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te cystitis
Acute cystitis
Cystitis is an infection of th e blad d er and ureth ra th at affects m ainly wom en and g irls
from 2 years of ag e. Escherichia coli is th e causativ e path og en in 70 to 95% of cases.
O th er path og ens includ e Proteus mirabilis, enterococcus, Klebsiella spp and in young
wom en, S. saprophyticus.
Clinical features
– Burning pain on urination and pollakiuria (passing of sm all quantities of urine m ore
frequently th an norm al); in ch ild ren: crying wh en passing urine; inv oluntary loss of
urine.
AN D
– N o fev er (or m ild fev er), no flank pain; no system ic sig ns and sym ptom s in ch ild ren
It is essential to rule out pyeloneph ritis (see pag e 226).
T h e sym ptom 'burning pain on urination' alone is insufficient to m ake th e d iag nosis. In
th e ev ent of abnorm al v ag inal d isch arg e, see pag e 233.
Laboratory
– U rine d ipstick test:
P erform d ipstick analysis for nitrites (wh ich ind icate th e presence of enterobacteria)
and leukocytes (wh ich ind icate an inflam m ation) in th e urine.
• If d ipstick analysis is neg ativ e for both nitrites and leukocytes, a urinary infection
is exclud ed .
• If d ipstick analysis is positiv e for nitrites and /or leukocytes, a urinary infection is
likely.
– M icroscopy/culture: wh en a d ipstick analysis is positiv e, it is recom m end ed to carry
out urine m icroscopy/culture in ord er to confirm th e infection and id entify th e
causativ e path og en, particularly in ch ild ren and preg nant wom en.
W h en urine m icroscopy is not feasible, an em pirical antibiotic treatm ent sh ould be
ad m inistered to patients with typical sig ns of cystitis and positiv e d ipstick urinalysis
(leucocytes and /or nitrites).
Note: asid e of th ese results, in areas w h ere urinary sch istosom iasis is end em ic, consid er
sch istosom iasis in patients w ith m acroscopic h aem aturia or m icroscopic h aem aturia
d etected by d ipstick test, especially in ch ild ren from 5 to 15 years, ev en if th e patient
m ay suffer from concom itant bacterial cystitis.
224
Acute cystitis
Cystitis is an infection of th e blad d er and ureth ra th at affects m ainly wom en and g irls
from 2 years of ag e. Escherichia coli is th e causativ e path og en in 70 to 95% of cases.
O th er path og ens includ e Proteus mirabilis, enterococcus, Klebsiella spp and in young
wom en, S. saprophyticus.
Clinical features
– Burning pain on urination and pollakiuria (passing of sm all quantities of urine m ore
frequently th an norm al); in ch ild ren: crying wh en passing urine; inv oluntary loss of
urine.
AN D
– N o fev er (or m ild fev er), no flank pain; no system ic sig ns and sym ptom s in ch ild ren
It is essential to rule out pyeloneph ritis (see pag e 226).
T h e sym ptom 'burning pain on urination' alone is insufficient to m ake th e d iag nosis. In
th e ev ent of abnorm al v ag inal d isch arg e, see pag e 233.
Laboratory
– U rine d ipstick test:
P erform d ipstick analysis for nitrites (wh ich ind icate th e presence of enterobacteria)
and leukocytes (wh ich ind icate an inflam m ation) in th e urine.
• If d ipstick analysis is neg ativ e for both nitrites and leukocytes, a urinary infection
is exclud ed .
• If d ipstick analysis is positiv e for nitrites and /or leukocytes, a urinary infection is
likely.
– M icroscopy/culture: wh en a d ipstick analysis is positiv e, it is recom m end ed to carry
out urine m icroscopy/culture in ord er to confirm th e infection and id entify th e
causativ e path og en, particularly in ch ild ren and preg nant wom en.
W h en urine m icroscopy is not feasible, an em pirical antibiotic treatm ent sh ould be
ad m inistered to patients with typical sig ns of cystitis and positiv e d ipstick urinalysis
(leucocytes and /or nitrites).
Note: asid e of th ese results, in areas w h ere urinary sch istosom iasis is end em ic, consid er
sch istosom iasis in patients w ith m acroscopic h aem aturia or m icroscopic h aem aturia
d etected by d ipstick test, especially in ch ild ren from 5 to 15 years, ev en if th e patient
m ay suffer from concom itant bacterial cystitis.
224
