Differential Diagnosis and Preliminary Diagnosis
The differential diagnosis includes urethritis, vaginitis, a more extensive UTI, and acute cystitis. First of all, if it were urethritis, it would probably be caused by a sexually transmitted pathogen, which is unlikely in this specific case. Neither the patient’s history and circumstances nor any other symptoms can point to an STD, that is why this alternative is less possible. As for vaginitis, it is a relatively reasonable variant though no evident indications of this type of infection were revealed by the physical examination. No signs of an upper UTI such as flank pain and fever appear.
Therefore, it is more likely that there is yet another case of acute cystitis, which is the preliminary diagnosis. Overall, if a woman has at least one sign of UTI, then there is a fifty percent chance of infection (Mayo Clinic Staff, 2019). Frequency and dysuria with no vaginal irritation or discharge is a particular combination of symptoms that increases the likelihood of a urinary tract infection to more than ninety percent (Mayo Clinic Staff, 2019). It effectively rules in the diagnosis that is based on the patient’s history.
Necessary Tests
To confirm the preliminary diagnosis, some tests are necessary. The most appropriate ones typically include laboratory tests such as a urinalysis, a urine culture, susceptibility testing, and a CBC with differential. Urinalysis will help find evidence of infection, including white blood cells and bacteria (“Urinary tract infection,” 2020). A urine culture test is needed to identify a certain microbe causing the infection (“Urinary tract infection,” 2020). Susceptibility testing (in case the urine culture is positive) will determine the most effective antimicrobial drug. The non-laboratory tests may include ordering imaging scans and special X-rays (urography or kidney and bladder ultrasound) (“Urinary tract infection,” 2020). They are necessary for adults with recurrent or frequent UTIs and help check for urinary tract structural problems or blockages.
Possible Causes of Recurrent Lower UTIs
Relapse and reinfection are the possible causes of recurrent lower UTIs. A relapse, which is the reappearance of the original infection, is caused by the same organism and typically occurs within two weeks after antibiotic therapy ends (Sampson, 2019). In this particular case, the diagnosis of relapse is not supported due to two reasons. First, the infectious agent’s identity is different all five times the patient experiences attacks of acute cystitis. Second, the recurrences are reported to occur at intervals of three weeks to three months after completing antibiotic therapy. Therefore, reinfection, which may be caused by the same or a different organism, does not imply an anatomical abnormality and can occur at any time, which is likely to be the reason for recurrent lower UTIs.
Collaborating with Professionals
Collaborating with professionals and referring the patients to other specialists is crucial in achieving the purpose of safe, effective, and complete treatment. In this particular case, it is possible to consult other healthcare providers when ordering tests and analyses and getting their results. Several specialists may help in understanding them correctly and considering all possible variants. Moreover, it is recommended to refer this patient to a nephrologist (“Urinary tract infection,” 2020). Researchers note that “long-lasting or repeated UTIs may also damage the kidneys and, in some cases, cause renal failure” (“Urinary tract infection,” 2020, para. 4). That is why consulting a specialist in this area is necessary as soon as possible after the patient comes to see her nurse practitioner provider.
References
Mayo Clinic Staff. (2019). Urinary tract infection (UTI). Mayo Clinic. Web.
Sampson, S. (2019). Acute cystitis. Healthline. Web.
Urinary tract infection. (2020). Lab Tests Online. Web.