Urinary tract infections - Causes, symptoms and treatment. MF.

Every year, a huge number of patients, both adults and children, regardless of gender, face such a serious medical problem as a urinary tract infection. Women suffer from this infection much more often than men, but men with the development of urinary tract infections expect a tendency to a protracted and even severe course of the disease.

Urinary tract infections are inflammatory diseases of the human urinary system caused by infectious microorganisms that have a recurring course with possible complications.

The urinary tract( urinary tract) is a single set of organs for the formation of urine and its excretion from the body, it is a serious system of isolation, from the clear functioning of which depends not only the state of the human body, but also the patient's life in some cases( in acute kidney failure).Urinary tracts are formed from buds of the bean-shaped form( urine is formed in them), ureters( urine enters the bladder through them), urinary bladder( urine reservoir), urethra or urethra( urine release outwards).

Urinary tracts play a significant role in maintaining the water-salt balance of the body, the production of a number of hormones( erythropoietin, for example), the release of a number of toxic substances from the body. For a day on average, up to 1.5-1.7 liters of urine is released, the amount of which can vary depending on the fluid, salt, urinary tract diseases.

Risk groups for urinary tract infections:

- Female sex( women are 5 times more likely to have such infections than men, this is due to the physiological characteristics of the woman's body - a short and wide urethra, which makes infection easier to enter the urinary tract).
- Children up to 3 years of age( inferiority of immunity, in particular, infections of the excreting system are the most frequent cause of fever of unknown origin among boys up to 3 years old).
- The elderly due to the development of age-related immunodeficiency.
- Patients with peculiarities of the structure of the urinary system( for example, an enlarged prostate gland can obstruct the flow of urine from the bladder).
- Patients with renal pathology( eg, urolithiasis, in which stones are an additional risk factor for the development of infections).
- Resuscitation and intensive care patients( such patients require urinary excretion with a urinary catheter for any period of time - these are the entrance gates of the infection).
- Patients with chronic diseases( for example, diabetes mellitus, in which there is a high risk of urinary tract infections by reducing the body's resistance).
- Women who use some methods of contraception( for example, diaphragmatic ring).

The factors predisposing to the occurrence of urinary tract infections are:

1) supercooling( most of the problems of this nature occur during the cool season),
2) presence of respiratory infection in the patient( frequent activation of urological
infections during the cold season),
3) decreased immunity,
4) disturbances in urinary outflow of various types.

Causes of urinary tract infections

In the kidneys, absolutely sterile microorganisms form urine, it contains only water, salts and various metabolic products. The infectious agent first penetrates into the urethra, where favorable conditions for its reproduction are created - urethritis develops. Further spreads higher to the bladder, in which inflammation of its mucosa occurs - cystitis. In the absence of adequate treatment, the ureters get the infection in the kidneys with the development of pyelonephritis. This is the most frequent ascending type of infection.

Anatomy of the urinary system

Pathogens causing urinary tract infections:

1) E. coli( Escherichia coli).This causative agent is a representative of normal flora of the colon, and getting it into the urethra is mainly due to non-observance of the rules of personal hygiene. Also, the E. coli is almost always present on the external genitalia.90% of all urinary tract infections are associated with the E. coli.
2) Chlamydia and mycoplasmas are microorganisms that affect mainly the urethra and the ducts of the reproductive system. They are transmitted mainly through sexual contact and affect the genitourinary system.
3) Klebsiella, Pseudomonas aeruginosa may be the causative agent of urinary tract infections in children.
4) Streptococcus serogroups A and B occur periodically.

How can microorganisms get into the urinary tract:

1) If the personal hygiene rules are not followed after visiting the toilet room.
2) During sexual intercourse and anal sex.
3) When using certain methods of contraception( diaphragmatic ring, spermicide).
4) Children have inflammatory changes due to stagnation of urine in the pathology of urinary tracts of various types.

Symptoms of urinary tract infections

What clinical forms of urinary tract infections occur in medical practice? It is an infection of the urethra or urethra - urethritis ;infection of the bladder - cystitis ;infection and inflammatory process in the kidney - pyelonephritis .

There are also two main types of infection spreading - an ascending infection and a descending infection. With an ascending infection, the inflammatory process affects the organs of the urinary system located anatomically below, and then the infection spreads to the upper organs. An example is cystitis and the subsequent development of pyelonephritis. One of the causes of ascending infection is the so-called problem of a functional nature in the form of vesicoureteral reflux, which is characterized by a reverse urine flow from the bladder to the ureters and even the kidneys. Descending infection by origin is more understandable. In this case, the pathogen spreads from the higher located parts of the urinary system to lower ones, for example, from the kidneys to the bladder.

Many cases of infectious diseases of the urinary system are asymptomatic. But still, for specific clinical forms, there are certain symptoms, which patients most often complain about. For most patients, nonspecific symptoms are typical: weakness, poor health, overwork, irritability. This symptom as causeless at first glance fever( temperature) - in the vast majority of cases, a sign of the inflammatory process in the kidneys.

When urethritis patients are concerned about : pain during urination, pain and burning at the beginning of the process of urination, discharge from the urethra of mucopurulent nature, having a specific odor.

With cystitis , frequent urination is noted, which can be painful, accompanied by painful sensations in the abdomen, a feeling of insufficient emptying of the bladder, and sometimes the temperature may rise.

Pyelonephritis is characterized by the appearance of pain in the lumbar region, an increase in body temperature( with acute process), chills, symptoms of intoxication( weakness, body aches), and the patient may not feel urinary problems. Only with an ascending infection can disturb first the pain when urinating, frequent urination.

Summarizing the above, we list the symptoms characteristic of genitourinary tract infections requiring medical attention:

1) pain, burning and rubbing when urinating;
2) frequent urination;
3) pains in the lower abdomen, in the lumbar region;
4) pain in the suprapubic region in women;
5) temperature and symptoms of intoxication without the effects of colds;
6) discharge from the urethra mucopurulent;
7) change in the color of urine - becomes cloudy, the appearance of mucus, flakes, veins of blood;

Features of urinary tract infections in children

Common causes of urinary tract infections in children are obstruction of the urogenital tract, various functional disorders, phimosis, congenital anomalies of the genito-urinary tract, and rare bladder emptying.

Symptoms of urinary tract infections in toddlers can be erased. Children under 1.5 years with such infection can become irritable, crying, refuse to eat, may not be very high, but unreasonable temperature, poorly doped with conventional antipyretic drugs. Only from the age of two the child complains of pains in the abdomen or back, pain in the lower abdomen, you will notice frequent urination, urination disorders, body temperature often rises, rather than remains normal.

The outcome of a urinary tract infection in a child is often favorable, but there are such consequences as sclerosis of kidney tissue, arterial hypertension, protein in the urine, functional kidney disorders.

Features of urinary tract infection in pregnant women

Up to 5% of pregnant women suffer from inflammatory diseases of the kidneys. The main reasons for this include hormonal changes in the body during pregnancy, a decrease in immunological defense of the body, a change in the location of certain organs associated with the growing fetus. For example, due to the increase in the size of the uterus, there is pressure on the bladder, stagnation occurs in the urinary organs, which will eventually lead to the multiplication of microorganisms. Such changes require frequent monitoring of this system in a pregnant woman.

Features of urinary tract infection in men

First of all, the causes leading to urinary tract infections in men differ from women. This is basically a pathology like urolithiasis and an increase in the size of the prostate gland. Hence the disturbed outflow of urine and inflammatory changes in the urinary system. In the treatment of men in this regard, such an item is included as removing the obstruction to urinary outflow( stone, for example).Also, certain problems cause a chronic inflammatory process in the prostate gland, which requires massive antibiotic therapy.

Diagnosis of urinary tract infections

A preliminary diagnosis is made based on the patient's clinical complaints, but not in all cases this is sufficient to establish the correct diagnosis. For example, pyelonephritis can be accompanied only by the temperature and symptoms of intoxication, pain in the lower back does not appear in the first day of the disease. Therefore, without additional laboratory methods of research, the doctor is difficult to diagnose.

Laboratory diagnostics includes:

1) general clinical tests: general blood test, general urine analysis, biochemical blood tests( urea, creatinine) and urine( diastase).
The most informative at the initial stage is the general analysis of urine. For the study, the average portion of the morning urine is taken. The study counts the number of leukocytes, erythrocytes, so you can suspect bacteriuria( bacterial inflammatory process).Also informative are such indicators as protein, sugar, specific gravity.
2) bacteriological method( sowing urine on special nutrient media in order to detect the growth of certain microorganisms in them), in which the average portion of morning urine is taken into sterile dishes;
3) method of PCR( with negative bapsoseve and ongoing infection of the urinary tract) - to identify such microorganisms as chlamydia, mycoplasma.
4) Instrumental diagnostic methods: ultrasound of the kidney and bladder, cystoscopy, radiocontrast study or intravenous urography, radionucleid studies and others.

Basic principles of treatment of urinary tract infections

1. Regimens of : home semi-post treatment for infections of the urinary system, and according to indications, hospitalization in the therapeutic or urological department of the hospital. Compliance diet regime with the restriction of salt and a sufficient amount of fluid in the absence of kidney failure. In diseases of the kidneys, diets № 7, 7а, 7b according to Pevzdner are shown.

2. Etiotropic treatment of ( antibacterial) includes various groups of drugs that are prescribed by
ONLY DOCTOR after setting the right diagnosis. SELFINATION will lead to the formation of antibiotic resistance to the pathogen of infection and the occurrence of frequent recurrences of the disease. For treatment, apply: primotoprim, bactrim, amoxicillin, nitrofurans, ampicillin, fluoroquinolones( ofloxacin, ciprofloxacin, norfloxacin), if necessary, combinations of drugs. The course of treatment should be 1-2 weeks, less often longer( with concomitant pathology, the development of septic complications, anomalies of the urinary system).After the end of treatment, it is mandatory to monitor the effectiveness of the treatment with a complete laboratory examination, appointed by the attending physician.

Running cases of urinary tract infections with the formation of prolonged flow sometimes require longer courses of etiotropic treatment for a total of several months.

Recommendations of the doctor for the prevention of prolonged flow of urinary tract infections:

- drinking regimen( sufficient fluid intake during the day);
- timely evacuation of the bladder;
- hygiene of the crotch area, daily shower instead of taking a bath;
- thorough hygiene after sexual intercourse;
- do not allow self-medication with antibiotics;
- avoiding spicy and salty foods, taking coffee;
- to drink cranberry juice;
- drastically reduce smoking until completely eliminated;
- avoid sexual intercourse during the treatment period;
- to exclude alcohol.

Features of treatment in pregnant women:

When registering urinary tract infections in pregnant women, treatment is carried out without delay to prevent more serious problems( premature birth, toxicosis, hypertension).The choice of antibacterial drug remains with the doctor and depends on the duration of pregnancy, evaluation of its effectiveness and possible risks to the fetus. Prescription of drugs is strictly individual.

3. Asynchronous therapy ( febrifugal at a temperature, urological fees, herbal
uroseptics, for example, phytolysin, immunomodulators and others).

4. Phytotherapy for infections of the urinary tract : apply herbal infusions( leaves of birch, bearberry, horsetail grass, dandelion root, juniper fruit, fennel fruits, black elderberry, parsley, chamomile flowers and others).

The main problem of urinary tract infections is the frequent development of a recurrent form of infection. This problem is typical for women, every 5th woman after the initial debut of a urinary tract infection meets with the repetition of all the symptoms, that is, the development of relapse, and sometimes of frequent relapses. One of the important properties of relapses is the formation of new mutated strains of microorganisms with an increase in the frequency of relapses. These mutated strains of bacteria already acquire resistance to specific drugs, which, of course, will affect the quality of treatment of subsequent exacerbations of the infection.

Relapses of urinary tract infection can be related to:

1) with an incomplete primary infection( due to improper low doses of antibacterial drugs, non-compliance with the treatment regimen, development of drug resistance to drugs);
2) with a long persistence of the pathogen( the ability of the pathogen to attach to the mucous membrane of the urinary tract and stay in the source of infection for a long time);
3) with the emergence of a re-infection( reinfection with a new causative agent of the periurethral space, direct bilge, skin of the perineum).

Prevention of infections of the urinary system

1) The timely recovery of chronic foci of
bacterial infection( tonsillitis, sinusitis, cholecystitis, dental caries and others) is important in preventive measures, from which the infection can spread with the bloodstream and affect the urinary system.
2) Compliance with hygienic rules for the care of intimate areas, especially girls and
women, pregnant women.
3) Avoid overwork, hypothermia of the body.
4) Timely correction of changes in the human immune system.
5) Timely treatment of diseases of the urinary system( urolithiasis, prostatitis, developmental anomalies).

The doctor infektsionist Bykova N.I.