MMIC PBL Case 1

Subject: MMIC
Case: Case 1 - Khong Fay Seah
Complaints: Fever, chills, dysuria,
Diagnosis: Urinary Tract Infection

Urinary Tract Infection: A urinary tract infection, or UTI, is an infection that can happen anywhere along the urinary tract. The urinary tract includes the bladder, kidneys, ureters and u rethra. [1]

Dysuria: Painful or difficult urination. This includes burning on urination. Dysuria is most commonly due to bacterial infection of the urinary tract causing inflammation of the bladder (cystitis) or kidney (pyelonephritis).
In women, dysuria may also reflect inflammation of the vagina (vaginitis) or vulva (vulvitis). And in men, dysuria may be due to inflammation of the prostate (prostatitis) or the urethra (urethritis) from gonorrhoea or chlamydia. [2]

Possible Pathogens

Possible Microorganisms	Descriptions
Escherichia Coli	Gram-negative bacilli
Klebsiella spp.	Gram-negative bacilli
Streptococcus spp. (GPC)	Gram-positive cocci
Staphylococcus spp. (GPC) Eg. S saprophyticus, Staphylococcus aureus	Gram-positive cocci
Pseudomonas spp.	Gram-positve bacilli
Proteus spp.	Gram-negative bacilli
Candida spp. Eg. Candida albicans	Fungus
Enterococcus faecalis	Gram-positive cocci
Morganella	Gram-negative bacilli
Serratia	Gram-negative bacilli

Investigation Required
Microscopy:
1) Gram stain - Differentiate Gram positive and Gram negative bacteria
2) Wet mount and KOH smear - Demonstration of pseudohyphae for identification of Candida spp.

Culture:
Aerobic culture on Blood plate agar(BAP), Cysteine Lactose Electrolyte Deficient medium (CLED), MacConkey (MAC)agar plate.

Other Tests:
1) Catalase Tests
2) Oxidase Tests
3) Biochemical Tests

Antimicrobial Susceptibility Test:
To determine the treatment

References:
1. MedlinePlus. (2007) Urinary Tract Infection. Retrieved December 02, 2007, from http://www.nlm.nih.gov/medlineplus/ency/article/000521.htm
http://www.nlm.nih.gov/medlineplus/ency/article/000521.htm > >urinary tract infection
2. MedicineNet, Inc. (2007) Definition of Dysuria. Retrieved December 02, 2007, from http://www.medterms.com/script/main/art.asp?articlekey=3163
http://www.medterms.com/script/main/hp.asp > dysuria

Boon Ching
Tg01