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BACILLURIA: GERMS IN URINE A Disorder which is Often Overlooked
Presence of living micro-organisms in the urine is a relatively common condition but the indefiniteness of the symptoms often leads to its existence being unsuspected or ignored. The patient may have vague complaints like headache, occasional pains of the lower belly, or the cardinal sign of frequency of micturation if not burning sensation upon passing urine.
Routine microscopic examination of urine is not a physician's habit, so he therefore generally overlooks this frequent condition. Even individuals in apparent normal health can sometimes be harboring infection in the urinary tract.
In addition to acute and chronic Bright's disease, which are described under that heading, there are certain inflammatory conditions of the kidney to which the term nephritis may be applied. These include temporary disturbances of its health as the consequence of poisons circulating in the blood and derived from something swallowed or absorbed, as from certain germs, such as those of diphtheria. In these conditions there may be a temporary disturbance of the kidney leading to the passage of a concentrated urine containing albumin or blood, but unless the poisoning is very severe it is unusual for the general symptoms of acute Bright's disease to develop; the kidney rapidly returns to normal after absorption of the irritating substance is discontinued.
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As a consequence of inflammation of the urinary tract the kidney may itself become inflamed. In these case, the inflammation affects first the pelvis of the kidney, i.e. the expanded upper end of the ureter, giving rise to a condition of pyelitis.
Pyelitis is liable to affect the kidney in two ways; it may lead to gross dilatation of the pelvis of the kidney, converting this into a large, painful bag of pus without marked. involvement of the cellular structures, a condition known as pyonephrosis (q.v.), or it may affect both the pelvis and the body of the kidney, when it is called pyelonephritis: Pain and irregular fever, often with rigors, are symptoms of both states.
The urinary tubules of the hidney discharge their contents into the expanded upper end of the ureter, known as the pelvis of the kidney. It is liable to become inflamed as a result of infection with microorganisms carried to it through the blood or lymph or reaching it by direct spread upwards from the lower reaches of the urinary tract as in a bladder infection (cystitis). This condition is known as pyelitis. Infection with germs from the bowel is the most common type, and is associated with the passage in the urine of large quantities of the common colon bacillus, a condition termed bacilluria (q.v.). Other organisms may cause pyelitis, e.g. the staphylococci and streptococci of acute infections of the bladder or urethra; but these organisms may also originate from a putrefactive bowel. As a consequence, in any case of pyelitis, bowel putrefaction must be assumed until proven otherwise. Needless to say, most cases of pyelitis are concomitant with constipation.
Pyelitis is one of the serious complications of pregnancy. It causes fever, malaise ard usually, frequeucy of micturition. In these cases the organism is derived from the bowel. In children, especially little girls, pyelitis is quite common. Any unexplained ill health of children associated with some variable degree of fever should arouse suspicion of pyelitis. In many cases the symptoms are very severe. Acute cases of pyelitis respond quickly to treatment. This consists in confinement to bed, clearing of the bowels by an active aperient or purge by Epsom salts, copious drinks of water and the administration of snfficiently large doses of alkalies to keep the urine definitely alkaline, potassium citrate being the most effective, but calcium salts can also be used. As a urinary tract disinfectant, Lugol’s iodine/iodide solution, several drops to a glass of water, four or more times daily for 7-14 days, as a course of treatment.
Chronic pyelitis is sometimes very resistant to treatment. This is particularly the case when mixed infection with several organisms is present. In these cases urinary antiseptics such as iodine and sulfa drugs which will increase the acidity of the urine are used in alternation with the alkaline treatment. And if these fail good results may be obtained by the use of vaccines prepared from the actual organisms found in the urine of the individual case