Urinary tract infection

“ Finally the retained urine infected through the blood or by a catheter, quickly passes into ammoniacal fermentation, with softening and detachment of the cystic epithelium, septic infection of the mucosa, and the extension of this infection through the ureters of the kidneys. The complication of infective inflammation of bladder and kidneys introduces one of the most dangerous conditions possible. ”

“ Fortunately, in the majority of cases, the number of parasites is small, though it may increase from repeated infections to 500 or more. In cases of comparatively light infection the disease is reduced to a slight chronic cystitis, with now and then exacerbations, in course of which a slight amount of blood and pus is passed in the urine. The disease may last for years without apparent increase. In the most severe cases death may occur from various causes, rupture of the bladder, ascending pyelo-nephritis, uræmia, albuminuria ”

“ Heart disease, throwing the blood pressure back on the veins and kidneys, is another cause. Disease of the ureter or bladder, preventing the escape of urine from the kidney and causing increased fullness and tension in its pelvis and tubes, will determine inflammation. Decomposition of the detained urine in such cases and the production of ammonia and other irritants must also be named. In elimination of bacteria through the kidney, the latter is liable to infection with consequent inflammation. The advance of bacteria upward from the bladder to the kidneys is another cause. ”

“ A long-continued fever, not especially intense and of a more or less distinctly intermittent type, especially if becoming at some definite period decidedly more intense, is likely to mean the invasion of a new tract of mucous membrane, such as that of the renal pelves or even of the kidney-substance itself. Continued or remittent urinary fever is of very grave import. With this fever will appear the dry red tongue and the distressing anorexia, nausea, and vomiting, with either constipation or diarrhoea. ”

“ Ordinarily, no attempt is made to identify any but the tubercle bacillus and the gonococcus.
Tubercle bacilli are nearly always present in the urine when tuberculosis exists in any part of the urinary tract, but are often difficult to find, especially when the urine contains little or no pus.
Detection of Tubercle Bacilli in Urine.—The urine should be obtained by catheter after careful cleansing of the parts.
(1) Centrifugalize thoroughly, after dissolving any sediment of urates or phosphates by gentle heat or acetic acid. Pour off the supernatant fluid, add water, and centrifugalize again. ”

“ Once in the human body, the blood carries them to the place where they develop into the adult worms, which eventually unite, and then the females begin producing the spined eggs.
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Symptoms.—In the urinary form the chief symptom is the passage of bloody urine, which usually shows itself about three months after infection, and is often associated with a good deal of irritation of the bladder and the pipe. The intestinal form may produce various symptoms. Sometimes a condition resembling enteric fever occurs, sometimes one like dysentery. Diarrhœa is common. ”

“ Epidemiology.—The ordinary method of transmission is by the agency of infected lice, but the disease can be produced artificially by the injection of the blood of an infected person. It is probable that urine also may be a factor in transmission, as Strong brought about infection by smearing skin abrasions with urinary sediment from trench fever cases. ”

“ If pyelitis have already been present, the change in the appearance of the urine will be less characteristic, but there may be a marked aggravation of symptoms when the contents of softened masses are added to the secretions of the mucous surface. There is likely to be much fluctuation in the quantity of débris present from day to day. Urinary fever of the hectic or subcontinued type, with anorexia, nausea, dry tongue, and diarrhoea, is present. In some cases the enlarged and irregular kidney may be felt. ”

“ Local disorders of the urinary organs are more frequent causes of the trouble, as inflammation of any part of the urinary tract, diabetes, nephritis, stone in the bladder, tumors, and malformations. The involuntary passage of urine may arise from irritability of bladder—the most frequent cause—or from weakness of the muscles which restrain the escape of urine, or from obstruction to flow of urine from the bladder, with overflow when it becomes distended. ”

“ Similarly foci of infection in the kidney may be found in distemper in the dog, and in the contagious pneumonia and influenza of the horse. In man infection from the bowel through the migration of the bacillus coli communis to the devitalized kidney and contents in hydronephrosis, has been traced, and the liability to this must be still greater after the surgical insertion of the ureters in the rectum as a substitute for the obliterated bladder and urethra. ”

“ Hyaline casts are the least significant of all the casts, [p. 115] and occur in many slight and transitory conditions. Small numbers are common following ether anesthesia, in fevers, after excessive exercise, and in congestions and irritations of the kidney. They are always present, and are usually stained yellow when the urine contains much bile. While they are found in all organic diseases of the kidney, they [p. 116] are most important in chronic interstitial nephritis. Here they are seldom abundant, but their constant presence is the most reliable urinary sign of the disease. ”

“ Infection by the genito-urinary surface is comparatively rare. The surface openings are usually closed, and the discharge of urine has a mechanical cleansing effect. The wide tube of the vagina is further protected by a normal bacterial flora which produces conditions hostile to other and pathogenic bacteria. The most common infections are the sexual diseases, which are due to organisms which find favorable conditions for growth in and on the surface and which are conveyed from a similar surface by sexual contact. ”

“ Besides this danger of infecting the innocent mother and child, gonorrhoea is not such an innocent disease even for the man himself. It is not a local disease only, it is a general infection and its manifestations may be as grave to the individual as syphilis. The infection may ascend to the urinary passages and cause a catarrh of the bladder and an infection of the ureters and kidneys. It may affect the genital organs, as the testicles and prostate in men, and uterus and tubes and ovaries in women. The germs of gonorrhoea may enter the blood and attack the joints. ”

“ As secondary causes are those in which the inflammation starting in the uriniferous tubes extends down to and implicates the pelvis, and the still more frequent instances of extension of purulent infection upward from the ureter, bladder or prostate, so as to involve the pelvis. So in blocking of the urethra by strongylus, stricture, clot or calculus, and in spasm of the sphincter vesicæ, the delayed urine is liable to undergo fermentation with evolution of ammonia, and not only the bladder but the ureter and renal pelvis may suffer. ”

“ During the course of any case of chronic Bright's disease there are usually periods during which the urine is scanty or suppressed, especially toward the close of the disease. The kidney lesions which complicate scarlet fever, yellow fever, and cholera are often attended with suppression of urine. Any diseases accompanied by a well-marked rise of temperature are apt to be associated with a diminution in the amount of urine. Injuries to the urethra, even very slight ones, may be followed by complete suppression of urine, without any changes in the kidneys except congestion. ”

“ Urination affords symptoms often of extreme consequence in disease. Suppression of urine is one of the most alarming of signs; an approximation to it only is likely to be met with in cholera, a late stage of scarlet fever, typhus or typhoid fever, in acute yellow atrophy of the liver, and in advanced kidney disease. Careful examination of the abdomen, by inspection, palpation, and percussion, as well as by inquiry of attendants, is needful in all cases of fever or other disorders with delirium or stupor, to ascertain the presence or absence of retention of urine. ”

“ It sometimes remains after an acute attack has passed off, but more commonly it results from long-continued irritation, such as may be produced by a urinary calculus in or by atony of the bladder. The symptoms are not so severe as in acute cystitis: the urine contains more mucus, but less pus and blood, and there is much less tendency to frequent micturition, the irritability of the bladder being greatly diminished. Frequently very large quantities of mucus are secreted, and the condition is then termed "catarrh of the bladder." Chronic inflammation is not in itself dangerous ”

“ When the urine is yellow and thin, it indicates that the disease is unconcocted; and if it (the disease) should be protracted, there maybe danger lest the patient should not hold out until the urine be concocted. But the most deadly of all kinds of urine are the fetid, watery, black, and thick; in adult men and women the black is of all kinds of urine the worst, but in children, the watery. In those who pass thin and crude urine for a length of time, if they have otherwise symptoms of convalescence, an abscess may be expected to form in the parts below the diaphragm. ”

“ More frequently cystitis is the result of inflammation due to continuity of tissue, and forms a complication of urethritis, vaginitis, and the conditions set up by retention of the after-birth. It may also result from ascending infection causing pyelo-nephritis, or ascending infection of any kind which eventually attacks the bladder. It is a very common consequence of the use of unclean catheters, but only in equines and females, as the catheter is not passed in the ox or bull until after urethrotomy. ”

“ In man the parasites and ova have been found in the minute veins of the bladder, ureter and pelvis of the kidney (more rarely in other organs) , where they infest the mucous and submucous tissues. In an affected bladder the mucous membrane presents swollen vascular patches of varying size, or warty prominences on which the urinary salts may be deposited. The ova often serve as a nucleus for urinary calculi. Similar changes may take place in the ureter, and the consequent swelling lead to obstruction to the passage of urine, and if left untreated to pyelitis and pyonephrosis. ”

“ But in every case disease-germs are the cause of the trouble, and they may be found in the urine. The first effect of inflammation is to render the bladder irritable, so that as soon as a few drops of urine have collected, the individual has intense or uncontrollable desire to micturate. The effort may be very painful and may be accompanied by bleeding from the overloaded blood-vessels of the inflamed membrane. In addition to blood, pus is likely to be found in the urine, which by this time is alkaline and ammoniacal, and teeming with micro-organisms. ”

“ Samples of urine collected from humans pose a real health risk to laboratory workers who collect and handle these samples. These risks are primarily due to personal contact with infective biological samples and can have serious health consequences, such as infectious hepatitis, and other diseases. ”

“ Any condition leading to disturbance of the function of the bladder, such as enlargement of the prostate, stricture of the urethra, stone, or injury, may cause cystitis by preparing the way for bacillary invasion. The bacilli of tuberculosis and of typhoid fever may set up cystitis by coming down into the bladder from the kidneys with the urine, or they reach it by the blood-stream, or invade it by the urethra. Another way of cystitis being set up is by the introduction of the germs of suppuration by a catheter or bougie sweeping them in from the urethra ”

“ If the urine is acid, bicarbonate of soda may be given, or citrate of soda; if alkaline, urotropine—a derivative of formic aldehyde—may prove a useful urinary disinfectant. If the straining and distress are great, a suppository of 1⁄4 or 1⁄2 a grain of morphia may be introduced into the rectum every two or three hours. The bowels must be kept freely open. If the urine is foul, the bladder should be frequently washed out by a soft catheter and two or three feet of india-rubber tubing with a funnel at the other end, weak and abundant hot lotions of Sanitas or Condy’s fluid being used. ”

“ Symptoms. The chief functions of the body do not appear to be disturbed, although the urine seems abnormal. Micturition is difficult, slow, and somewhat painful, and is followed by long-continued tenesmus.
The urine appears whitish, purulent, slimy, or of a deeper tint, 514rapidly becoming blackish. It is of ammoniacal or fœtid odour, and decomposes quickly.
The period of development may be prolonged, and recovery rarely occurs spontaneously. The condition often leads to ascending infection, inflammation of the ureters, pyelitis, and nephritis. ”

“ It is through the kidneys that the bacteria themselves largely leave the animal body, and trouble is liable to come during their passage. Further, exposure to cold tends to increase the urinary secretion, over-stimulating the kidneys, and the same may come from diuretic drinking waters and condition powders, also from cantharides and other diuretic agents applied to the skin. Urea and many toxins are diuretic, hence the occurrence of polyuria at and after the crisis of fevers. ”