Clinical Cases in UTI and Pyelonephritis
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Questions and Answers

What is the most likely diagnosis for the 36-year-old female with vomiting, left flank pain, and a temperature of 38.8°C?

  • Appendicitis
  • Diverticulitis
  • Pyelonephritis (correct)
  • Pneumonia
  • Which microbiology investigation is most crucial initially in the case of the patient with suspected pyelonephritis?

  • MSU & Blood cultures (correct)
  • Pro-calcitonin level
  • Aspirate from left kidney for Gram stain
  • Faeces for culture/PCR
  • Why is nitrofurantoin not suitable for treating the case of pyelonephritis?

  • It is ineffective against Escherichia coli.
  • It requires a longer duration of treatment.
  • It cannot be secreted through the kidneys if they're not functioning properly. (correct)
  • It is only effective for upper urinary tract infections.
  • In the case of the 2-day-old baby suspected of having meningitis, what is the most likely causative pathogen?

    <p>E. coli</p> Signup and view all the answers

    What is the empiric treatment recommended for suspected early neonatal meningitis?

    <p>IV Cefotaxime / Amoxicillin / Gentamicin</p> Signup and view all the answers

    Which antibiotic is specifically noted to be effective against lower urinary tract infections?

    <p>Nitrofurantoin</p> Signup and view all the answers

    What finding on Day 1 of the laboratory report suggests a significant infection?

    <p>Urine white cell count &gt;100/µl</p> Signup and view all the answers

    Which antibiotic is indicated for upper urinary tract infections like pyelonephritis?

    <p>Cefuroxime</p> Signup and view all the answers

    What distinguishes lactose fermenters from non-lactose fermenters in terms of coloration?

    <p>Lactose fermenters turn pink, non-lactose fermenters appear pale or colourless.</p> Signup and view all the answers

    Which part of the cell structure helps Enterobacterales evade the immune system?

    <p>Capsule</p> Signup and view all the answers

    What is the role of adhesins in the pathogenesis of Enterobacterales?

    <p>They facilitate attachment to host cells.</p> Signup and view all the answers

    What characteristic is true about Enterobacterales in terms of anaerobic capability?

    <p>They are facultative anaerobes.</p> Signup and view all the answers

    What type of toxin is released by Enterobacterales when the bacteria is alive?

    <p>Exotoxin</p> Signup and view all the answers

    Which of the following correctly describes the structure of the Gram-negative cell wall?

    <p>It contains lipopolysaccharides and O-antigens.</p> Signup and view all the answers

    What causes damage to the host cells in an infection with Enterobacterales?

    <p>Exotoxin production</p> Signup and view all the answers

    Which antigen helps Enterobacterales avoid immune recognition?

    <p>K-antigen</p> Signup and view all the answers

    What is the primary cause of cystitis?

    <p>Bacterial infection of the bladder</p> Signup and view all the answers

    What makes Carbapenemase-Producing Enterobacteriaceae (CPE) particularly dangerous?

    <p>They produce enzymes that inactivate carbapenems.</p> Signup and view all the answers

    Which condition is NOT commonly associated with infections from Proteus mirabilis?

    <p>Stomach ulcers</p> Signup and view all the answers

    What characteristic is used to identify non-lactose fermenters like Proteus mirabilis?

    <p>They exhibit swarming behavior on agar.</p> Signup and view all the answers

    What type of infection is particularly associated with long-term catheters in patients with urinary tract abnormalities caused by Proteus mirabilis?

    <p>Urinary tract infections</p> Signup and view all the answers

    What type of enzyme do CPE like Enterobacterales produce that contributes to their antibiotic resistance?

    <p>Carbapenemases</p> Signup and view all the answers

    What condition is associated with low white blood cell count and increases the risk of neutropenic sepsis?

    <p>Neutropenia</p> Signup and view all the answers

    Which infection is commonly associated with urinary catheters?

    <p>Complicated urinary tract infection</p> Signup and view all the answers

    What common adverse effect is Proteus mirabilis infection associated with in the urinary system?

    <p>Kidney or bladder stone formation</p> Signup and view all the answers

    Which Enterobacteriaceae species is recognized for producing an unpleasant fish-like smell?

    <p>Proteus mirabilis</p> Signup and view all the answers

    Pseudomonas aeruginosa is most likely to cause what type of eye infection?

    <p>Keratitis</p> Signup and view all the answers

    What is one of the main challenges in managing infections caused by CPE?

    <p>They are resistant to most antibiotics.</p> Signup and view all the answers

    Which of the following antibiotics is commonly used to treat Pseudomonas aeruginosa infections?

    <p>Piperacillin-tazobactam</p> Signup and view all the answers

    Burkholderia cepacia is primarily known for causing infections in which patient population?

    <p>Patients with cystic fibrosis</p> Signup and view all the answers

    What is the primary characteristic of opportunistic pathogens?

    <p>They require a compromised host defense to cause infection.</p> Signup and view all the answers

    What syndrome is associated with Burkholderia cepacia infections?

    <p>Cepacia syndrome</p> Signup and view all the answers

    Burkholderia pseudomallei is known to cause which disease?

    <p>Melioidosis</p> Signup and view all the answers

    What type of bacterial resistance is exhibited by Klebsiella pneumoniae in the reported cases?

    <p>Carbapenemase production</p> Signup and view all the answers

    Which antibiotic was found to be effective against Klebsiella pneumoniae in the laboratory report?

    <p>Piperacillin-Tazobactam</p> Signup and view all the answers

    What significant risk does the isolation of the Klebsiella pneumoniae represent in the clinical setting?

    <p>Infection control risk due to resistance genes</p> Signup and view all the answers

    What is the function of plasmids in relation to antibiotic resistance?

    <p>They transmit resistance genes between bacteria</p> Signup and view all the answers

    Which antibiotic is sometimes less effective against ESBL producing bacteria?

    <p>Ceftriaxone</p> Signup and view all the answers

    Which of the following antibiotics showed resistance in the isolated Klebsiella pneumoniae from the rectal swab?

    <p>Amoxicillin</p> Signup and view all the answers

    Why was no antibiotic treatment indicated for the 70-year-old female in the ICU?

    <p>She was colonized only without active infection</p> Signup and view all the answers

    What type of infections are commonly caused by ESBL producing bacteria like Klebsiella pneumoniae?

    <p>Urinary tract infections</p> Signup and view all the answers

    Study Notes

    Enterobacterales Overview

    • Enterobacterales include important pathogens such as Citrobacter, Salmonella, Shigella, and Yersinia; often associated with antibiotic exposure.
    • Most Enterobacterales are motile and facultative anaerobes, capable of growing in the presence or absence of oxygen.

    Lactose Fermenters vs. Non-Lactose Fermenters

    • Lactose fermenters (e.g., Escherichia coli) turn pink on agar, while non-lactose fermenters appear pale or colourless.
    • Both types can ferment glucose and other carbohydrates.

    Structural Components of Enterobacterales

    • Contains a cell wall with lipopolysaccharide (LPS) O-antigen and lipid A, which acts as an endotoxin.
    • Key virulence factors include a capsule for immune evasion, fimbriae for adhesion, and flagella.

    Pathogenesis Mechanisms

    • Pathogens attach to epithelial cells using adhesins and pili, enabling colonization and spread.
    • LPS and toxins cause damage to host cells while the bacterial capsule aids in evading the immune response.

    Clinical Cases and Treatments

    • Cystitis: Commonly results from bladder infections; treatment typically involves Nitrofurantoin.
    • Empiric Treatment for Pyelonephritis: IV Cefuroxime or Gentamicin is required due to Nitrofurantoin's ineffectiveness in upper urinary tract infections.

    Causative Agents of Meningitis

    • Early neonatal meningitis often caused by E. coli transmitted during delivery.
    • Empiric Treatment: IV Cefotaxime, Amoxicillin and Gentamicin prescribed.

    Extended-Spectrum Beta-Lactamase (ESBL)

    • ESBL-producing bacteria (e.g., E. coli, Klebsiella) are resistant to many antibiotics, complicating treatment.
    • ESBLs are prevalent in healthcare settings, especially in older adults and nursing homes.

    Carbapenemase-Producing Enterobacteriaceae (CPE)

    • CPE can inactivate carbapenems, posing significant treatment challenges; resistance genes are often carried on plasmids.
    • Infections occur in the bowel and are increasingly found in hospital environments.

    Proteus mirabilis

    • Non-lactose fermenter with characteristic swarming on agar.
    • Associated with urinary tract infections, particularly in patients with urinary abnormalities.

    Other Pathogens in Enterobacterales

    • Burkholderia cepacia: Causes opportunistic infections in cystic fibrosis patients; known for rapid transmission and multi-resistance.
    • Burkholderia pseudomallei: Causes melioidosis, particularly in Southeast Asia; transmitted via contaminated water.

    Pseudomonas aeruginosa Clinical Presentations

    • Eye infections linked to trauma or surgery; can lead to severe complications.
    • Otitis externa, especially in swimmers, can become severe in immunocompromised patients.

    Treatment Options for Pseudomonas aeruginosa

    • Common treatments include Piperacillin-tazobactam, Ceftazidime, Ciprofloxacin, and reserved use of Carbapenems like Meropenem.

    Opportunistic Pathogens

    • Caused by inherently low-virulence organisms; infection typically occurs in immunocompromised hosts, including those on chemotherapy or corticosteroids.

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    Description

    This quiz evaluates clinical knowledge surrounding urinary tract infections and pyelonephritis, highlighting case scenarios related to management and diagnosis. Test your ability to identify likely sources of abdominal pain and vomiting in women with flank pain.

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