mDR ARCHANA NARANG, MEDICAL OFFICER (T), MD, ISM & H,

mDR SAURAV ARORA, SENIOR RESEARCH FELLOW, SHMC & H

mshmc.thyroidclinic@gmail.com
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UTI:-
 Common afliction to seek medical
attention
 Infancy to old age
 The most common infections during
pregnancy
 In pregnancy, the rate of progression of
lower UTI to pyleonephritis is reported to
be as high as 40 %
 UTI is defined as the presence of at least
100,000 organisms per milliliter of urine
in an asymptomatic patient or as more
than 100 organisms per milliliter of urine
with accompanying pyuria (>7 WBCs/ml)
in a symptomatic patient
 Usually Acute
 Majority due to a single pathogen
 Usually an Enterobacteriaceae
 90% of all UTI
 Gram negative bacilli
 Common intestinal flora

Y


  most commonly isolated

pathogen ~80% of all UTI
 Gram -ve
 Cause 90-95% of UTI¶s
 Most often, E. coli.
 Others include:
 Proteus mirabilis and Klebsiella.
 Gram +ve
 Pathogens include:
 Staph saprophyticus,
 Staph aureus,
 Group A beta hemolytic streptococci
and enterococci.
 Increased frequency and urgency of urination
 Dysuria
 Retropubic/suprapubic/renal area pain during
or after urination
 Sudden onset of pain in one or both of the loins
radiating to iliac fossae and suprapubic area
 Cloudy urine with unpleasant odor
 Hematuria
 Fever with rigors and vomiting
 Asymptomatic bacteriuria (ASB)
 More than 100,000 organisms/ml in 2 consecutive urine
samples in the absence of symptoms (found in 2-10% of
cases)
 Most common pathogen- Y
 
   

  
  Klebsiella pneumoniae (5%),
Enterobacter species (3%), Group B beta-hemolytic
streptococcus (1%)
 Upper urinary tract infection (Cystitis)
 Lower urinary tract infection (Acute
pyelonephritis)
 Physiological changes during pregnancy

 Hormonal and mechanical changes

increase the risk of urinary stasis in
pregnancy resulting in urinanry tract
infections(UTI)

 Difficulty in maintaining hygiene may also

lead to increase in frequency of urinary
tract infections (UTI) in pregnant women
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Fetal complications
rPreterm labor, prematurity, low birth
weight
rIntrauterine growth retardation,
neonatal death

Maternal complications
rAnemia, hypertension, transient renal
failure
rAcute respiratory distress syndrome,
sepsis
 Untreated upper UTIs have been associated
with a low birth weight, prematurity,
premature labor, hypertension and/or
preeclampsia, anemia

 There is increased tendency in progression

of lower UTIs (cystitis) to pyelonephritis in
pregnant patients (40%of cases)
 A 27 year old pregnant female, dentist by
profession, in 30th weeks of gestation
presented with following symptoms:
 Pain in pubic region after urination
 Increased frequency of urination
 Increased urgency of urination
 Cloudy urine with unpleasent smell

Her routine lab investigations done 15 days back were normal

On the basis of above symptoms Urinary Tract Infection was
suspected
 Urine: routine/microscopic
 Dipstick to detect white blood cells

Reports revealed:
 Turbid urine with traces of albumin
 Pus cells 35-40/hpf
 Epithelial cells many/hpf
 Bacetria 1+/HPF
URINARY TRACT INFECTION
 Homoeopathic treatment: Patient was put
on Equisetum 30 on the basis of symptom
similarity
 Following symptoms were taken into
consideration:
 ÷      
not better after urinating.
 Frequent and intolerable urging to urinate, with severe pain
at close of urination; urine flows only drop by drop.
 Passes large quantity of clear, watery urine, without relief.
 Sharp, burning, cutting pain in urethra while urinating.
 Retention and dysuria during pregnancy and after delivery.
 Albuminuria and involuntary urination.
 Pain deep in region of right kidney, extending to lower
abdomen, with urgent desire to micturate; right lumbar
region painful.
Auxillary methods adopted
 Advise to increase fluid intake
 Advise to empty bladder as soon as there
is urge to urinate
 Review after 7 days with urine test -
routine and microscopic
 Therapeutic, preventive and auxillary
measures are to be continued
 Follow up every week with urine routine
investigation
 Advise to report immediately if symptoms
worsen or she develops fever with rigors
& vomiting, sudden severe pain in loins or
renal region
 Improvement in symptoms of dysuria
 No Pain in pubic region
 Urine examination after 2wks:
 Albumin - Absent
 Pus cells ± Ocassional
 RBCs ±Absent
 Bacteria - Absent
oUTIs are common complications of
pregnancy and may lead to significant
morbidity for both mother and fetus
oAll pregnant women should be screened for
bacteriuria in the first trimester
oWomen with a history of recurrent UTI or
urinary tract anomalies should have repeat
bacteriuria screening throughout pregnancy
oAll bacteriuria should be treated during
pregnancy
o Homoeopathic treatment of pregnant women for
ASB may prevent morbidity associated with
symptomatic UTIs
o Treatment with Homoeopathic medicines is cost
effective, safe and nontoxic to the fetus
o If symptoms worsens or there is no improvement
in lab parameters even after 10-15days of
treatment, patient should be referred
o Women should be followed closely after
treatment of bacteriuria because recurrence may
occur in up to one third of patients