Wednesday, April 15, 2015

2-day history of dysuria

A 20-year-old female patient presents with a 2-day history of dysuria, lower abdominal pain and low-grade fever. Her urine is cloudy with pyuria and abundant grampositive bacteria.

She is a college student who is sexually active with no previous history of sexually transmitted diseases.

lower abdominal pain 
Which organism is most likely responsible for this
woman’s symptoms?
a. Enterococcus faecalis
b. Escherichia coli
c. Neisseria gonorrhoeae

d. Staphylococcus saprophyticus

e. Candida albicans

The answer is d. T he patient’s urinary tract infection (UT I) is caused by gram-positive bacteria. T his excludes E coli and N gonorrhoeae, both of which are gram-negative, and C albicans, which is a yeast. Enterococcus faecalis and S saprophyticus are gram-positive bacteria that can cause UT I, but the second agent is a more likely cause of UT I in young women. Staphylococcus saprophyticus colonizes the rectum or the urogenital tract of approximately 5% to 10% of women and is second only to E coli as the causative agent of uncomplicated urinary tract infections in young sexually active women. Such infections are successfully treated with fluoroquinolones or trimethoprim-sulfamethoxazole.


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