Editing Urinary tract infection (section)

==Diagnosis==
[[Image:Bacteriuria pyuria 4.jpg|thumb|Multiple [[bacilli]] (rod-shaped bacteria, here shown as black and bean-shaped) shown between white blood cells in urinary microscopy. These changes are indicative of a urinary tract infection.]]
In straightforward cases, a diagnosis may be made and treatment given based on symptoms alone without further laboratory confirmation.<ref name=Review08/> In complicated or questionable cases, it may be useful to confirm the diagnosis via [[urinalysis]], looking for the presence of [[urinary nitrite]]s, [[white blood cells]] (leukocytes), or [[leukocyte esterase]].<ref name="Detweiler2015">{{cite journal | vauthors = Detweiler K, Mayers D, Fletcher SG | title = Bacteruria and Urinary Tract Infections in the Elderly | journal = The Urologic Clinics of North America | volume = 42 | issue = 4 | pages = 561–568 | date = November 2015 | pmid = 26475952 | doi = 10.1016/j.ucl.2015.07.002 | type = Review }}</ref> Another test, [[urine microscopy]], looks for the presence of [[red blood cells]], white blood cells, or bacteria.<!-- <ref name=Review08/> --> Urine [[microbiological culture|culture]] is deemed positive if it shows a bacterial colony count of greater than or equal to 10<sup>3</sup> [[colony-forming unit]]s per mL of a typical urinary tract organism.<!-- <ref name=Review08/> --> Antibiotic sensitivity can also be tested with these cultures, making them useful in the selection of antibiotic treatment.<!-- <ref name=Review08/> --> However, women with negative cultures may still improve with antibiotic treatment.<ref name=Review08/> As symptoms can be vague and without reliable tests for urinary tract infections, diagnosis can be difficult in the elderly.<ref name=Elder2011/>

===Based on pH===
Normal urine pH is slightly acidic, with usual values of 6.0 to 7.5, but the normal range is 4.5 to 8.0. A urine pH of 8.5 or 9.0 is indicative of a urea-splitting organism, such as Proteus, Klebsiella, or Ureaplasma urealyticum; therefore, an asymptomatic patient with a high pH means UTI regardless of the other urine test results. Alkaline pH also can signify struvite kidney stones, which are also known as "infection stones".<ref name=statspe>{{cite journal | title = Urinary Tract Infection | journal = Statpearls | date = 2020 | pmid = 29261874 | vauthors = Bono MJ, Leslie SW, Reygaert WC }} [[File:CC-BY icon.svg|50px]] Text was copied from this source, which is available under a [https://creativecommons.org/licenses/by/4.0/ Creative Commons Attribution 4.0 International License] {{Webarchive|url=https://web.archive.org/web/20171016050101/https://creativecommons.org/licenses/by/4.0/ |date=16 October 2017 }}.</ref>

===Classification===
A urinary tract infection may involve only the lower urinary tract, in which case it is known as a bladder infection. Alternatively, it may involve the upper urinary tract, in which case it is known as pyelonephritis.<!-- <ref name=EM2011/> --> If the urine contains significant bacteria but there are no symptoms, the condition is known as [[asymptomatic bacteriuria]].<ref name=EM2011/> If a urinary tract infection involves the upper tract, and the person has [[diabetes mellitus]], is pregnant, is male, or [[immunocompromised]], it is considered complicated.<ref name=Sal2011/><ref name=AFP2011/> Otherwise if a woman is healthy and [[premenopausal]] it is considered uncomplicated.<ref name=AFP2011/> In children when a urinary tract infection is associated with a fever, it is deemed to be an upper urinary tract infection.<ref name=PeadsNA2011>{{cite journal | vauthors = Bhat RG, Katy TA, Place FC | title = Pediatric urinary tract infections | journal = Emergency Medicine Clinics of North America | volume = 29 | issue = 3 | pages = 637–653 | date = August 2011 | pmid = 21782079 | doi = 10.1016/j.emc.2011.04.004 }}</ref>

===Children===
To make the diagnosis of a urinary tract infection in children, a positive urinary culture is required.<!-- <ref name=PeadsNA2011/> --> Contamination poses a frequent challenge depending on the method of collection used, thus a cutoff of 10<sup>5</sup>{{nbsp}}CFU/mL is used for a "clean-catch" mid stream sample, 10<sup>4</sup>{{nbsp}}CFU/mL is used for catheter-obtained specimens, and 10<sup>2</sup>{{nbsp}}CFU/mL is used for [[suprapubic aspiration]]s (a sample drawn directly from the bladder with a needle).<!-- <ref name=PeadsNA2011/> --> The use of "urine bags" to collect samples is discouraged by the [[World Health Organization]] due to the high rate of contamination when cultured, and catheterization is preferred in those not toilet trained.<!-- <ref name=PeadsNA2011/> --> Some, such as the [[American Academy of Pediatrics]] recommends [[renal ultrasound]] and [[voiding cystourethrogram]] (watching a person's urethra and urinary bladder with real time x-rays while they urinate) in all children less than two years old who have had a urinary tract infection.<!-- <ref name=PeadsNA2011/> --> However, because there is a lack of effective treatment if problems are found, others such as the [[National Institute for Health and Care Excellence]] only recommends routine imaging in those less than six months old or who have unusual findings.<ref name=PeadsNA2011/>

===Differential diagnosis===
In women with [[cervicitis]] (inflammation of the [[cervix]]) or [[vaginitis]] (inflammation of the [[vagina]]) and in young men with UTI symptoms, a ''[[Chlamydia trachomatis]]'' or ''[[Neisseria gonorrhoeae]]'' infection may be the cause.<ref name=EM2011/><ref>{{cite journal | vauthors = Raynor MC, Carson CC | title = Urinary infections in men | journal = The Medical Clinics of North America | volume = 95 | issue = 1 | pages = 43–54 | date = January 2011 | pmid = 21095410 | doi = 10.1016/j.mcna.2010.08.015 }}</ref> These infections are typically classified as a [[urethritis]] rather than a urinary tract infection. Vaginitis may also be due to a [[candidal vulvovaginitis|yeast infection]].<ref name=Book2011>{{cite book| vauthors = Hui D | veditors = Leung A, Padwal R |title=Approach to internal medicine : a resource book for clinical practice|publisher=Springer|location=New York|isbn=978-1-4419-6504-2|page=244 |url=https://books.google.com/books?id=lnXNpj5ZzKMC&pg=PA244 |edition=3rd |url-status=live|archive-url=https://web.archive.org/web/20160520142217/https://books.google.com/books?id=lnXNpj5ZzKMC&pg=PA244|archive-date=20 May 2016|date=15 January 2011}}</ref> [[Interstitial cystitis]] (chronic pain in the bladder) may be considered for people who experience multiple episodes of UTI symptoms but urine cultures remain negative and not improved with antibiotics.<ref>{{cite book| veditors = Kursh ED, Ulchaker JC |title=Office urology|year=2000|publisher=Humana Press|location=Totowa, N.J.|isbn=978-0-89603-789-2|page=131|url=https://books.google.com/books?id=AdYs-QwU8KQC&pg=PA131|url-status=live|archive-url=https://web.archive.org/web/20160504192213/https://books.google.com/books?id=AdYs-QwU8KQC&pg=PA131|archive-date=4 May 2016}}</ref> [[Prostatitis]] (inflammation of the [[prostate]]) may also be considered in the differential diagnosis.<ref>{{cite book | veditors = Mick NW, Peters JR, Egan D, Nadel ES, Walls R, Silvers S |title=Blueprints emergency medicine|year=2006|publisher=Lippincott Williams & Wilkins|location=Baltimore, Md.|isbn=978-1-4051-0461-6|page=152|url=https://books.google.com/books?id=NvqaWHi1OTsC&pg=RA1-PA152|edition=2nd|url-status=live|archive-url=https://web.archive.org/web/20160527135605/https://books.google.com/books?id=NvqaWHi1OTsC&pg=RA1-PA152|archive-date=27 May 2016}}</ref>

[[Hemorrhagic cystitis]], characterized by [[hematuria|blood in the urine]], can occur secondary to a number of causes including: infections, [[radiation therapy]], underlying cancer, medications and toxins.<ref name=Keanse2009/> Medications that commonly cause this problem include the [[chemotherapeutic agent]] [[cyclophosphamide]] with rates of 2–40%.<ref name=Keanse2009>{{cite book | veditors = Graham SD, Keane, James TE, Glenn F |title=Glenn's urologic surgery|year=2009|publisher=Lippincott Williams & Wilkins|location=Philadelphia, Pa.|isbn=9780781791410|page=148|url=https://books.google.com/books?id=GahMzaKgMKAC&pg=PA148|edition=7th|url-status=live|archive-url=https://web.archive.org/web/20160424192313/https://books.google.com/books?id=GahMzaKgMKAC&pg=PA148|archive-date=24 April 2016}}</ref> [[Eosinophilic cystitis]] is a rare condition where [[eosinophiles]] are present in the bladder wall.<ref name=Kramer2002/> Signs and symptoms are similar to a bladder infection.<ref name=Kramer2002>{{cite book| veditors = Belman AB, King LR, Kramer SA |title=Clinical pediatric urology |year=2002 |publisher=Dunitz |location=London |isbn=9781901865639 |page=338 |url= https://books.google.com/books?id=IKexq6xCRmIC&pg=PA338|edition=4.|url-status=live|archive-url=https://web.archive.org/web/20160515140354/https://books.google.com/books?id=IKexq6xCRmIC&pg=PA338|archive-date=15 May 2016}}</ref> Its cause is not entirely clear; however, it may be linked to [[food allergies]], [[infections]], and medications among others.<ref>{{cite journal | vauthors = Popescu OE, Landas SK, Haas GP | title = The spectrum of eosinophilic cystitis in males: case series and literature review | journal = Archives of Pathology & Laboratory Medicine | volume = 133 | issue = 2 | pages = 289–294 | date = February 2009 | pmid = 19195972 | doi = 10.5858/133.2.289 }}</ref>