Asymptomatic and symptomatic UTI
Researchers have extensively investigated the infection among people of different age groups belonging to different races and have produced reliable output. Asymptomatic bacteriuria is defined as a condition where the symptoms are not observed in the patient. Studies have substantiated an enumeration of 103 CFU/ ml of sample to be appropriate for the diagnosis of group B streptococcus (GBS) urinary tract infection [Brett-white, M.D. (2011)]. The researchers also feel that the diagnosis of UTI among asymptomatic patients should be supported by positive cultures for uropathogens to confirm the presence of the infection [Brett-white, M.D. (2011)]. Attempts have been made to demonstrate the occurrence of asymptomatic and symptomatic UTI as a consequence of bacteriuria which is the presence of bacteria in urine. Despite the fact, that symptomatic bacteriuria is common among the pregnant women and leads to various complications, asymptomatic bacteriuria could also lead to assorted complications. Studies in the past have carried out a convoluted analysis to explore the incidence of asymptomatic bacteriuria among pregnant women at Komfo Anokye Teaching Hospital (KATH), Ghana. They have defined urinary tract infection as microbial colonization of urine and tissue invasion of any structure of the urinary tract. The incidence of UTI among pregnant women across the world varies widely and has been demonstrated by the scientific studies carried out by the researchers. In Canada the prevalence rate varies from 4-7% and 7% of incidence has been recorded in Ethiopia. Experimental studies have revealed the incidence of the infection up to 23.9%. Reports have also suggested a higher rate of prevalence up to 86.6% in the Southern part of Nigeria. It is understood from the above findings that the rate of occurrence of UTI in Nigeria has drastically increased over a period of 8 years. Additional reports have illustrated the occurrence of asymptomatic bacteriuria among pregnant and non-pregnant women ranging from 5 to 9%. Lack of proper treatment can lead to consequences like acute cystitis and phylonephritis cropping up at a rate of 15 to 45% and pregnant women are prone to higher risk compared to non-pregnant women. The rate of occurrence is 4 times higher during pregnancy compared to non-pregnant women.
Attempts have been made to prove the role of asymptomatic bacteriuria in causing symptomatic bacteriuria and research studies have confirmed the occurrence of symptomatic bacteriuria due to untreated asymptomatic bacteriuria. Thus asymptomatic bacteriuria accounts to about 70% of cases of symptomatic UTI among unscreened pregnant women. Asymptomatic bacteriuria is generally defined as a true bacteriuria in absence of specific symptoms during acute UTI. The criteria for diagnosing is the presence of >105 bacteria/ml in a single sample of mid stream urine or presence of same amount of bacteria in two consecutive clean catch urine samples. The occurrence of asymptomatic bacteriuria during pregnancy ranges between 2 to 10%. Certain experimental analysis has claimed the prevalence of symptomatic UTI as a consequence of physiological changes during pregnancy(Brett-white, M.D. (2011). In addition, glycosuria, proteinuria and aminoaciduria also facilitate the bacterial growth. Hence it is understood that 20-40% of patients during their pregnancy diagnosed with asymptomatic bacteriuria are vulnerable to develop symptomatic bacteriuria in due course if untreated. This in turn leads to phylonephritis which in later stages causes kidney failure. Usage of antibiotics is necessary to alleviate the prevalence of phylonephritis. A similar kind of study was carried out to investigate the prevalence of asymptomatic bacteriuria and the associated risk factors among pregnant women during the first pre-natal visit. They have stressed on the significance of physiological factors leading to UTI. Research studies have explored the role of S. aureus in association with urinary tract infection and subsequent bacteremia. According to their study, the presence of S. aureus was apparent in the urine samples of the long term care patients. In spite of its association with UTI, the significance of Staphylococcal bacteriuria is tentative. Their study has proposed S. aureus as a urinary pathogen and its colonization of the urinary tract can lead to future complications. Urinary tract instrumentation and presence of indwelling catheters elevates the risk of S. aureus carriage in the urinary tract. Hence it is understood that asymptomatic UTI is a consequence of bacterial infection in the absence of symptoms and can transform in to symptomatic UTI under severe circumstances and one of the prime reasons for this to occur is the lack of adequate medical facilities and health care centers. However, the fact of occurrence of the infection as a consequence of long term hospitalized conditions cannot be contracdicted. Several research studies have confirmed the presence of the infection based on a specific enumeration which ranges from 103 to 105 CFU/ ml and the presence of symptoms is a vital indication for the onset of the symptomatic UTI. However, the count varies as certain studies have considered a count less than 105 cfu/ ml to signify the infection. But majority of the research studies in relation to UTI usually consider a count of 100000 cfu/ ml. The prime reason for taking the enumeration in to consideration is due to the fact that urine is considered to be sterile and the presence of bacteria in the urine is a consequence of bacterial colonization due to infection.
