UTIs
What is an opportunistic infection?
An infection caused by an organism that is usually considered a part of our normal flora and normally does not cause an infection.
Bonus Q: who is more at risk of developing an opportunistic infection?
Who is recommended to get the shingles vaccine?
Anyone over 60 years old.
What is a chronic latent infection?
An infection in which the original virus becomes dormant only to reactivate years later and cause a new infection.
Bonus Q: What chronic latent infection was discussed in the video lecture?
Which is the rarest form of meningitis: bacterial, viral, or fungal?
Fungal meningitis is the most rare.
Where does meningitis cause inflammation?
The meninges and CSF
Bonus Q: Is meningitis caused by bacteria, a virus, or a fungus?
How is bacterial meningitis diagnosed?
-lumbar puncture
-blood cultures
Bonus Q: List at least two things that will be measured in the lumbar puncture.
List one example of an upper urinary tract infection and one lower UTI.
Upper: pyelonephritis (inflammation of the kidney)
Lower: cystitis (traditional UTI, inflammation of the bladder), urethritis, and prostatitis.
Bonus Q: are boys or girls more likely to develop a UTI?
The Herpes Varicella-Zoster virus is known to cause what chronic latent infection?
Shingles
Bonus Q: What primary infection does this virus cause first?
What is shingles an infection of?
The nerve cells and skin.
Bonus Q: Is shingles caused by a bacteria or by a virus? (+100 pts for naming the pathogen)
What is a positive Kernig’s sign?
A patient is laid on their back and leg is lifted up. When the knee is slowly straightened by the physician, it is stiff and causes intense pain.
Bonus Q: Is this diagnostic of meningitis?
What is a positive Brudzinski’s sign?
Patient is laid on their back. When the head and neck are lifted up, this causes immense pain and they draw their knees up at the same time.
Bonus Q: This test is more reliably indicative than Kernig’s of what infection?
What patients are at the highest risk of developing fungal meningitis?
Immunosuppressed patients, such as cancer patients.
Bonus Q: What is the most common cause of fungal meningitis?
What can put someone more at risk of developing a UTI)
-urinary stasis (ex: immobile, bed rest)
-irritants (ex: bubble bath)
-bladder catheterization
-illness (ex: DM, MS, abx therapy, spinal cord injury)
-family history of UTIs
-race (2-4x higher in white children than black children)
What is at least one clinical manifestation of shingles?
-painful, itchy, tingly rash (dermatomes are connected to nerves)
-rash in 1-2 adjacent dermatomes, often on the trunk (rash with develop in clusters, then dry out as new ones form. Will often last for 2-4 weeks)
-headache
-photophobia
-malaise
What is postherpetic neuralgia, a potential complication of shingles?
Persistent pain in the same area of the shingles rash, even after the rash is gone. More common as people get older.
Bonus Q: how long can this last?
Is the blood-brain barrier altered by bacterial meningitis? If so, how?
The bacterial by-products and inflammatory mediators alter the permeability of the blood brain barrier.
A lumbar puncture is done on a patient with suspected meningitis. The CSF fluid drawn is very cloudy with a decreased glucose level. What type of meningitis do you suspect this is?
Bacterial meningitis.
Why would we see decreased levels of glucose in the CSF in a patient with bacterial meningitis versus a patient with viral meningitis?
The bacteria in the CSF will eat/use the available glucose for themselves while the virus will not.
What are at least 3 potential patient eduction topics concerning UTIs?
-Perineal Hygiene (wipe front to back)
-Avoid tight clothing
-Cotton underwear
-Avoid “holding” urine
-Encourage frequent urination
-Empty bladder completely
-Avoid straining with stool/constipation
-Increase dietary fiber
-Encourage generous fluid intake
What are some ways we can help treat/manage the symptoms of shingles?
-analgesics
-wet compresses
-calamine lotion
-colloidal oatmeal baths
Bonus Q: what type of medications needs to be needs as soon as the rash appears to help treat the shingles infection?
List at least two potential complications of shingles.
-postherpetic neuralgia
-bacterial superinfection (especially if their picked at the rash scabs)
-cranial and peripheral nerve palsies
-meningoencephalitis (inflammation of brain membranes and surrounding cerebral tissue), pneumonitis (alveoli inflammation), etc…
-herpes zoster ophthalmicus (inflammation of the eye)
For bacterial meningitis, what bacteria is known to cause meningitis in neonates and which is known to cause outbreak/epidemic meningitis?
Group B strep and gram negative bacilli are the leading causes of meningitis in neonates.
Neisseria meningitidis is the main cause of meningitis outbreaks.
Bonus Q: Where are outbreaks of meningitis more likely to happen?
What are at least 3 clinical manifestations of viral meningitis?
-headache
-low-grade fever
-GI upset
-positive Kernig’s sign
-positive Brudinski’s sign
What are at least 3 clinical manifestations of fungal meningitis?
-stiff neck
-fever
-headache
-nausea and vomiting
-photophobia
-LOC changes
What is the most common gram-negative bacterial cause of UTIs?
E. coli
List at least 3 clinical manifestations of bacterial meningitis in older children and adults.
-Nuchal/neck rigidity
-Positive Kernig and Brudzinski signs
-LOC changes (early
-seizures (early)
-photophobia
-Headache
-vomiting
-Fever (high_ and chills)
-Abrupt onset
-Petechial rash (very late sign, probably have sepsis and DIC too now)
Bonus Q: What are at last 2 clinical manifestations in infants?
What are potential complications of bacterial meningitis if it spreads to cranial nerves?
-deafness
-blindness
-paralysis
Bonus Q: Will these complications/symptoms go away once the meningitis is resolved?
What is the pharmacologic treatment of UTIs in children vs adults?
Children (over 1 month old): cephalosporin
Adults: trimethoprim-sulfamethoxazole