GENITOURINARY TRACT

INFECTIONS

Apolinario, Ma. Jesusa

De Sotto, Ryan
Edora, Jessica Laraine
ANATOMY
MALE
FEMALE
KIDNEY
 BACTERIAL PROSTATITIS
• ACUTE BACTERIAL PROSTATITIS
• most rare type
• Type 1
• Well-defined infectious disease of the LUT
• Bacterial cause is E. coli
• Frequently presents with bacteremia
SIGNS AND SYMPTOMS

• Dysuria
• Urinary frequency
• Intense suprapubic pain
• Urinary obstruction
• Fever
• Arthralgia
• Myalgia
• Malaise
EPIDEMIOLOGY

• 6% incidence, prevalence rate is 8%

• Occurs in 0.02% of all patients of prostatitis
• It is the third most common diagnosis in men
older than 50 years, after BPH and prostate
cancer
ETIOLOGIC AGENTS
• Escherichia coli
• Proteus mirabilis
• Klebsiella species
• Enterobacter species
• Pseudomonas aeruginosa
• Serratia species
• Staphylococcus aureus
ETIOLOGIC AGENTS
• Of all the possible pathogens of ABP,
Escherichia coli is the most common

Escherichia coli
• Gram-negative, facultative anaerobic and non-
sporulating

• 37°C, but some laboratory strains can multiply at

temperatures of up to 49°C
E. coli growth in MacConkey agar
E. coli growth on EMB
PATHOGENESIS
• Uropathogenic E. coli (UPEC) is responsible for
approximately 90% of urinary tract infections (UTI)

• Uropathogenic E. coli utilize P fimbriae

• Uropathogenic E. coli produce alpha- and beta-hemolysins,

which cause lysis of urinary tract cells

• UPEC can evade the body's innate immune defenses

• They also have the ability to form K antigen, capsular

polysaccharides that contribute to biofilm formation
LABORATORY DIAGNOSIS
• Gentle rectal examination
• Prostatic massage
• Unadvisable because it could precipitate bacteremia
• Prostate-specific antigen
• CT scan
• Careful Transrectal Ultrasound
• Bladder Scanning
TREATMENT and PREVENTION

• rapid initiation of broad-spectrum parenteral

antibiotics
• Penicillin or Penicillin-derivatives with addition
of Aminoglycoside
• Fluoroquinones after initial therapy
• Healthy way of living
• Increase fluid intake
 BACTERIAL PROSTATITIS
• CHRONIC BACTERIAL PROSTATITIS

• diagnosed with recurrent UTI

• most common cause of relapsing urinary tract infection
in males.
• Asymptomatic periods are interspersed between
episodes of recurrent bacteriuria.
• condition is characterized by bacterial growth in culture
of the expressed prostatic fluid, semen, or post massage
urine specimen
SIGNS and SYMPTOMS
• Genitourinary pain
• Dysuria
• hematospermia
• Clear urethral discharge
• perineal, scrotal, and low back discomfort
• Vague discomfort in pelvis, perineum, lower
abdomen, back and testis
EPIDEMIOLOGY

• Affects 5%-10% of all patients have this type of

prostatitis
• occurs in less than 5% of patients with
prostatitis
ETIOLOGIC AGENTS

• same as in acute bacterial prostatitis.

• Most infections are caused by a single
pathogen
• Obligate anaerobic bacteria rarely cause
prostatic infection.
ETIOLOGIC AGENTS
• Escherichia coli (80%)
• Klebsiella species
• Enterobacter species
• Proteus enterococci species
• Pseudomonas species
• Staphylococcus species
ETIOLOGIC AGENTS

• The role of the gram-positive organisms

Staphylococcus epidermidis and
Staphylococcus saprophyticus is controversial
PATHOGENESIS
• Biofilm-producing E. coli are resistant to immune factors
and antibiotic therapy
• The actual routes of prostatic infection are unknown in
most cases
• Routes of infection include the following:
• Ascending urethral infection
• Reflux of infected urine into prostatic ducts
• Migration of rectal bacteria via direct extension or
lymphogenous spread
• Hematogenous infection
LABORATORY DIAGNOSIS
• expressed prostatic secretions or EPS
• Prostate specific antigen
• Prostatic massage
TREATMENT and PREVENTION
• Treatment requires prolonged courses (4-8
weeks) of antibiotics
• These include quinolones (ciprofloxacin,
levofloxacin), sulfas (Bactrim, Septra) and
macrolides (erythromycin, clarithromycin)
• Radical transurethral prostatectomy
• Healthy diet
TREATMENT and PREVENTION
• Antimicrobial agents that most effectively
penetrate into the prostatic fluid
fluoroquinolones and TMP-SMZ
• Treatment should be guided by urine culture
results
GENITOURINARY TUBERCULOSIS
• associated with pulmonary infection or occurs
during reactivation many years later from
infection previously seeded in the kidneys
• second most common form of the disease
after pulmonary tuberculosis
 Signs and Symptoms

• fever
• weight loss
• Urgency
• Frequency
• flank pain
• suprapubic pain
• hematuria
 Epidemiology
• affects between 3.5 and 4 million people per
year worldwide
• 4% to 9% of people with active pulmonary
tuberculosis develop genitourinary
involvement
• often occurs in older people and in
immigrants from places with high prevalence
rates
• predominantly a disease of young adults, with
roughly half of the patients between 20 to 40
years, and 75 percent under 50
 Etiologic agent

• caused by Mycobacterium tuberculosis

• Mycobacterium tuberculosis is an
aerobic, non-sporeforming, nonmotile
bacillus
 Pathogenesis

• Mycobacterium tuberculosis bacilli are

inhaled through the lungs to the alveoli
• some are carried to the region's lymph
nodes
• thoracic duct may deliver mycobacteria
to the venous blood
• may result in seeding of different
organs, including the kidneys
• the bacteria lodge within the tissues of
the genitourinary tract
• form caseating granulomas
• damage may obstruct the drainage
system and impair the blood supply,
causing hypertension
Infected kidney
 Laboratory Diagnosis
• Routine urinalysis
• Early morning urine specimens 3 days in a
row
• Urine culture
• Skin test (Intradermal Mantoux)
• Intravenous urogram
• Kidney-ureter-bladder (KUB) x-ray
 Treatment and Prevention
• early diagnosis is important
• contact with people with active pulmonary tuberculosis should
be avoided
• GENERAL MANAGEMENT:
-Bed rest
-ensure adequate nutrition
• DRUG THERAPY:
-rifampin
-ethambutol
-isoniazid
• SURGERY:
-may be necessary to remove a nonfunctioning kidney
 EPIDIDYMITIS
• is an inflammation or infection of the
epididymis
• common cause of intrascrotal inflammation
• most often caused by a bacterial infection or
by a sexually transmitted disease (STD) such
as gonorrhea or chlamydia
• non-infectious cause of epididymitis is the
use of anti-arrhythmic medication,
amiodarone
 Signs andSymptoms
• Painful scrotal swelling(testes enlarged)
• Testicular lump
• Tender, swollen testicle on affected side
• Tender, swollen groin area on affected side
• Testicle pain aggravated by bowel movement
• Chills and fever
• Discharge from urethra (the opening at the end of the
penis)
• Blood in the semen
• Groinpain
• Painful intercourse
• Enlarged lymph nodes in the groin
• Pain or discomfort in the lower abdomen or pelvic area
• Pain in urination
 Epidemiology
• most common in men between the ages
of 19 and 35
• incidence is approximately 600,000
cases per year
• Men who have recently had surgery or
have a history of structural problems
involving the genitourinary tract
 Etiologic Agent
• gram-negative aerobic rods caused more
than two thirds of the cases of bacterial
epididymitis
• coliform organisms:
- Escherichia coli
- Pseudomonas sp.
• Mycobacterium tuberculosis (TB) can
manifest also as epididymitis
 Complications
• Infertility
• Scrotal abscess formation
• Shrinkage of the affected testicle
• Epididymo-orchitis
 Diagnosis
• Urinalysis and culture
• CBC
• Gram stain
• physical exam
• rectal examination
• STD screening
• Ultrasound imaging
• Nuclear scan of the testicles
 Treatment and Prevention
• Antibiotic therapy:
- trimethoprim sulfamethoxazole, ceftriaxone,
doxycycline or azithromycin, fluoroquinolone and
trimethoprim sulfamethoxazole
• Analgesics for pain control
• Supportive care
• Bed rest
• Scrotal elevation
• Wear an athletic supporter
• Apply cold packs to your scrotum
• Surgery is sometimes necessary
• a follow-up visit with your health care
provider
 CYSTITIS
• Cystitis is an inflammation of the bladder, sometimes
involving the tube that drains urine from the bladder, called
the urethra.

• Cystitis is the most common form of urinary tract infection

and occurs mainly in women. But men and children also
can experience cystitis.

• Bacterial infection causes most bouts of cystitis. This

bacterial growth causes the inside walls of the bladder to
become inflamed.
 TYPES
• There are many types of cystitis but the only
significant kind of this disease is the
Emphysemtous cystitis which is caused by
gas-forming organisms such as E. coli and
Aerobacter aerogenes.
• Other types include hemmorhagic and
ulcerative cystitis which are under acute
simple infection and cystitis follicularis which
belongs to the chronic infection.
ETIOLOGIC AGENTS
• Organisms inhabiting the perineal area,
especially Esherichia coli, Proteus and
Klebsiella, are the common infectious agents.

• Other causative agents include;

pseudomonas and Corynebacterium.
 PATHOGENESIS
• Uropathogenic E. coli frequently produce the
extracellular protein hemolysin

• Adherence properties of gram-negative

organisms of the vaginal mucous membrane

• Ascending of the bacteria from the vaginal

reservoir to the bladder mucosal surface and
invasion of the vesical wall
 EPIDEMIOLOGY

• This disease can occur to 2 out of 100 people

and most cases are found in women.
SIGNS AND SYMPTOMS
• Pressure in the lower pelvis
• Dysuria
• urgency
• Nocturia
• Hematuria
• Foul odor of Urine
LABORATORY DIAGNOSIS
• Urine analysis is done if the doctor suspects infection of
the bladder
• Cystoscopy is done with a cytoscope and used remove a
sample tissue for further analysis and inspection
• Imaging tests like X-ray or ultrasound is quite important
to help rule out other potential causes of bladder
inflammation, such as a tumor or structural abnormality.
 TREATMENT AND
PREVENTION
• Cystitis caused by bacterial infection is generally treated
with antibiotics which serves as the first line of treatment
for cystitis caused by bacteria.
• Keeping the genital area clean and remembering to wipe
from front to back may reduce the chance of introducing
bacteria from the rectal area to the urethra.

• Increasing the intake of fluids may allow frequent

urination to flush the bacteria from the bladder.
 TREATMENT AND
PREVENTION
• Urinating immediately after sexual intercourse
may help eliminate any bacteria that may have
been introduced during intercourse.
 EMPHYSEMATOUS
CYSTITIS
• A rare form of infectious cystitis
characterized by the presence of gas in
the bladder wall.
• Emphysematous cystitis is nearly
always associated with diabetes
mellitus, because gas in the bladder
wall is the result of fermentation of
urinary glucose to carbon dioxide
SIGNS AND SYMPTOMS
• dysuria,
• haematuria
• pneumaturia
• Glycosuria
 ETIOLOGIC AGENTS
• Escherichia coli and Aerobacter
aerogenes are the most commonly
isolated organisms from the infected
part.
 PATHOGENESIS
• The pathogenesis of emphysematous
cystitis is poorly understood
•Elevated tissue glucose levels in diabetic patients
may provide a more favorable microenvironment for
gas-forming microbes
 DIAGNOSIS
• Radiographs
Conventional radiographs demonstrate irregular
humps in the bladder wall.

• Intravenous urography
Intravenous urography confirms the presence of
gas in the bladder, as a horizontal air contrast level on
erect films.

• Ultrasound
Ultrasound may detect bladder wall air as
intramural echogenic foci with "dirty" shadowing.
 TREATMENT AND
PREVENTION
• Antibiotics are used to control bacterial infection. It is vital
that one finish an entire course of prescribed antibiotics.
• Commonly used antibiotics include:
• Nitrofurantoin
• Trimethoprim-sulfamethoxazole
• Amoxicillin
• Cephalosporins
• Ciprofloxacin or levofloxacin
 URETHRITIS
• Inflammation of urethra

• Very common condition that is also

associated with both nonspecific
genital infections and specific
STD’s
 2 Divisions:
• Gonococcal urethritis
- infection with Neisseria
gonorrhoeae

• Non-gonococcal urethritis
- urethritis is present but
gonococci are not detected
 EPIDEMIOLOGY
• Occurs both in men and women
• Condition generally diagnosed only
in men
• When in women and is not
associated with a urinary bladder
infection(cystitis) it is called
urethral syndrome
 SIGNS AND SYMPTOMS

• First symptoms usually appear

after 1-3 weeks of initial infection:

• More frequent need to urinate

• Itch in the urethra
• Burning sensation on urination
• Signs:
• Men: urethral discharge
- clear, white or yellow
- varies from a few drops to large
amounts
• Women: urethral discharge
- slightly clear, white or yellow
- more noticeable during morning
hours
 ETIOLOGIC AGENTS
• Gonococcal urethritis
- Neisseria gonorrhoeae
• Non-gonococcal urethritis
- Chlamydia trachomatis
- Ureaplasma urealyticum
 PATHOGENESIS
• spread of Neisseria gonorrhoeae
gonorrhoeae to the urethra
Duringsexual
to the urethra during sexual intercourse
intercourse

• Attachment of Escherichia coli

fimbrae on urethral epithelium
 DIAGNOSIS
• Personal history
• Symptoms noted
• Endourethral swabs
• Gram stain
• Urine examination
 TREATMENT
• Gonococcal urethritis:
- ceftriaxone
- ciprofloxacin
• Non-gonococcal urethritis:
- tetracycline
- erythromycin
 Pyelonephritis: Upper Urinary
Tract Infection

• infection of kidney (parenchyma) and pelvis

(pyelum)

• usually results from non-contagious bacterial

infection of the bladder
 Urethra: male vs. female

Female urethra

Male urethra
Etiologic agents
primary etiologic agent:
•Escherichia coli

Growth on MAC
Growth on EMB
secondary etiologic agents:

•Klebsiella pneumoniae

•Proteus mirabilis

•Pseudomonas aeruginosa

•Enterobacter spp.
Pyelonephritis: Upper Urinary Tract
Infection
Pathogenesis
•Ascending route of infection
•Hematogenous spread
•Vesicoureteral reflux
•Kidney stones
•Instrumentation
•Urinary tract obstructions- chronic pyelonephritis
 Acute Pyelonephritis

•a sudden inflammation caused by bacteria

•most frequently occurs as a result of ascending

movement of bacteria

•can be resolved without permanent damage to

tubules
Signs and Symptoms

•shaking chills
•high fever
•flank tenderness /back pain
•dysuria
•hematuria

irritative voiding symptoms:

•dysuria
•a sense of urgency
•increased frequency of urination
 Chronic pyelonephritis
•also called Chronic Infective Tubulointerstitial
Nephritis
•persistent or recurrent kidney inflammation

•occurs almost exclusively in patients with major

anatomic abnormalities
Diagnosis

•results of physical examination

•laboratory tests:
•blood tests and blood cultures
•urinalysis
•urine culture
Treatment

•antibiotic therapy (ciprofloxacin,

ampicillin or trimethoprim-
sulfamethoxazole)

•initial hospitalization

•surgery

•follow-up treatment
Prevention

• increase fluid intake (cranberry juice,

blueberry juice, and fermented milk products)

•strict personal hygiene

•frequent urination
 Glomerulonephritis

•a range of immune-mediated disorders that

cause inflammation within the glomerulus and
other compartments of the kidney

•In 1% of children and 10% of adults who have

acute glomerulonephritis, it evolves into rapidly
progressive glomerulonephritis
GLOMERULUS: NORMAL VS. INFECTED WITH GN

www.unckidneycenter.org
Acute Postreptococcal Glomerulonephritis

• animmune complex disease caused by

group A Beta-hemolytic streptococcus types
12 and 49

• typically occurs 10 to 14 days following a

streptococcal infection
Rapidly Progressive Glomerulonephritis

• results in a rapid decrease in glomerular

filtration rate

• presence of crescents in the majority of the

glomeruli
 Etiologic agent

Streptococcus pyogenes

β-hemolytic acitivity of Streptococcus

pyogenes on SBAP
 Pathogenesis

• formation of antibodies by S. pyogenes

- hyaluronic acid capsule
- M protein
- protein F
- DNase
 Signs and Symptoms
• severe and rapid loss of kidney
function

• proteinuria

• cola- colored urine (hematuria)

• hypertension

• edema

• decreased urine volume

 Diagnosis

• physical exam

• kidney biopsy
 Treatment
• APGN
- antibiotic treatment (Penicillin)

- peritoneal dialysis

• RPGN
- treatment with streroids and or
cyclophosphamide