Gina presents with pain on urination. When asked she mentions really needing to go and having very little urine in comparison to the urgent need she has to urinate. She also mentions that she has suprapubic pain just befor urination and that it seems like she is urinating more frequently. Her vital signs are all normal. Examination of the genitalia did not reveal any vaginal discharge. A dipstick test of her urine was positive for leukocyte esterase and nitrites. Urine pH was 6.5.
A. Which of the following is the most appropriate diagnosis for Gina's current condition?
urethritis- yes she has dysuria and so she has urethritis. However, she also has a even more invasive infection in that she also has a bladder infection.
cystitis*- dysuria, with increases in urgency and frequency indicate more than just a urethral infection. Suprapubic pain pre-void also indicates cystitis.
pyelonephritis- no fever, back or flank pain. Probably has not ascended to the kidney yet.
pelvic inflammatory disease- this is a urinary tract infection not an infection of the reproductive tract- no spotting, abdominal pain associated with the uterus, no vaginal discharges.
vaginitis- no vaginal discharge
B. Which of the following is the most common cause of her current condition?
Escherichia coli*- most common cause. Is nitrite positive too.
Klebsiella pneumoniae- not the most common cause
Proteus mirabilis- not the most common cause and it would have raised the pH of the urine.
Staphylococcus saprophyticus- second most common cause and nitrites negative.
Enterococcus faecalis - not the most common and nitrites negative.
C. If her urine pH had been 8.0 then which of the following would have been the most likely cause of her current condition?
Escherichia coli - would not raise pH- no urease
Klebsiella pneumoniae- would not raise pH as much, not enough urease
Proteus mirabilis*- produces lots of urease, the most likely
Staphylococcus saprophyticus - nitrites negative
Enterococcus faecalis- nitrites negative
D. If her dipstick tests were positive for leukocyte esterase but negative for nitrites and the pH had been 6.5 then which of the following would have been the most likely cause of her current condition (note the organism in the urine this time was catalase positive)?
Escherichia coli - would be positive for nitrites
Klebsiella pneumoniae- would be positive for nitrites
Proteus mirabilis- would be positive for nitrites
Staphylococcus saprophyticus*- negative for nitrites the second most common cause of UTI and is catalase positive.
Enterococcus faecalis- negative for nitrites but is catalase negative.
