1. Urinary Tract Infection

2. URINARY TRACT INFECTION DEFINITION: TISSUE RESPONSE TO THE PRESENCE OF SIGNIFICANT AMOUNT OF BACTERIA IN THE URINE

3. Physical Composition and Chemical Properties Urine  95% water  5% waste products  Other dissolved chemicals Urea, uric acid, ammonia, calcium, creatine, sodium, chloride, potassium, sulfates, phosphates, bicarbonates, hydrogen ions, urobilinogen

4. Specimens Types Varies in method used and in time frame in which to collect specimen Types of specimens:  Random  First morning  Clean catch midstream  24 hour

5. Specimens Types (cont.)  Random – most common, taken anytime of day  First morning – has a greater concentration of substances, taken in morning  Clean catch midstream – the urethral area is cleaned, urine is tested for microorganisms or presence of infection  24 hour – used for quantitative and qualitative analysis of substances. Some common 24-hour preservatives are hydrochloric acid, boric acid, acetic acid and thymol.

6. LABORATORY EVALUATION Other types of Urine sampling: Catheterization Suprapubic aspiration Pediatric Bag

7. Catheterization  Urinary catheter  Urinary catheter – plastic tube inserted to provide urinary drainage

8. Types Of Urine Collection Suprapubic Aspiration Specimen This method is used when a bedridden patient cannot be catheterized or a sterile specimen is required. The urine specimen is collected by needle aspiration through the abdominal wall into the bladder.

9. Specimen Collection Supra-pubic Needle Aspiration

10. Types Of Urine Collection Pediatric Specimen For infants and small children, a special urine collection bag is adhered to the skin surrounding the urethral area. Once the collection is completed, the urine is poured into a collection cup.

12. Urinalysis Evaluation of urine to obtain information about body health and disease Three types of testing:  Physical  Chemical  Microscopic

13. Preservation and Storage Changes that affect the chemical or microscopic properties of urine occur if urine is kept at room temperature for more than 1 hour Refrigeration – most common method for storing and preserving urine It prevents bacterial growth for 24 hours. After 24 hours use chemical preservation

14. Physical Examination of Urine Visual examination of physical characteristics  Color and turbidity  Volume  Odor  Specific gravity  The refractometer or a reagent strip is used to measure specific gravity Reagent Strips Refractometer

15. Chemical Analysis Urine Dipstick Glucose Bilirubin Ketones Specific Gravity Blood pH Protein Urobilinogen Nitrite Leukocyte Esterase

16. Chemical Analysis

17. Chemicals Found in Urine  Ketone bodies  Ketone bodies – may indicate that patient is following a low carbohydrate diet or that patient has conditions such as starvation  pH  pH – provides information about metabolic status, diet, medication or several conditions  Blood (hematuria)  Blood (hematuria) – may indicate patient is menstruating, have urinary tract infection or trauma

18. Chemicals Found in Urine (cont.) Bilirubin or urobilinogen Bilirubin or urobilinogen – first signs of liver disease Glucose Glucose – common in patients with diabetes Protein Protein – usually indicates renal disease Nitrite Nitrite – suggests bacterial infection Leukocytes Leukocytes – urinary or renal infection

19. Microscopic Examination of Urine  Microscopic examination used to view elements not visible without microscope  Centrifuge spins urine to cause heavier substances to settle to the bottom Casts Yeasts Parasites Cells Crystals Bacteria

20. Microscopic Examination RBCs

21. RBCs

22. WBCs

23. Squamous Cells

24. Microscopic Examination

25. Yeasts

26. Yeasts

27. RBCs Cast

28. Microscopic Examination WBCs Cast

29. Microscopic Examination Hyaline Cast

30. Microscopic Examination Waxy Cast

31. Urinary Crystals Classification Normal and Abnormal Normal Acidic crystals Normal Alkaline crystals Abnormal crystals - metabolic origin

32. Amorphous Urates and Phosphates

33. Microscopic Examination Calcium Oxalate Crystals

34. Microscopic Examination Calcium Oxalate Crystals Dumbbell Shape

35. Microscopic Examination Triple Phosphate Crystals

36. Ammonium Biurate

37. Uric acid crystal

38. leucine crystal

39. Microscopic Examination Tyrosine Crystals

40. Microscopic Examination Cystine Crystals

41. Cystine crystals in urine Cystine, an amino acid, is an abnormal finding in urine. Rarely seen, these crystals are found in acid urine and are seen as thin, colorless, hexagonal plates.

42. LABORATORY EVALUATION Urine culture Midstream clean catch  10 ⁵ colony forming units Cathterization  10.000 CFU Suprapubic aspiration  any growth

43. Mix the urine sample to re-suspend microorganism present. Dip a 1 μl or 10 μl calibrated loop in vertical position in the urine and remove the loop and use the collected fluid to inoculate Blood and MacConkey agars respectively. Culturing Procedure

45.  A plate count of 100,000 CFU/ml of pure culture should be considered positive and isolated organism should be identified and sensitivity test will be performed.  A plate count between 10,000 – 100,000 CFU/ml is considered suspected.  A plate count less than 10,000 CFU/ml is considered negative. Colony counting

46. Inoculation of Urine Inoculation of urine for quantitative culture (colony forming units→cfu’s) performed with a calibrated 0.001 mL and 0.01 mL plastic or wire loop Sheep blood agar (SBA) utilized for quantitative urine culture With 0.001 ml loop, 1 colony on SBA equivalent to 1,000 cfu’s per mL of urine With 0.01 ml loop, 1 colony on SBA equivalent to 100 cfu’s per mL of urine

48. Infecting organisms E.coliProteus KlebsiellaPseudomonas Staphylococci Enterococci

49. E.coli IMViC reaction of E. coli: + + - - KIA A/A

50. Klebsiella species Significant biochemical reactions Lactose positive Most are urease positive Non-motile

51. Klebsiella species IMViC reaction of K. pneumoniae: - - + +

52. Proteus spp. KIA: G+, K/A SIM: H2S+, I variabil, M+ Urea: + Simmons: +

53. Proteus spp. Proteus - Members of the genus Proteus will swarm at certain intervals and produce a pattern of rings due to their motility.

55. Pseudomonas aeruginosa Greenish discoloration of media due to production of pyocyanin by Pseudomonas aeruginosa

56. Pseudomonas spp.

57. Pseudomonas aeruginosa Results of oxidase test

58. Staphylococcus aureus G-positive cocci in clusters, typical of Staphylococcus aureus Catalase test used to differentiate Staphylococci from Streptococci

59. Coagulase test used to differentiate S. aureus from other Staphylococcus spp.

60. Staphylococcus saprophyticus Coagulase-negative staphylococci Novobiocin Resistant: Zone is less than or equal to 16mm

62. Schistosomiasis Females are slender and delicate, whereas males are much bigger and have a spiny trough or groove into which the female fits and locks in. The male consumes blood and feeds the female most of it, which she turns into eggs, which pass out of the host and can begin the life cycle again.

63. (1) The adult worms look like nematodes, elongated cylindrical in shape. (2) Two sexes are separate. (3) egg without operculum, but with a terminal spine. (4) only one intermediate host required. (5) The infective stage is cercaria. (6) The infective route is by skin. (7) The eggs are main pathogenic stage. Blood fluke is a special kind of flukes because of following characters:

65. Paired male and female adult worms. The female is the darker, curled worm within the male's gynacophoric canal.

66. Mature egg is oval in shape, slight yellow in color, shell is thin without an operculum but with a terminal spine. The content is a miracidium. Cercaria is infective stage. It is composed of the body and forked tail (including tail stem and fork) and has 5 pairs of penetrating glands in the body.

67. oval in shape, slight yellow in color, shell is thin without an operculum but with a terminal spine.

68. A Comparison of Schistosome Eggs S. mansoni Lateral spine S. haematobium Terminal spine S. japonicum No spine

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