Editing Urinary tract infection (section)

==Signs and symptoms==
[[File:Pyuria2011.JPG|thumb|Urine may contain pus (a condition known as [[pyuria]]) as seen from a person with [[sepsis]] due to a urinary tract infection.]]

Lower urinary tract infection is also referred to as a bladder infection. The most common symptoms are [[dysuria|burning with urination]] and having to urinate frequently (or an urge to urinate) in the absence of [[vaginal discharge]] and significant pain.<ref name=Review08/> These symptoms may vary from mild to severe<ref name=EM2011/> and in healthy women last an average of six{{nbsp}}days.<ref name=AFP2011/> Some pain above the [[pubic bone]] or in the [[lower back pain|lower back]] may be present.<!-- <ref name=EM2011/> --> People experiencing an upper urinary tract infection, or [[pyelonephritis]], may experience [[abdominal pain|flank pain]], [[fever]], or nausea and [[vomiting]] in addition to the classic symptoms of a lower urinary tract infection.<ref name=EM2011/> Rarely, the urine may appear [[Hematuria|bloody]]<ref name=Sal2011/> or contain visible [[pyuria|pus in the urine]].<ref>{{cite book| vauthors = Arellano RS |title=Non-vascular interventional radiology of the abdomen|publisher=Springer|location=New York|isbn=978-1-4419-7731-1|page=67|url=https://books.google.com/books?id=au-OpXwnibMC&pg=PA67|url-status=live|archive-url=https://web.archive.org/web/20160610151717/https://books.google.com/books?id=au-OpXwnibMC&pg=PA67|archive-date=10 June 2016|date=19 January 2011}}</ref>

UTIs have been associated with onset or worsening of [[delirium]], [[dementia]], and [[neuropsychiatric disorder]]s such as [[depression (mood)|depression]] and [[psychosis]]. However, there is insufficient evidence to determine whether UTI causes confusion.<ref name="pmid26554322">{{cite journal | vauthors = Chae JH, Miller BJ | title = Beyond Urinary Tract Infections (UTIs) and Delirium: A Systematic Review of UTIs and Neuropsychiatric Disorders | journal = Journal of Psychiatric Practice | volume = 21 | issue = 6 | pages = 402–411 | date = November 2015 | pmid = 26554322 | doi = 10.1097/PRA.0000000000000105 | s2cid = 24455646 }}</ref><ref name="pmid34448496">{{cite journal | vauthors = Krinitski D, Kasina R, Klöppel S, Lenouvel E | title = Associations of delirium with urinary tract infections and asymptomatic bacteriuria in adults aged 65 and older: A systematic review and meta-analysis | journal = Journal of the American Geriatrics Society | volume = 69 | issue = 11 | pages = 3312–3323 | date = November 2021 | pmid = 34448496 | pmc = 9292354 | doi = 10.1111/jgs.17418 }}</ref><ref name="pmid24596591">{{cite journal | vauthors = Balogun SA, Philbrick JT | title = Delirium, a Symptom of UTI in the Elderly: Fact or Fable? A Systematic Review | journal = Canadian Geriatrics Journal | volume = 17 | issue = 1 | pages = 22–26 | date = March 2014 | pmid = 24596591 | pmc = 3940475 | doi = 10.5770/cgj.17.90 }}</ref><ref name="Mayne-2019">{{cite journal | vauthors = Mayne S, Bowden A, Sundvall PD, Gunnarsson R | title = The scientific evidence for a potential link between confusion and urinary tract infection in the elderly is still confusing - a systematic literature review | journal = BMC Geriatrics | volume = 19 | issue = 1 | pages = 32 | date = February 2019 | pmid = 30717706 | pmc = 6360770 | doi = 10.1186/s12877-019-1049-7 | doi-access = free }}</ref> The reasons for this are unknown, but may involve a UTI-mediated [[systemic effect|systemic]] [[inflammatory response]] which affects the brain.<ref name="pmid26554322" /><ref name="pmid34448496" /><ref name="pmid34711238">{{cite journal | vauthors = Rashid MH, Sparrow NA, Anwar F, Guidry G, Covarrubias AE, Pang H, Bogguri C, Karumanchi SA, Lahiri S | title = Interleukin-6 mediates delirium-like phenotypes in a murine model of urinary tract infection | journal = Journal of Neuroinflammation | volume = 18 | issue = 1 | pages = 247 | date = October 2021 | pmid = 34711238 | pmc = 8554965 | doi = 10.1186/s12974-021-02304-x | doi-access = free }}</ref><ref name="pmid35389369">{{cite journal | vauthors = Jiang Z, Liang F, Zhang Y, Dong Y, Song A, Zhu X, Zhang Y, Xie Z | title = Urinary Catheterization Induces Delirium-Like Behavior Through Glucose Metabolism Impairment in Mice | journal = Anesthesia and Analgesia | volume = 135 | issue = 3 | pages = 641–652 | date = September 2022 | pmid = 35389369 | pmc = 9388475 | doi = 10.1213/ANE.0000000000006008 }}</ref> [[Cytokine]]s such as [[interleukin-6]] produced as part of the inflammatory response may produce [[neuroinflammation]], in turn affecting [[dopaminergic]] and/or [[glutamatergic]] [[neurotransmission]] as well as brain [[glucose]] [[metabolism]].<ref name="pmid26554322" /><ref name="pmid34448496" /><ref name="pmid34711238" /><ref name="pmid35389369" />

===Children===
In young children, the only symptom of a urinary tract infection (UTI) may be a fever.<ref name=PeadsNA2011/> Because of the lack of more obvious symptoms, when females under the age of two or uncircumcised males less than a year exhibit a fever, a culture of the urine is recommended by many medical associations.<ref name=PeadsNA2011/> Infants may feed poorly, vomit, sleep more, or show signs of [[jaundice]].<ref name=PeadsNA2011/> In older children, new onset [[urinary incontinence]] (loss of bladder control) may occur.<ref name=PeadsNA2011/> About 1 in 400 infants of one to three months of age with a UTI also have [[bacterial meningitis]].<ref>{{cite journal | vauthors = Nugent J, Childers M, Singh-Miller N, Howard R, Allard R, Eberly M | title = Risk of Meningitis in Infants Aged 29 to 90 Days with Urinary Tract Infection: A Systematic Review and Meta-Analysis | journal = The Journal of Pediatrics | volume = 212 | pages = 102–110.e5 | date = September 2019 | pmid = 31230888 | doi = 10.1016/j.jpeds.2019.04.053 | s2cid = 195327630 }}</ref>

===Elderly===
Urinary tract symptoms are frequently lacking in the [[Old age|elderly]].<ref name=Elder2011/> The presentations may be vague and include incontinence, a [[Altered level of consciousness|change in mental status]], or fatigue as the only symptoms,<ref name=EM2011/> while some present to a health care provider with [[sepsis]], an infection of the blood, as the first symptoms.<ref name=Sal2011/> Diagnosis can be complicated by the fact that many elderly people have preexisting incontinence or [[dementia]].<ref name=Elder2011/>

It is reasonable to obtain a urine culture in those with signs of systemic infection that may be unable to report urinary symptoms, such as when advanced [[dementia]] is present.<ref name=AMDA2015>{{Citation |author1 = AMDA – The Society for Post-Acute and Long-Term Care Medicine |author1-link = AMDA – The Society for Post-Acute and Long-Term Care Medicine |date = February 2014 |title = Ten Things Physicians and Patients Should Question |publisher = AMDA – The Society for Post-Acute and Long-Term Care Medicine |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/doctor-patient-lists/amda/ |access-date = 20 April 2015 |url-status = live |archive-url = https://web.archive.org/web/20140913011101/http://www.choosingwisely.org/doctor-patient-lists/amda/ |archive-date = 13 September 2014 }}</ref> Systemic signs of infection include a [[fever]] or increase in temperature of more than {{convert|1.1|C-change|F-change}} from usual, chills, and an [[leukocytosis|increased white blood cell count]].<ref name=AMDA2015/>