactic interleukin-8 released upon bacterial
attachment to uroepithelial cells with recruitment of
phagocytic neutrophils and eradication of bacteriuria
27. Pathophysiology of urinary tract infection
• Hematogenous seeding of renal cortex less frequent
than ascending infection
• Kidney a common site of abscess formation in
Staphylococcus aureus bacteremia, less often in
candidemia, rarely with gram-negative bacteremia
• Hematogenous seeding of kidney also occurs with
Salmonella (typhoid) and Mycobacterium
tuberculosis
• Evidence for a role of periureteral and renal
lymphatics in urinary infection lacking
28. Common Uropathogens
• Escherichia coli
• Other Enterobacteriaceae (Klebsiella, Enterobacter,
Proteus, Citrobacter)
• Pseudomonas aeruginosa
• Enterococcus
• Staphylococcus saprophyticus
• Staphylococcus aureus1
• Streptococcus agalactiae (group B)2
• Candida
1Associated with staphylococcemia
2Denotes vaginal colonization in pregnant women
29. Uncommon Uropathogens
• Corynebacterium urealyticum1
• Haemophilus influenzae and H. parainfluenzae2
• Blastomyces dermatitidis3
• Neisseria gonorrhaeae4
• Mycobacterium tuberculosis5
1Colistin nalidixic acid (CNA) agar
2Chocolate agar
3Brain heart infusion, inhibitory mold, or Sabourad
dextrose agar
4Enhanced recovery with chocolate agar
5Lowenstein-Jensen medium, Middlebrook broth or
agar
30. Commensal Microflora of the Urethra
• Coagulase-negative staphylococci (except S.
saprophyticus)
• Viridans and non-hemolytic streptococci
• Lactobacilli
• Diphtheroids (Corynebacterium except C.
urealyticum)
• Saprophytic Neisseria
• Anaerobic bacteria
31. Common Risk Factors for Urinary Tract
Infection: Women
– Urinary tract obstruction (including calculi)
– Catheterization (straight, indwelling)
– Pregnancy
– Urologic instrumentation or surgery
– Neurogenic bladder
– Renal transplantation
– Sexual intercourse
– Estrogen deficiency (loss of vaginal lactobacilli)
32. Signs and Symptoms of Lower Urinary Tract Infection
• Inflammatory irritation of urethral and bladder
mucosa
• Frequent and painful urination of small volumes of
turbid urine
• Occasional suprapubic pain or sensation of
heaviness
• Fever generally absent
33. Signs and Symptoms of Upper Urinary Tract Infection
• Fever and chills (systemic reaction)
• Flank pain
• Lower urinary tract signs and symptoms (frequency,
urgency, and dysuria)
34. Asymptomatic Bacteriuria
• Presence of uropathogens by culture without signs
or symptoms of urinary tract infection
• Clinically significant (should be treated) with
preschool children (? vesicoureteral reflux,
congenital urinary tract anomaly), pregnant women,
and adults with obstructive uropathy
• Without clinical significance (should not be treated)
for adults in absence of urinary tract obstruction
35. Urinary Tract Specimens
• First-voided morning urine optimal (generally
bacteria have been proliferating in bladder urine for
several hours)
• Midstream urine specimens (initially voided urine
contains urethral commensals)
• Indwelling catheters (freshly placed, urine aspirated
by needle inserted into catheter) (Foley catheter tips
not acceptable)
• Straight catheter specimens
• Suprapubic aspirates (infants or children, recovery
of anaerobes)1
• Cystoscopic collection of urine
1Contamination-free specimen
36. Collection of Urine Specimens
• Urine collected in sterile specimen container must be
processed within 2 hours, or refrigerated and processed within
24 hours
• Urine collected in sterile specimen container with borate
preservative should be processed within 24 hours (no
refrigeration required)
37. Inoculation of Urine
• Inoculation of urine for quantitative culture (colony forming
units→cfu’s) performed with a calibrated 0.001 mL and 0.01 mL
plastic or wire loop
• Sheep blood agar (SBA) utilized for quantitative urine culture
• With 0.001 ml loop, 1 colony on SBA equivalent to 1,000 cfu’s per
mL of urine
• With 0.01 ml loop, 1 colony on SBA equivalent to 100 cfu’s per mL
of urine
• MacConkey agar utilized as selective differential agar for gram-
negative bacteria, colistin nalidixic acid agar as selective agar for
gram-positive bacteria, and chocolate agar for fastidious gram-
negative bacteria (Haemophilus)
38. Interpretation of Urine Cultures: General Guidelines
• A single species of Enterobacteriaceae recovered at
>105 cfu’s/mL urine: with patients symptomatic for
urinary tract infection, 95% probability of true
bacteriuria
• A single species of Enterobacteriaceae recovered at
104-105 cfu’s/mL urine: with patients symptomatic for
urinary tract infection, 33% probability of true
bacteriuira
• Gram-positive, fungal, and fastidious uropathogens
often present in lower numbers (104-105 cfu’s/mL urine)
• Urethral commensals recovered at <104 cfu’s/mL urine
39. Cumitech Guidelines for Inoculation of Urine Cultures1
• Routine: uncomplicated urinary tract infection in
ambulatory outpatients (0.001 mL loop, SBA, MAC; 24
hr incubation)
• Surveillance: neurogenic bladder, indwelling catheter,
geriatric patents (0.001 mL loop, SBA, MAC, CNA; 24 hr
incubation)
• Special: suprapubic aspirates or straight catheter
specimens where previous cultures negative,
unresponsive to therapy, or possibility of unusual
urinary tract pathogen (0.001 and 0.01 mL loop, BA,
MAC, CHOC; minimum 48 hr incubation)
1Clarridge, Johnson, Pezzlo, and Weissfeld, ASM Cumitech 2B, November 1998.
40. Cumitech Guidelines for Interpretation of Routine
Urine Cultures1
• One isolate at >104: Full ID and Susceptibility
• One or two gram-negative isolates at >105 and
other isolates at least 10X less: Full ID and
Susceptibility of gram-negative isolates
• Other patterns of isolates at >104:
Presumptive ID only
• Ignore mixed urethral flora at <104
1Clarridge, Johnson, Pezzlo, and Weissfeld, ASM Cumitech 2B, November
1998.
41. Cumitech Guidelines for Interpretation of
Surveillance Urine Cultures1
• One isolate at >104: Full ID and Susceptibility
• One gram-negative isolate at >105 with others at least
10X less: Full ID and Susceptibility
• Other patterns of isolates at >104: Presumptive ID only
• Ignore mixed urethral flora at <104
• One or two isolates at >102 to 105: Full ID and
Susceptibility
1Clarridge, Johnson, Pezzlo, and Weissfeld, Cumitech 2B, November 1998
42. ASM Manual Guidelines for Urine Culture Results
Likely to Be Significant1
• Midstream, female with cystitis, >102 with positive
urine leukocyte esterase
• Midstream, female with pyelonephritis, >105 with
positive urine leukocyte esterase
• Midstream, asymptomatic, >105 with negative urine
leukocyte esterase (usually)
• Midstream, male with UTI: >103 with leukocyte with
urine leukocyte esterase positive
• Straight catheter: >102 with urine leukocyte esterase
positive
• Indwelling catheter: >103 with urine leukocyte esterase
positive or negative
1 th
43. NMH Guidelines for Interpretation of Urine Cultures1
Urine leukocyte esterase positive
One or two organisms at >103: Full ID and Susceptibility
One organism at >104 with others (2 or more) at least 10X
less: Full ID and susceptibility of predominant organism
Report all group B β-hemolytic streptococci for women <
50 years
1Modified from ASM Cumitech, ASM Manual, and CDC MMWR 2002;51 (RR-11):1-22
44. COMPLICATION
UTIs are associated with risks to both the fetus
and the mother
* pyelonephritis
* preterm birth
* low birth weight
* increased perinatal mortality
45. Prevention
• Drink 6-8 glasses of water each day and eliminate
refined foods, fruit juices, caffeine, alcohol, and sugar.
• Take Vitamin C (250 to 500 mg), Beta-carotene (25,000
to 50,000 IU per day) and Zinc (30-50 mg per day) to
help fight infection.
• Develop a habit of urinating as soon as the need is felt
and empty your bladder completely when you urinate.
• Urinate before and after intercourse.
• Avoid intercourse while you are being treated for an UTI.
46. • After urinating, blot dry (do not rub), and keep your
genital area clean. Make sure you wipe from the
front toward the back.
• Avoid using strong soaps, douches, antiseptic
creams, feminine hygiene sprays, and powders.
• Avoid wearing tight-fitting pants.
• Don't soak in the bathtub longer than 30 minutes or
more than twice a day.
47. References
• Sobel and Kaye. Urinary Tract Infections. In
Mandell, Douglas, and Bennett’s Principles and
Practice of Infectious Diseases, 6th edition, Elsevier,
2005, pp. 975-905.
• Clarride, Johnson, Pezzlo, and Weissfeld.
Laboratory Diagnosis of Urinary Tract Infections.
Cumitech 2B, ASM Press, 1998, pp. 2-19.
• Thomson, Jr. and Miller. Specimen Collection,
Transport, and Processing: Bacteriology. In Manual
of Clinical Microbiology, 8th edition, ASM Press,
2003, pp. 286-330.
• Chapter 60. Infections of the Urinary Tract. In Bailey
& Scott’s Diagnostic Microbiology, 11th edition,
Mosby, pp. 927-938,