Dysuria and Frequency of Micturition - Essay Example

Symptomatic acute bacterial urinary tract infections (UTIs) are among the most common bacterial infections treated by healthcare professionals. Cystitis accounts for most of these, whereas more than 100,000 patients are admitted to a hospital annually for acute pyelonephritis treatment. Women have many more UTIs than men. Bacteria ascending from the colonized urethra enter the bladder and perhaps the kidneys. The short length of the female urethra allows easier access by bacteria to the bladder. Contributing to contamination, the warm moist vulva and rectum are both nearby. Similarly, sexual intercourse increases bladder inoculation. Infections result from the interaction between bacteria and host. Bacterial virulence factors are important, as they enhance colonization and invasion of the lower and upper urinary tract. The principal virulence factor is increased adherence to either vaginal or uroepithelial cells. The bacterial species most frequently recovered from infected urine culture is Escherichia coli.

Bacterial cystitis almost always results from the entry of bacteria colonizing the anterior urethra and periurethral skin into the bladder. Hematogenous or lymphatic spread from sites of infection elsewhere is very unusual. The short female urethra is an insufficient anatomic barrier to the entry of urethral bacteria, which may be massaged easily into the bladder. This may explain the association of urinary tract infections and bacteriuria with sexual activity. Presumably, bacteria are massaged into the bladder during sexual intercourse. Once within the bladder, bacteria may ascend within the ureters, enhanced by vesicourethral reflux, into the renal pelvis and cause upper tract infection. The renal parenchyma also can be infected by blood-borne organisms, especially during staphylococcal bacteremia. Mycobacterium tuberculosis gains access to the kidney through this route and also perhaps by ascension.

Signs and Symptoms

There is a broad spectrum of symptoms in UTIs, ranging from patients who are completely asymptomatic to those with symptoms referable to the urethra, bladder, or both, and to those with the full-blown syndrome of acute pyelonephritis with fever and loin pain. Acute bacterial infection of the bladder is referred to as acute cystitis. Acute cystitis is characterized by inflammation limited to the superficial mucosal layer of the bladder. Patients with cystitis generally complain of dysuria, urgency, and frequency. Hematuria, low back pain, and lower abdominal pain also may be present. Fever and costovertebral-angle tenderness are both absent in most cases. Clinical signs and symptoms are notoriously inaccurate in localizing the site of infection, however, up to 50% of women with symptoms and signs of cystitis on clinical examination are found to have a silent renal infection.

Diagnoses

The most frequent presenting complaints in otherwise healthy, immunocompetent nonpregnant women are dysuria, frequency, urgency, and incontinence. For a culture specimen to be informative, it must be accurately collected. A "clean catch" midstream voided urine specimen is usually sufficient. A patient must understand the reasons for and the steps associated with urine specimen collection, which are designed to prevent contamination by other bacteria from the vulva, vagina, and/or rectum. More than one bacterial species identified in a urine culture usually indicates specimen collection contamination. Initially, a patient spreads her labia and wipes the periurethral area from front to back with antiseptic tissue. With labia spread, she begins urinating but does not collect the initial stream. A sample is then collected into a sterile specimen cup. The specimen cup is sterile and should be handled by the patient in such a way as to avoid contamination. After collection, a urine specimen is delivered promptly to the laboratory and should be plated for culture within 2 hours of collection unless it is refrigerated. In voided urine samples obtained from patients with urinary tract symptoms, the finding of more than 105 organisms of a single bacterial species is highly predictive of infection. In addition, the finding of a combination of several organisms present in quantities greater than 105/mL of urine, together with pyuria, dysuria, urgency, and frequency, is considered to be diagnostic of infection.

Conclusion

This is possibly a case of a urinary tract infection. Ms. David is a woman and her symptoms beginning with dysuria and frequency suggest at least antecedent cystitis. Following that, this infection could have ascended the upper urinary tract to lead to symptoms of loss of appetite. The absence of fever is usual, but in her case back pain increases the suspicion of affection of the kidney. Perhaps due to this reason, she is passing less urine, which has quite a possibility to raise the urea leading to accumulation of water in the body. This has been manifested as a gain in weight.