Urinary tract infections are a common bacterial infection of the urinary system. Multiplication of organisms in the urinary tract is associated with clinicopathological outcomes. (UTI) is prevalent in women, uncommon in men, but particularly important in children. Recurrent infections are common in youngsters, pregnant women, and people who practice poor personal hygiene. It entails significant morbidity and, if complex, can lead to renal failure. It is also a leading cause of life-threatening gram-negative septicaemia. It can be asymptomatic (asymptomatic bacteriuria) or symptomatic, including cystitis, prostatitis, and pyelonephritis.
Clinical Presentations of UTI: Asymptomatic bacteriuria, Acute cystitis, urethritis, prostatitis, Necrotising papillitis, Acute pyelitis and pyelonephritis.
Pathogenesis of UTI: UTI may be uncomplicated or complicated. Complicated UTI is associated with abnormal urinary tract and may lead to permanent renal damage, while uncomplicated UTI rarely does so.
Uncomplicated:Urinary tract is anatomically and functionally normal,Normal renal function,Use of diaphragm with spermicide; frequent sexual intercourse, diabetes, incontinence of urine, previoushistory of UTI are risk factors.
Complicated:Abnormal urinary tract e.g., obstruction, calculous, vesicoureteral reflux, indwelling catheter, neurological abnormality, chronic prostatitis or benign prostate hypertrophy, cystic kidney, analgesic nephropathy, neurogenic bladder. Systemic disorders that predispose to UTI e.g., diabetes, granulocytopenia, AIDS.
Organisms causing UTI:
Outside Hospital:E. coli and other coliform bacteria,(70% approx.), Proteus mirabilis(10-15% approx.), Staphylococcus epidermidis (10%), Klebsiella species4%,Enterococcusfaecalis6%, Pseudomonas1-2%.
Klebsiella B-proteus, pseudomonasis involved commonly in hospital-acquired UTI with urological abnormalities, i.e. stone or obstruction while E. coli causes infection without such abnormality.
Staphylococcus is most common organism involved in UTI inyoung women.
Routes of infection.Ascending transurethral route (commonest).
The blood stream (haematogenous) It occurs indebilitated and immunocompromised patients.
The lymphatics, By direct extension (e.g. from varicocele fistula)
Factors predisposing to UTI:
Multiplication of the organisms depends on the size of inoculum and virulence of the bacteria. The various predisposing factors to UTI.
Short urethra in females, Close proximity to faecal flora, Sexual activity,
Alteration in vaginal pH (post-menopausal)
Repeated pregnancies, Women using diaphragm as contraceptive.
Indwelling urinary catheter,
Medical illnesses: Diabetes mellitus,Immunosuppression, AIDS
Vesico-ureteric reflux in children.
Obstruction:Stricture of urethra, Prostate hypertrophy, Urinary stone, Urological malignancy.
Asymptomatic bacteriuria means the presence bacteria in significant numbers in the urinary tract (colonies of >100,000 per ml or more) in a freshly voided midstream sample of urine without any symptom.
Urethritis and cystitis are characterised by inflammation of the urethra and bladder with symptoms of increased frequency of micturating dysuria, strangury and suprapubic pain during and after voiding.
Prostatitis means inflammation of the prostate with symptoms of dysuria, urgency, frequency and pain in the lower abdomen.
Acute pyelitis or pyelonephritisIt is bacterial infection of the renal parenchyma andrenal pelvis, usually due to transurethral ascent of the organisms.
Adult patients usually complain of pain in one or both lain radiating to the iliac fossae or suprapubic region. About one-third of cases have dysuria and associated cystitis.
Fever is usually present with chills and rigors and vomiting may occur. Gram-negative septicaemia and hypotension may complicate the clinical picture.
Patients with diabetes may present with obstructive uropathy associated with acute papillary necrosis. Here sloughed papillae obstruct the ureter.
There is guarding and tenderness in the lumbar region. The renal angles on the back may be tender.
Acute pyelonephritis in infants and children may present just with fever with no localising symptoms. Convulsions may be the earliest feature associated with apathy, abdominal distention and diarrhoea. In a febrile child, the urine must be examined for pus cells and bacteria.
Investigations Of UTI:
TLC, DLC shows leucocytosis.
Urine dipstick test for nitrate or leucocyte esterase -Positive test indicate UTI.
Complete urine examination reveals pus cells, bacteria, red cells and epithelial casts. Pyuria, bacteriuria and WBC casts are characteristic.
Midstream urine for culture and sensitivity may reveal the offending organism. Blood culture may also be positive.
Ultrasonography of kidneys, ureters may show an abnormality e.g., hydronephrosis due to stone.
- Acute papillary necrosis, acute renal failure.
- Gram-negative septicaemia, abscess formation.
- Urinary obstruction by pas, chronic pyelonephritis.
For establishing the diagnosis of symptomatic UTI, it is essential to demonstrate bacterial colony count of >10/ml of urine in a freshly voided clean midstream sample of urine in addition to neutrophils (pus cells) in the urine.
For asymptomatic urine infection, two consecutive urines.specimens should demonstrate 10 bacteria/ml in both the specimens for diagnosis and treatment.
A quick test i.e., the dipstick test for nitrite or leucocyte esterase is used as a surrogate marker for bacteriuria.
Symptomatic relief includes adequate hydration (fluid intake), frequent voiding of urine and use of analgesics for pain.
In children with vesicoureteral reflux, triple micturition which involves emptying of bladder before going to bed at night and two additional voiding in the same session, helps in preventing the ascent of urine along the ureter during bladder emptying.
Steps for Prevention of UTIs In Women
Periodic emptying of bladder during the day and beforegoing to bed.
Adequate fluid intake.
To empty bladder before and after sexual intercourse.
In sexually active females with recurrent UTI, good perineal hygiene, emptying of bladder before and after intercourse.
Homoeopathic Treatment of UTIs:
APIS MELLIFICA:The patient complains of severe burning pains and soreness while passing urine. The amount of urine becomes scanty.The urine may pass involuntarily as the urge to urinate is very frequent. The last few drops burn violently.There is a characteristic stinging pain while urinating.
CANTHARIS: The patient complaints of an intolerable constant urge to urinate at very short intervals.The urine is hot and there is a burning sensation while passing the urine. There is a characteristic symptom of cantharis that the urine flows drop by drop.It produces burning and pain in the urethra. Sexual intercourse worsens the symptoms.
EQUISETUM: feeling of fullness in the bladder.There is a constant urge to urinate. The patient is not relieved after passing the urine.There is a characteristic symptom of equisetum that there is a violent pain at the closure of urination.The drop by drop passing of urine makes the daily activities difficult. The patient complains of a cutting pain in the urethra.
KREOSOTE:The urine is offensive. itching in the urethra and other genital organs.The patient is always in a hurry to urinate. The urine flow drop by drop.The itching and burning sensation remain constant in the genital area.
STAPHYSAGRIA: For urinary tract infection due to sexual intercourse. It is helpful for newly married people with increased urinary frequency. The urine flow drop by drop.There is a sensation of fullness in the bladder. Burning sensation remains constant even while not urinating.Urging and pain increase after passing urine.
SEPIA: For long-standing urinary tract infection. Pain and discomfort in the lower abdominal region and waist. The urinary bladder is mainly affected. the symptoms of pain in the lower abdomen are relieved by using heating pads. The patient complains of a constant desire to urinate.There is a burning sensation each time while passing urine.
SARSAPARILLA:A characteristic symptom of violent pain at the closure of urination.The urinary stream is weak. the urine may flow drop by drop. There is a pain in the lower abdominal region.patients who have renal stones or kidney stones. There is a feeling of fullness in the bladder as if the bladder is not completely voided.
PULSATILLA: For frequent urge to urinate with burning pains,The pain remains constant before and after urination. Sometimes, the urine is passed involuntarily.Citrus juices and cold beverages worsen the symptoms.
ACONITE: The urine quantity becomes scanty. There is pain and discomfort in the lower abdomen. The patient is anxious before urination. There is a burning sensation in the urethra. Occasionally blood can be present in the urine. It is also helpful for people suffering from prostatic issues.
MERCURIUS: The patient complains of slightly greenish discharge from the urethra. The urge to urinate is constant and strong.It makes the patient very irritable. There is pain at the beginning of urination. The urine is dark and offensive.The urine is scanty.