Star Team

Patient : Maisy Hong
Age : 67
Urine Specimen 3

Patient complains involve fever, chills, bladder distension; on indwelling catheter. This patient is diagnosed to be suffering from Urinary Tract Infection (UTI) by the doctor.

UTI is bacterial infection of the urinary tract. This infection stimulates the inflammation process thus explaining fever and chills suffered by the patient. Bladder distention is refered as abnormal enlargement of the bladder, resulting from an inability to excrete urine, causing its accumulation. Distention can be caused by a mechanical or anatomic obstruction, neuromuscular disorder, or the use of certain drugs. It is relatively common in all ages and both sexes. [1]

An indwelling urinary catheter can result in urine retention and bladder distention. While the catheter is in place, inadequate drainage due to kinked tubing or an occluded lumen may lead to urine retention. In addition, a misplaced urinary catheter or irritation with catheter removal may cause edema, thereby blocking urine outflow. [1]

Possible Microorganisms casing UTI [2]
· S. epidermidis
· S. saprophyticus
· E.coli
· Proteus
· Serratia
· P. aeruginosa
· Enterococci
· Acinetobacter
· Klebsiella

However, possible microorganisms that are causing the UTI in this patient are as follows [2]:
· S. epidermidis
· Enterococci
· E.coli
· Proteus
· Serratia
· P. aeruginosa
· Acinetobacter

S.saprophyticus and Klebsiella are removed as S. sapro is commonly found in young women (patient is a 67 year-old woman) while Klebsiella is commonly found in the bronchi rather than the urinary tract [2].


Laboratory tests to be carried out:

Urine samples collected from patient are cultured onto blood agar and MacConkey agar so that colonies will grow after incubation. Colonies on blood agar will be used for other tests that will confirm the identity of microorganism causing the UTI [4].

S. epidermidis [2]
· Gram-stain – gram-positive
· Coagulase test – coagulase negative, no agglutination appears

2. Enterococci [2,3]
· Gram-stain – gram-positive cocci that tend to appear in pairs

3. E.coli [2,3,4]
· Appears as lactose-fermenting colonies
· Gram-stain – gram-negative
· Indole test – positive
· MUG test – positive
· Methyl red test – positive
· Voges Proskauer – negative
· Citrate test - negative

Proteus [2,3,4]
· Producing swarming effect on blood agar with pungent odour
· Growth in potassium cyanide medium - positive
· Xylose fermentation - positive
· Phenylalaninie deamination - positive

Serratia [2,3]
· Gram-stain – gram-negative
· Methyl red test – negative
· Citrate test – positive
· Tryptophan - positive
· Oxidation - postive
· Fermentation - positive

P.aeruginosa [2,3,4]
· Green background around colonies in blood plate
· Non-lactose fermentors on MacConkey plate
· Gram-stain – gram-negative
· Oxidation – positive
· Citrate test – positive
· Indole test - neagtive

Acinetobacter [2,3]
· Generally non-lactose fermenting
· Gram-stain – gram-negative
· Oxidative – negative
· Nitrate - negative

References
1. Wrong Diagnosis.Com (2007) Bladder Distension. Retrieved 2nd December, 2007, from
http://www.wrongdiagnosis.com/symptoms/blood_in_urine/book-causes-16a.htm

2. Medical Microbiology Lecture Notes

3. Wikipedia.com (2007). Retrieved 2nd December, 2007, from
http://www.wikipedia.com/

4. Student Attachment materials


phuiyuen, TG02