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Genitourinary Infection
EFRIDA
WARGANEGARA
GENITOURINARY INFECTION
I.
Urogenital Infection
1. Infeksi Saluran Kemih
a. Bacterial Cystitis
b. Leptospirosis
2. Infeksi Saluran Genital
a. Bacterial Vaginosis
b. Staphylococcal Toxic Shock Syndrome
II.
I. Urogenital
Infection
1. Urinary Tract Infection
a. Bacterial Cystitis
b. Leptospirosis
2. Genital System Disease
a. Bacterial Vaginosis
b. Staphylococcal Toxic Shock
Syndrome
Introduction
Introduction
UTI is arise by :
- the ascent of bacteria following colonization of
periurethral area by fecal organism
- hematogenous infection of the kidney much
rarer
- Anaesthesia and mayor surgery (for example)
temporarely stop the reflex ability to urinate,
and urine accumulation in the bladder.
- Even being too busy to empty the bladder
may predispose a person to infection
- Most cases of UTIs occur in otherwise healthy
young women with normal urinary flow
Introduction
Introduction
The Urinary Tract is one of the most common sites
of bacterial infection, particularly in females (the
mayority of patients are women)
10-20% of women have UTI at some time in their
life by the age of 30 years and have
recurrent
infection
Majority of infection are acute and short lived
contributed to a significant amount of morbidity in
population.
Severe infection result in loss of renal function
and serious longterm sequele
Introduction
Introduction
Other Classification :
1. according symptom
- Symptomatic UTI
- Asymptomatic UTI
2. According structure
- Complicated UTI
Normal Flora
The
Commonly
in women and
man, there is m.o. in distal
urehtra (1/3 distal)
M.o.
ENTRY
Pathogenesis of UTI
Factors predisposing to infection
A. Mechanical Factors
- anything that disrups normal urine flow or
complete emptying of the bladder or facilitates
acces of m.o. to the bladder will predispose
to infection
- the shorter female urethra is risk for fecal
contamination
- sexual intercouse facilitates the movement of
m.o. up the
urethra, particularly women
- in women preceeding bacterial colonization of
Pathogenesis of UTI
B. Obstruction to complete bladder
emptying
- Pregnancy, prostatic hypertrophy, renal
calculi,
tumors and strictures of any sort causes
obstruction UTI when residual urine
more
than 2-3 ml, infection is more likely
- Loss of neurological control of the bladder
and
sphincter resultant large residual volume
urine in the bladder functional obstruction
Pathogenesis of UTI
D. Diabetic
- may suffer more severe UTI and when
diabetic neuropathy interference with
normal
bladder function persistent UTI
commonly
occur
E. Catheterization
- is another major predisposing factor for
UTI
- During insertion of catheter m.o.
Pathogenesis of UTI
Bacterial Virulence Factors
Pathogenesis of UTI
Defence Mechanism of
Urinary Tract
1. Faktor Urine :
2. Faktor Hidrokinetik
- Eksresi urine secara periodik
- Pengenceran sisa urin krn aliran
dari ginjal
- Pengosongan sempurna urine
Defence Mechanism of
Urinary Tract
3. Faktor Mukosa
- Mukosa vesika urinaria t.d sel epitel
lebih dari satu lapisan
- Mukosa sal. Kemih dan vesika urinaria
ditutupi oleh mukus mencegah
penempelan
- Efek antribakteri dari sekret prostat
- Sekresi lokal IgA mencegah
penempelan m.o. pada uroepithelium
dan mencegah toksin penetralisir dari
- Urine midstream
2. Kultur
- Umumnya ISK ditandai dengan adanya bakteriuri
- Bakteriuri Infectif :
a. jumlah m.o. > 100.000 per ml urine
b. jumlah m.o. < 100.000 per ml urine dengan
lekosituri
c. jumlah m.o. < 100.000 per ml urine, pada kultur
kedua
didapatkan jenis m.o. yang sama
d. jumlah m.o. < 100.000 per ml urine, t.d. satu
Prevention of UTI
4. Sisi Infeksi :
2.
3.
Bacterial Cystitis
Cystitis (inflamation of the bladder) most
common type of UTI
Bacterial Cystitis (BC) common among
otherwise healthy women and is also a frequent
healthcare-associated infection
Sign and Symptom
BC sometime asymptomatic, especially among
children and the elderly
Symptom (if occur) : typically start suddenly and
include a burning pain during urination, urgent
need to urinate, and frequent release of small
amount of urine
Bacterial Cystitis
Sign and Symptom (continued)
The urine is cloudy due to accumulation of WBC and
may be a pale red color to blood.
It also often has a bad smell
The area above the pubic bonr may be painful
because of the underlying inflamed bladder
Sometime a more serious condition occurs
(Pyelonephritis), the symptom include fever, chills,
vomiting, back pain and tenderness overlying the
kidneys
Repeated episode of pyelonephritis lead to scarring
and shrinkage of the kidneys and can cause kidney
failure
Bacterial Cystitis
Causative Agents
Ussually from the normal intestinal microbiota
More than 80% : caused by spesific uropathogenic strain
of Escherichia coli.
The remaining infections (young women) caused by other
Enterobacteriaceae members Gram (-) Klebsiella and
Proteus species, or Gram (+) Staph. saprophyticus).
Hospitalized patient and people with long standing
bladder catheter, often chronically infected with multiple
species of bacteria Gram (-) Serratia marcencens and
Pseudomonas aeruginosa and Gram (+) Enterococcus
faecalis.
Many of these species are resistance to antibiotics and
are difficult to treat.
Bacterial Cystitis
Pathogenesis
Ussually agent reach the bladder by moving up the urethra,
helped by motility of m.o.
Uropathoegenic E.coli (UPEC) strain have fimbriae that attach
specifically to receptor on bladder epithelial cell
Bacterial attachment followed by the death and sloughing of
this superficial layer of cells
Bacteria enter the epithelium by endocytosis and multiply to
create intracellular bacterial communities (IBCs) biofilm-like in
nature
Bacteria later detach from the outer surface of IBC and move into
the bladder lumen to attach to surrounding epithelium new
IBCs
UPEC may eventually establish a dormant intracellular reservoir
that resists antibiotics and is undetected by immune system,
often leading to chronic or recurrent infections
Bacterial Cystitis
Epidemiology
About 30% of women develop cystitis at some time during their life.
Factors that predispose women to UTIs include :
* Short urethra risk for fecal contamination
* Sexual intercourse 1/3 UTI associated with sexintercourse
* Birth control devices diaphragma compress urethra
and slow the flow of urine increasing the risk UTIs
Other factors involved in development of UTIs include :
* Enlargeed prostate age 50 , enlargement prostate gland
compresses uretgra difficult to completely empty the
bladder
* Catheterization - bacteria to reach to bladder UTIs
* Paraplegia paralysis of the lower half of body - cannot urinate
normally require catheter
Bacterial Cystitis
Treatment and Prevention
Cystitis easily to treat with a few days of an antibiotic
effective against to causative bacterium
Pyelonephritis more serious condition, usually
requires hospitalization and intravenous antibiotic
treatment
To prevent UTIs :
* drinking enough to ensure urinating at least four or
five
times daily
* urinating immediately after sexual intercourse
* wiping from front to back after defecation to minimize
fecal contamination of the urethra
B. Faktor patogenisitas
1. M.o. segera menempel pd mukosa via villi
shg menimbulkan
kerusakan
(lanjutan)
(lanjutan)
2. Staphylococcus saphrophyticus
A. Sifat Umum :
- Termasuk Staphylococcus, seluruhnya
catalase (+), gram (+),
biasanya tersusun dlm sel tunggal,
diplokokus, rantai pendek
dlm jaringan
- Non hemolitik, coagulase (+), resisten
novobiosin,
kultur
pada agar darah
- Tidak mempunyai protein A
B. Faktor Patogenitas : m.o. menempel pada sel
uroepithelial
(lanjutan)
3. Proteus mirabilis
A. Sifat Umum :
- Bakteri gram (-), batang pendek, bergerak
- Menghasilkan pertumbuhan swarming yg
khas pada
kultur pada agar darah
- bersifat opportunistik, transmisi mel.
kateter
B. Faktor Patogenisitas :
- menghasilkan protease yg kuat yg dpt
menghidrolisis urea
jadi amonia dan CO2
- Hasil dari batu & calculus menyebabkan
obstruksi sal. kemih
C. Gejala Klinik : ISK terjadi baik pada
(lanjutan)
4. Enterococcus faecalis
A. Sifat Umum :
- Dulu diklasifikasi sbg Group D
Streptococcus
- Merupakan flora normal pada usus dan oral
pada manusia
dan hewan
- bersifat B-hemolitik, paling sering adalah a
atau Y hemolitik
- Dapat dibedakan mel. reaksi thdp
antiserum, resistensi
bacitracin, tumbuh dlm 40% bile, pH 9.0 /
sol. 6.5 % garam
B. Faktor Patogenisitas : belum diidentifikasi
- M.o. umumnya noninvasif, menyebabkan
infeksi nosokomial
Pathogenesis
Women with BV
* characteristik changes in the vagina, including a loss of
acidity of the vaginal secretion (N : pH 3,8-4,2)
* disruption of the normal microbiota
* substantial increase in the number of clue cells (epithelial
cells that have sloughed off the vaginal wall and are
coverred with bacteria)
* There is no inflammation unless another, concurrent
vaginal infection is present
* The strong fishy odor is caused by metabolic product of
the anaerobic bacteria and is used for diagnosis in the
whiff test
Clue Cells
Diagnosis
Three of the four criteria should be
positive :
thin homogeneous discharge.
pH of discharge >4.5.
Clue cells in saline wet mount or
Gram stain of vaginal discharge.
Mixture of vaginal discharge and 10%
KOH liberates an "amine-like" or "fishy"
odor.
Pathogenesis