2. INFECTION OF THE URINARY TRACT CENERAL CONSIDERATION
2. INFECTION OF THE URINARY TRACT CENERAL CONSIDERATION
The term urinary tract infection denotes a wide variety of clinical entities in which the common denominator is the presence of a significantly large number of
microorganisms in any portion of the urinary tract, Microorganisms may be evident
only in the urine (bacteriuria) or there may be evidence of infection of an organ
--ureteritis, prostatitis, cystitis, pyelonephritis. At any given time, any one of these organs may be asymptomatic or symptomatic.
Infection in any part of the urinary
tract may spread to any other part of the tract.
Symptomatic urinary tract infection may be acute or chronic. The term relapse
implies recurrence of infection with the same organism, while the term reinfection implies infection with another organism.
In traditional Chinese medicine, the condition is thought to be due to accumulation and stagnation of the pathogenic damp and
heat factors in the urinary bladder. The main symptoms are frequency and urgency of urination, painful urination with scanty
urine. It belongs to "lin symptom complex" (abnormalities of micturition) category.
1. Lower tract involvement
Burning pain on urination, often with turbid, foul-smelling, or dark urine, frequency, and suprapubic or lower abdominal
discomfort. There are usually no positive physical findings unless the upper tract is involved also.
Microscopic examination of a properly collected urine specimen usually shows significant bacteriuria and pyuria and
occasionally hematuria. Bacteriuria is confirmed by culture. Leukocytosis is rare unless the upper tract is also involved.
2. Acute pyelonephritis
Sudden rise of body temperature to 102 to 105 degrees fahrenheit, shaking chills, aching pain in one or both costovertebral
areas or flanks, and symptoms of bladder inflammation. Physical examination reveals tenderness in the region of one or both
kidneys; at times, a tender kidney may be detected by palpation. Laboratory tests show polymorphonuclear leukocytosis, and the
urine is laden with leukocytes. Stain of the sediment reveals numerous bacteria, usually gram-negative bacilli, and culture confirms
this. In a small proportion of cases, culture is also positive. DIAGNOSIS
? General symptoms and signs: sudden rise of body temperature to 39 degrees
centigrade, chilliness, fever, headache, malaise, nausea and vomiting.
? Urinal tract infection symptoms and signs: costovertebral angle pain and
tenderness, abdominal pain, frequency of urine, urodynia, dysuria and lower abdominal discomfort.
? Laboratory findings: significant bacteriuria, proteinuria, pyuria. The bacteria in the urine are often coated with
immunoglobulin as revealed by immunofluorescence. Leukocytosis is common with a marked shift to the left. Blood culture is
I. Treatment in Western medicine.
1. Specific measures
A. For the first attack of urinary infection, give sulfisoxazole or trisulfapyrimidines, 4g daily in divided doses by mouth for 3 to
7 days. Infections limited to the lower tract are sometimes eradicated if treated for just 1 to 3 days with ampicillin, 2 to 4g/d;
amoxicillin 1 to 3g/d; or trimethoprim-sulfamethoxazole, one 80mg/400mg tablet 2 to 4 times daily. Oral cephalexin, 2 to 4g/d, or
cephradine, 2 to 4g/d, may be equally effective. Maintain an alkaline urine pH. If symptoms have not improved and the urine has
not cleared, shown by microscopy on the fourth day of treatment, re-examine the urine for possible resistant microorganisms.
Follow-up at 3-6 weeks after treatment is stopped should demonstrate absence of bacteriuria; otherwise, retreat.
B. For recurrence of urinary tract infection, select an antimicrobial drug on the basis of antimicrobial susceptibility tests of
cultured organisms. Give the drug for 10 to 14 days in doses sufficient to maintain high urine levels. Re-examine the urine 2 and 6
weeks after treatment is ceased.
C. For second recurrence or failure of bacteriuria, perform tests of renal
function and excretory urograms and consider referral to urologist for a work-up for possible obstruction, reflux and localization
of infection in the upper or lower tract. Men with recurrent urinary tract infection and probable prostatitis as a persistent focus
often fail to be cured by 10 to 14 days of treatment in these patients. A 12 to 20 week trial of trimethoprim-sulfamethaxazole or
ampicillin is indicated if the organism is susceptible to that drug mixture.
2. General measures
Forcing fluids may relieve signs and symptoms but should be limited to amounts
that will avoid undue dilution of antimicrobials in the urine. Analgesics may be
required briefly for pain. Metabolic abnormalities such as diabetes mellitus must be identified and treated.
II. Treatment in Chinese medicine.
1. Herb therapy
A. For heat Lin. The main manifestations are oscillations between chills and
fever, distention and pain of the hypogastrium, difficulty of urination, dark urine,
burning pain of the urethra on micturition, rapid pulse and yellow coating of the
tongue. The rule of the treatment is to dissipate heat and detoxify the body. The
common formula is Xiao Chai Hu Tang He Ba Zheng San Jia Jian.
Chinese thorowax 30g
Herba polygoniaviculare 30g
Fringed pink 30g
Asiatic plantain seed 30g
Chinese violet 30g
Henon bamboo leaf 10g
Oriental water plantain 12g
Decoction and dosage. All the above herbs are put together into a boiler to be simmered twice and then the broth of each
mixed, half of the mixed broth each time, twice a day. Two to four doses are prescribed.