012-3-11 Clinical manifestations Cystitis s The onset of cystitis is rapid, and symptoms develop a Cystitis over less than 24 hours s Patients with cystitis usually report dysuria, frequency, a Pyelonephritis urgency, and suprapubic pain a Urine is bloody in -30% of cases. a Urosepsis s Clinically, it is often impossible to differentiate between cystitis and urethritis caused by chlamydia, ureaplasma Cystitis(cont. Py a Fever is unusual among patients with cystitis a rapid onset, with or without a The patients are often with the fever and flank pain Cystitis patients normally have symptoms for 3 to 5 days m About 1/3 of patients develop bacteremia Antibiotic therapy does not markedly reduce the duration a The typical flank pain results from inflammation and edema of the renal parenchyma. Differential diagnosis of pyelonephritis Urosepsis is renal calculi. which may result in a similar location of the pain but ning condition caused by characteristically do not cause fever. ition of bacteria from the urine in a patient with with flank pain similar to that in a patient with right-sided pyelonephritis (and most. eason for urosepsis is withdrawal nsertion)of a bladder catheter (urinanalysis can make differential diagnosis) a Therefore, uroseptic patients do not always have a renal infection2012-3-11 5 Clinical manifestations „ Cystitis „ Pyelonephritis „ Urosepsis Cystitis „ The onset of cystitis is rapid, and symptoms develop over less than 24 hours. „ Patients with cystitis usually report dysuria, frequency, urgency and suprapubic pain urgency, and suprapubic pain. „ Urine is bloody in ～30% of cases. „ Clinically, it is often impossible to differentiate between cystitis and urethritis caused by chlamydia, ureaplasma, or gonococci. Cystitis (cont.) „ Fever is unusual among patients with cystitis. „ In sexually active women, cystitis commonly occurs 24 to 48 hours after intercourse esp without post 48 hours after intercourse, esp. without post-voiding voiding . „ Cystitis patients normally have symptoms for 3 to 5 days. Antibiotic therapy does not markedly reduce the duration. Pyelonephritis „ Pyelonephritis also has a rapid onset, with or without preceding cystitis symptoms. „ The patients are often with the The patients are often with the fever and flank pain flank pain. „ About 1/3 of patients develop bacteremia. „ The typical flank pain results from inflammation and edema of the renal parenchyma. Differential diagnosis of pyelonephritis „ An important differential diagnosis is renal calculi, which may result in a similar location of the pain but characteristically do not cause fever. „ Patients with appendicitis and cholecystitis can present with flank pain similar to that in a patient with right-sided pyelonephritis. (urinanalysis can make differential diagnosis) Urosepsis „ Urosepsis is a life-threatening condition caused by dissemination of bacteria from the urine in a patient with bacteriuria. „ The most common reason for urosepsis is withdrawal (and sometimes insertion) of a bladder catheter. „ Therefore, uroseptic patients do not always have a renal infection