Một phụ nữ 70 tuổi nhập viện sau khi bị đột quỵ. Về việc tiếp nhận, cô là comatosed, và nó là nhận thấy rằng cô ấy không ngăn lại được nước tiểu và có một ống thông bàng quang chèn vào. Cô ấy không tỉnh lại trong tuần tới, trong đó thời gian cô có một truyền iv. | M E D I C A L MICROBIOLOGY Case study 3 A 70 year old lady is admitted to hospital having suffered a stroke . On admission she is comatosed and it is noticed that she is incontinent ofnrine and has a bladder catheter inserted She does not regain consciousness over the which period she has an i V infusion On admission she is noticed to be febrile temperature 38 0 C but this subsides. On day 5 she is again febrile and has a temperature of 38 5 C By day 7 her temperature hasrallenbutsheishypotensive and has poor urinary output Questions 1 How would you investigate the cause of fever 2 A catheter specimen of urine CSU is taken and reveals whitecells andoverlO 5 bacteria per ml of mixed flora How would you interpret this 3 Results of examination and further investigation show - Chest is clear except for crepitations at bothbases. -Suprapubic specimen of urine shows white cells and over 105 E coli ml. Blood cultures grow a coliform in one bottle. What is the diagnosis 4 How would you manage this case 5 Is the urinary tract the only possible source of the bacteraemia 6 What is the pathogenesis of the hypotension M E D I C A L MICROBIOLOGY Answers 1. Fever may result from infectious and non-infectious aetiology. Strokes themselves may provoke fever -the likely reason for the initial fever. Common sites of infection in such patients are the lungs and urinary tract. The chest should be examined and a chest X-ray taken if appropriate. Samples of urine and blood should be taken for microscopy and culture. 2. Catheter specimens of urine are easily contaminated this is borne out in this case by the mixed flora. The presence of leucocytes occurs with the trauma and irritation caused by the catheter. Notwithstanding this does not rule out bladder infection. 3. The diagnosis is an E. coli urinary tract infection and septicaemia. 4. This is a grey area in view of the patient s age and underlying condition. If her prognosis is generally good then she would be managed
