Case study- answer only 5 questions to be answered

Case Study #1

Geraldine said one of her two daughters was admitted to University of Toledo Medical Center on October 14th after suffering stomaching cramps and passing blood. 

Age: 19 yr old female

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Medical History

     -History of urinary tract infection (UTI)-4 months prior to admission

     -Treated with oral ampicillin-Resistance to ampicillin can occur because the oral medication is rapidly excreted and the duration of significant drug concentration in the urine is short. An additional reason is that ß-lactams are relatively ineffective in clearing gram negative rods from the vaginal and colonic mucosa, thus possibly predisposing to recurrences when used to treat UTI


Five Days Prior to Admission

  • Nausea w/out vomiting

One Day Prior to Admission

  • Left flank pain
  • Fevers (38.8oC)
  • Chills
  • Increased urinary frequency
  • Foul smelling urine

Physical examination

  • Left costovertebral angle tenderness


  • -Notable for >50 WBC/ high power field, 3-10RBC/ high power field, and 3+ bacteria
  • -Urinary culture was positive for >100,000 CFU of an org/ml


  • >50 WBC
    • Pyuria refers to the presence of abnormal numbers of leukocytes that may appear with infection in either the upper or lower urinary tract. White cells from the vagina, especially in the presence of vaginal and cervical infections, may contaminate the urine. If two or more leukocytes per each high power field appear in non-contaminated urine, the specimen is probably abnormal.
  • 3-10 RBC
    • Theoretically, no red cells should be found, but some find their way into the urine even in very healthy individuals. However, if one or more red cells can be found in every high power field, and if contamination can be ruled out, the specimen is probably abnormal.
  • 3+ bacteria
    • Bacteria are common in urine specimens because of the abundant normal microbial flora of the vagina and because of their ability to rapidly multiply in urine standing at room temperature.
    • Diagnosis of bacteriuria in a case of suspected urinary tract infection requires culture. A colony count may also be done to see if significant numbers of bacteria are present. Generally, more than 100,000/ml of one organism reflects significant bacteriuria.

UTI are a bacterial infection of the urinary bladder (cystitis) or of the kidneys (pyelonephritis)

Nearly all UTI’s are caused by bacteria and enter the urethral opening and move upward to the urinary bladder and sometimes the kidneys

Possible pathogens for a UTI:


   -enterobacteriae   à   Klebsiella

   -P. mirabilis

   -P. aeruginosa

   -Enterococci (group D)



  1. While samples are being analyzed, what questions would you ask the mom and daughters (including the one hospitalized)?
  • What, if any of the above infectious agents, is the likely cause?  Why?  Explain.
  • How would you proceed with your investigation following your initial data collection? 
  • What additional interviews and samples would need to be conducted?
  • What public health measures must be taken to stop any further morbidity and prevent it in the future?
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