The patient is a 50 years old Caucasian female, heterosexual, married, and has one adult son. Her medical history includes mastopathy and uterine fibroids which she claims to have since she was around 30 years old, as well as chronic bronchitis. The patient stated she has been smoking daily for the past five years, and only recently has decided to quit the habit. Additionally, the patient claims there was no history of any chronic diseases in her family except for her mother’s hypertension.
The patient presented with strong pain in the small back, irradiating below the belly button, as well claimed to have dysuria for the past three days. Her skin is pale and is covered with sweat, she has vomited twice in an hour, and is feeling cold. Palpation causes severe pain and shows enlarged left kidney, and percussion also provokes painful feelings in the patient’s left side.
The first test is the bacterial culture of urine collected from the patient’s bladder with a catheter – it is required to determine whether there is an infection in the bladder or urinary tract. Secondly, a blood test should be conducted, as the physician needs to see any deviations from normal results. Urinalysis is another test that the physician requires in order to determine the cause of dysuria and pain. An ultrasound of both kidneys is also needed, as the patient shows signs of severe pain in that area. Finally, another ultrasound – of uterus and ovaries – should be conducted to determine whether the organs are causing the symptoms and patient’s distress.
The bacterial culture shows large amounts of Escherichia coli and Staphylococcus saprophyticus in the urine, which indicates the presence of a bacterial infection in the bladder and/or urinary tract. In the blood, neutrophilic leukocytosis with a shift to the left, a slight acceleration of ESR, and positive acute phase reactions in the biochemical study are detected. This also points to the infection in the urinary system as the main cause of the symptoms. Urinalysis shows the decrease in urine’s density, as well as the presence of large amounts of leucocytes and erythrocytes – another sign of a severe inflammatory process in the urinary system. The ultrasound of kidneys revealed enlarged left kidney with pronounced compaction of the parenchyma, showing that the infection is likely to originate from there. However, the ultrasound of uterus and ovaries showed no signs of unusual changes except for those related to patient’s fibroids, from which it can be concluded that the infection did not expand to this area.
The main diagnosis that can be concluded from the evidence is the urinary tract infection. This kind of infections is often accompanied by feeling of cold and back pain, both of which are the patient’s major complaints. According to Masajtis-Zagajewska and Nowicki (2017), “the diagnosis of urinary tract infection is based on the presence of clinical symptoms in combination with the presence of bacteria and leucocytes in urine” (p. 286). Moreover, the patient is 50 years old, which is another risk factor for the urinary tract infection. Storme et al. (2019) state that aging influences the bladder directly, increasing the chances of UTI. The patient’s blood analyses and urinalysis show clear signs of inflammatory process located in the left kidney which is enlarged according to the results of ultrasound.
Before proceeding to treatment, it is necessary to consider the issue of resistance of UTI pathogens to antibacterial drugs. The choice of antimicrobial drug depends on the type of pathogen and its sensitivity to antibiotics and the nephrotoxicity of the drugs. Ampicillin, amoxicillin, and ciprofloxacin might be a good first choice of antibiotics. Additional, non-antibiotic treatment should also be prescribed to relieve patient’s distress. Sihra et al. (2018) claim that cranberries, probiotics, D-mannose, estrogens, and immunostimulants can be safely used for treating the UTI in addition to antibiotics. The patient should also adhere to a diet with no spicy, fried, and salty products, as well as reduce the consumption of caffeine.
Masajtis-Zagajewska, A., & Nowicki, M. (2017). New markers of urinary tract infection. Clinica Chimica Acta, 471, 286–291. Web.
Sihra, N., Goodman, A., Zakri, R., Sahai, A., & Malde, S. (2018). Nonantibiotic prevention and management of recurrent urinary tract infection. Nature Reviews Urology, 15(12), 750–776. Web.
Storme, O., Tirán Saucedo, J., Garcia-Mora, A., Dehesa-Dávila, M., & Naber, K. G. (2019). Risk factors and predisposing conditions for urinary tract infection. Therapeutic Advances in Urology, 11, 19–28. Web.