This document discusses infections of the urinary tract, including cystitis, pyelonephritis, and prostatitis. It describes the pathogenesis, etiology, signs and symptoms, diagnosis, and treatment of these conditions. Cystitis is typically caused by E. coli and presents with dysuria, urinary frequency, and suprapubic pain. Pyelonephritis is more severe, presenting with fever, chills, and lumbar or flank pain. Treatment involves antibiotics like amoxicillin, cephalosporins, or fluoroquinolones depending on the infection. Prostatitis can be acute or chronic, caused by bacteria like E. coli, and treated with antibiotics like cephalospor

1. UNIVERSIDAD TECNICA DE MACHALA
ACADEMIC UNIT OF CHEMICAL
SCIENCES AND HEALTH
MEDICINE SCHOOL
ENGLISH
INFECTIONS OF THE
URINARY TRACT
STUDENTS
William Cruz
Kevin Herrera
TEACHER:
Mgs. Barreto Huilcapi Lina Maribel
CLASS:
EIGHTH SEMESTER ‘’A’’
Machala, El Oro
2018

2. INFECTIONS OF THE URINARY TRACT
Infections of the urinary tract follow in frequency those of the respiratory system. In
women, the prevalence of Urinary Tract Infection is 1%, school age 5% coinciding
with the beginning of sexual relations and pregnancy.
The UTI can be located in the urethra (urethritis), bladder (cystitis), prostate
(prostatitis), kidney (pyelonephritis).
CYSTITIS AND PYELONEPHRITIS
Pathogenesis: Most episodes of UTI precede significant periurethral colonization by
microorganisms. The urethral colonization by E. coli, supposes presence of receptors
in urothelium that fix serogroups of E. coli.
From the urinary meatus, microorganisms can ascend to the bladder. The female
urethra is short and the passage of microorganisms into the bladder is frequent
especially in intercourse. Once the microorganisms have reached the bladder, the
development of infection is related to the bacterial population density present in the
urine and the virulence factors of the microorganisms.
Etiology: E. coli, is the causative organism of 80% of uncomplicated UTIs, the
complicated infection is produced by E. coli in 50% cases, the rest are due to other
enterobacteria.
Pathological anatomy: Cystitis is the superficial inflammation of the bladder wall
characterized by the appearance of an inflammatory infiltrate, edema, hyperemia of
the mucosa. If this progresses, focal or diffuse hemorrhages and purulent exudate
appear.
In pyelonephritis, an inflammatory infiltrate with a predominance of
polymorphonuclear leukocytes located in the renal lobe, with a triangular appearance
with the base directed outwards, is observed. If there is urethral obstruction, it can
affect the entire kidney.

3. Signs and symptons: Cystitis is characterized by the appearance of dysuria, urinary
frequency and urgent urination, with less frequent incontinence, tenesmus and
suprapubic pain that may increase with urination.
Pyelonephritis usually starts suddenly with high fever, chills and general condition,
pain in the lumbar fossa, sometimes with nausea and vomiting the pain radiates to the
flank, the iliac fossa on the same side or the epigastrium.
Diagnosis: The diagnosis of cystitis is clinical, but can be confirmed with the
existence of leukocyturia, although leukocyturia is not specific for UTI can be seen in
interstitial nephropathies, urolithiasis, urothelial tumors, polycystic kidney disease,
renal tuberculosis, non-bacterial cystitis.
The urine culture identifies the causative organism and urine serves as a good culture
medium for most enterobacteria.
In the case of complicated pyelonephritis, blood cultures should be performed and
general analyzes should include a blood count and serum creatinine and C-reactive
protein determinations.
Differential diagnosis: if the patient presents a urinary urgency, incontinence or
urinary frequency, she is likely to have cystitis. The diagnostic problem arises when
the main symptom is dysuria. The diagnosis of acute pyelonephritis does not pose
difficulties if the patient presents with fever, pain in the lumbar fossa and cystic
syndrome.
Treatment
Cystitis: the antibiotic of choice should be against E.coli such as amoxicillin,
cotrimoxazole, 1 and 2 generation cephalosporins. The fosfomycin 3g single dose,
nitrofurantoin 100mg / 12h for 5-7 days, colimycin are active against 90% of strains
of E.coli.

4. Bacteriuria: the majority of patients do not require treatment, except in children
under 5 years of age with vesicoureteral discharge. The antibiotic treatment is chosen
according to the sensitivity of the causative organism and is maintained for 7 days. In
the first trimester of pregnancy, nitrofurantoin and cotrimoxazole are prohibited.
Pyelonephritis: third-generation oral cephalosporin (cephalexin 200 - 400mg / 12h),
in patients allergic to beta-lactams treatment is started with aminoglycosides in a
single daily dose for 2-3 days followed by fluorquinolones administered orally.
If the evolution is favorable, within 3-5 days the temperature is normalized and the C-
reactive protein decreases to less than half the initial value.
Prognosis and prophylaxis: the clinical improvement of the patient with urinary
infection is not always accompanied by bacteriological cure since bacteriuria can
persist in the absence of symptoms.
Reinfection is more frequent in women and is easy to recognize when the
microorganism is different from the initial one. Most of the reinfections are due to the
persistence of periurethral colonization by E. coli and can not be differentiated from a
recurrence.
The treatment of recurrences is done with an antibiotic chosen according to the
result of the antibiogram, preferably for fluoroquinolones or cotrimoxazole, for the
selective antibacterial spectrum against gram-negative bacilli.
PROSTATITIS
Inflammation of the prostate gland or prostatitis are classified into four categories: a)
acute bacterial prostatitis, b) chronic bacterial prostatitis, c) chronic pelvic pain
syndrome, d) asymptomatic inflammatory prostatitis.
Etiopathogenesis: Both acute and chronic bacterial prostatitis are due to gram-
negative bacilli, particularly E. coli followed by other enterobacteria.

5. Signs and symptons: bacterial prostatitis caused by high fever, chills, general
condition, dysuria, frequency, urethral obstruction symptoms, loss of voiding force.
Diagnosis: Prostatic touch, PSA increase and eventually a transrectal ultrasound or a
grammagraph made with leukocytes marked with indium can confirm the diagnosis
Treatment: third generation cephalosporin (ceftriaxone or cefotaxime), in case of
allergy to penicillin; administer aztreonam or with an Aminoglycoside in a single
daily dose
In chronic bacterial prostatitis, the choice of antibiotic is made according to the
sensitivity of the microorganism isolated in the urine culture, here trimethoprim,
fluoroquinolones, rifampicin, macrolides are included among the antibiotics that
penetrate better the prostatic acinus.
BIBLIOGRAPHIC REFERENCE
J. Mensa Pueyo. "Infections of the urinary tract", Farreras, V. Rozman, C, Internal
Medicine, Barcelona-Spain, Elsevier, 2016, Vol. 1, p., 861 - 868