Star Team

Name of patient: Khong Fay Seah
Sex : Female
Age: 27 years old
Specimen: Urine [specimen 1]

Clinical Diagnosis
Complaints: Fever, Chills, Dysuria
Diagnosis: Urinary Tract Infection (UTI)

Interpretation of clinical diagnosis (complaints)
Fever [1]
Fever a common manifestation of infection and inflammation [such as influenza, urinary tract infection, bowel disease]. Fever can be caused by many bacterial products, most notably, endotoxin of gram-negative bacteria. Endotoxin would result in the release of endogenus pyrogen, which derived from monocytes and macrophages. Other substances that can cause fever are interlukin 1 and interferons.

Chills [2]
The word ‘chill’ refers to an episode of shivering, accompanied by paleness and feeling cold. Chills may occur at the beginning of an infection, and is usually associated with fever. Chills are caused by rapid muscle contraction and relaxation, and are the body's way of generating heat when the body feels that it is cold. Causes of chills includes exposure to cold environment and virus and bacterial infections [such as meningitis, urinary tract infection, pneumonia]

Dysuria [3]
Dysuria is a condition whereby there is discomfort/pain during urination. Causes of dysuria includes urinary tract infection, cystitis, prostatitis and urethritis

Interpretation of clinical diagnosis (urinary tract infection)
Urinary Tract Infection (UTI) is an infection that can occur along the urinary tract. [bladder, kidney, uretha, ureters] UTI can be classified into lower and upper tract infections. [4]

Although UTIs occur in both men and women, women tend to suffer more from it because of the anatomical difference. Women's urethra tube is shorter than men's, and the opening is just a short distance away from the vaginal tract and the rectal openings. Because of this, there is a higher risk of bacteria from these adjacent areas to scuttle up the tube into the bladder. [5]

Microorganism that causes urinary tract infection [4,6]

A) Bacteria [6]
1) Escherichia coli [About 75% of community acquired UTI and 40% of hospital acquired UTI are caused by E. coli]

2) Staphylococcus saprophyticus [About 5% of community acquired UTI and 1% of hospital acquired UTI are caused by S. saprophyticus]

3) Proteus mirabilis [About 3% of community acquired UTI and 10% of hospital acquired UTI are caused by P. mirabilis]

4) Pseudomonas aerginosa [About 1% of community acquired UTI and 5% of hospital acquired UTI are caused by P. aerginosa]

5) Enterobacter faecalis [About 5% of community acquired UTI and 8% of hospital acquired UTI are caused by E. faecalis]

6) Staphylococcus epidermidis [About 2% of community acquired UTI and 3% of hospital acquired UTI are caused by S. epidermidis]

7) Other Enterobactriaceae [About 5% of community acquired UTI and 25% of hospital acquired UTI are caused by other Enterobactriaceae such as Klebsiella, Enterobacter and Serratia]

In addition, Acinetobacter sp. causes nosocomial UTI. Other less common microorganism that causes UTI include Mycobacterium tuberculosis. [7]

B) Viruses [6]
1) Adenovirus
2) Human polyoma virus

C) Parasites [6]
1) Trichomonas vaginalis
2) Schistoma haematobium

D) Fungi [6]
1) Candida albicans

In this PBL, only bacteria is being dealt with thus viruses, parasites and fungus are eliminated.

Of all the bacterium that causes urinary tract infection, E. coli is the most common organism that is being isolated and it may be the most probable microganism isolated in this specimen. Mycobacterium tuberculosis causing UTI is considered relatively rare.

Escherichia coli [4]

-Aerobic, gram negative bacilli
Confirmatory test
-Microscopy and gram staining shows motile gram-negative rod
-Cultures shows dry flat lactose-fermenting colonies on MacConkey agar and haemolytic colonies on blood agar
-Biochemical test to be done/results for E. coil a) Citrate, H2S, Urea and Voges-Proskauer (VP) negative
b) Indole positive
c) Ferments both glucose and lactose with gas

Staphylococcus saprophyticus [4,6]

-Aerobic, Facultatively Anaerobic, gram positive cocci Confirmatory test
-Microscopy and gram staining shows gram-positive cocci
- White, smooth and shiny colonies
-Absence of hemolysis on blood agar
-Biochemical test to be done/results for S. saprophyticus
a) Coagulase negative
b) Deoxyribonuclease negative c) Mannitol fermentation negative

Proteus mirabilis [4,6]

-Aerobic, motile, non-spore fermenting gram-negative rod
Confirmatory test
-Microscopy and gram staining shows motile gram-negative rod
-Pale colonies on MacConkey’s agar
-Biochemical test to be done/results for P. mirabilis
a) H2S, Urea and Indole positive
b) Voges-Proskauer (VP) negative c) non-lactose fermenting

Pseudomonas aerginosa [4,6]

-Aerobic, gram-negative rod
Confirmatory test
-Microscopy and gram staining shows motile gram-negative rod
-Flat and green pigmentation on MacConkey’s agar
-Biochemical test to be done/results for P. aerginosa
a) Citrate, Oxidase positive
b) Non-lactose fermenting Indole negative

References
[1] Coico, R., Sunshine, G. and Benjamini, E. (2003) Immunology: A Short Course. John Wiley & Sons, Inc., Hoboken, New Jersey.

[2] http://www.nlm.nih.gov/ Search NLM Web Site> Chills

[3] http://www.medterms.com/> MedTerms Dictionary> Dysuria> Medical Dictionary> Dysuria

[4] Spicer W. J. (2000). Clinical Bacteriology, Mycology and Parasitology: An illustrated colour text. Churchchill Livingstone

[5] http://www.juicing-for-health.com/> Google Search> www.juicing-for-health.com >Urinary Tract Infections

[6] Elliott, T., Hastings, M. and Desselberger, U. (1997). Lecture Notes on Medical Microbiology. Blackwell Science Ltd.

[7] http://www.phagetherapycenter.com/ >>Clinics>What we treat> Chronic and Acute Urinary Tract Infections (UTI) and Cystitis

Eugene Wong

TG02

# posted by Star team @ 8:22 PM