<div id="pf1" class="pf w0 h0" data-page-no="1"><div class="pc pc1 w0 h0"><img class="bi x0 y0 w1 h1" alt src="https://files.passeidireto.com/e78ed9d7-0969-4804-95c1-3a92effc5fc9/bg1.png" alt="Pré-visualização de imagem de arquivo"><div class="t m0 x1 h2 y1 ff1 fs0 fc0 sc0 ls4 ws15"> </div><div class="c x2 y2 w2 h3"><div class="t m0 x3 h4 y3 ff2 fs1 fc1 sc0 ls4 ws15">Aula </div><div class="t m0 x4 h5 y4 ff3 fs2 fc1 sc0 ls4 ws15">6 </div></div><div class="c x0 y5 w3 h6"><div class="t m0 x5 h7 y6 ff2 fs1 fc1 sc0 ls4 ws15">Manual para as Aulas Práticas de Microbiologia<span class="ff4"> </span></div></div><div class="c x0 y7 w4 h8"><div class="t m0 x6 h9 y8 ff2 fs3 fc0 sc0 ls4 ws15">Infecção Urinár<span class="blank _0"></span>ia </div></div><div class="t m0 x7 h4 y9 ff2 fs1 fc0 sc0 ls4 ws15"> </div><div class="t m0 x7 ha ya ff5 fs4 fc1 sc0 ls4 ws15"> </div><div class="t m0 x7 ha yb ff5 fs4 fc1 sc0 ls4 ws15"> </div><div class="t m0 x7 ha yc ff5 fs4 fc1 sc0 ls4 ws15"> </div><div class="t m0 x8 hb yd ff5 fs5 fc1 sc0 ls5 ws0">OBJECTIVOS<span class="ls4 ws15"> </span></div><div class="t m0 x1 hc ye ff4 fs6 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 hd yf ff4 fs5 fc0 sc0 ls4 ws15">No final da aula<span class="blank _0"></span> os estudantes </div><div class="t m0 x1 hd y10 ff4 fs5 fc0 sc0 ls4 ws15">deverão<span class="blank _0"></span> ser capazes <span class="ls6">de:<span class="blank _0"></span> <span class="ls4"> </span></span></div><div class="t m0 x1 he y11 ff6 fs5 fc0 sc0 ls4 ws1">□<span class="ff7 ls0 ws15"> <span class="ff4 ls4">Nomear o<span class="blank _0"></span>s agentes etiológ<span class="blank _0"></span>icos </span></span></div><div class="t m0 x9 hd y12 ff4 fs5 fc0 sc0 ls4 ws15">mais frequentes em i<span class="blank _0"></span>nfecções </div><div class="t m0 x9 hd y13 ff4 fs5 fc0 sc0 ls4 ws15">urinárias. </div><div class="t m0 x1 he y14 ff6 fs5 fc0 sc0 ls4 ws1">□<span class="ff7 ls0 ws15"> <span class="ff4 ls4">Descre<span class="blank _0"></span>ver as estratégias de </span></span></div><div class="t m0 x9 hd y15 ff4 fs5 fc0 sc0 ls7 ws15">colhe<span class="blank _0"></span>ita de ur<span class="blank _0"></span>ina para<span class="blank _0"></span> o </div><div class="t m0 x9 hd y16 ff4 fs5 fc0 sc0 ls4 ws15">diagnóstico bacte<span class="blank _0"></span>riológico de </div><div class="t m0 x9 hd y17 ff4 fs5 fc0 sc0 ls4 ws15">infecção urinár<span class="blank _0"></span>ia em difere<span class="blank _0"></span>ntes </div><div class="t m0 x9 hd y18 ff4 fs5 fc0 sc0 ls4 ws15">situações clínicas<span class="blank _0"></span>. </div><div class="t m0 x1 he y19 ff6 fs5 fc0 sc0 ls4 ws1">□<span class="ff7 ls0 ws15"> <span class="ff4 ls4">Observar e<span class="blank _0"></span> realizar o </span></span></div><div class="t m0 x9 hd y1a ff4 fs5 fc0 sc0 ls4 ws15">procedimento de ro<span class="blank _0"></span>tina <span class="ls6">que l<span class="blank _0"></span>ev<span class="blank _0"></span>a à </span></div><div class="t m0 x9 hd y1b ff4 fs5 fc0 sc0 ls4 ws15">identificação do<span class="blank _0"></span>s agentes </div><div class="t m0 x9 hd y1c ff4 fs5 fc0 sc0 ls4 ws15">etiológicos na uri<span class="blank _0"></span>na: </div><div class="t m0 xa he y1d ff6 fs5 fc0 sc0 ls4 ws1">□<span class="ff7 ls1 ws15"> <span class="ff4 ls4">Realização de<span class="blank _0"></span> exames directos </span></span></div><div class="t m0 xb hd y1e ff4 fs5 fc0 sc0 ls4 ws15">de urina, a fre<span class="blank _0"></span>sco e após </div><div class="t m0 xc hd yf ff4 fs5 fc0 sc0 ls4 ws15">coloração pel<span class="blank _0"></span>o método de </div><div class="t m0 xc hd y10 ff4 fs5 fc0 sc0 ls4 ws15">Gram, obser<span class="blank _0"></span>vação microscópica </div><div class="t m0 xc hd y11 ff4 fs5 fc0 sc0 ls8 ws15">e in<span class="blank _1"> </span>terp<span class="blank _1"> </span>retaçã<span class="blank _1"> </span>o. <span class="ls4"> </span></div><div class="t m0 xd he y12 ff6 fs5 fc0 sc0 ls4 ws1">□<span class="ff7 ls1 ws15"> <span class="ff4 ls4">Sementeira de me<span class="blank _0"></span>ios de cultura<span class="blank _0"></span> </span></span></div><div class="t m0 xc hd y13 ff4 fs5 fc0 sc0 ls4 ws15">apropriados (g<span class="blank _0"></span>elose sangue e </div><div class="t m0 xc hd y14 ff4 fs5 fc0 sc0 ls6 ws15">MacCo<span class="blank _0"></span>nkey<span class="blank _0"></span>). <span class="ls4"> </span></div><div class="t m0 xd he y15 ff6 fs5 fc0 sc0 ls4 ws1">□<span class="ff7 ls1 ws15"> <span class="ff4 ls4">Observação e<span class="blank _0"></span> descrição de </span></span></div><div class="t m0 xc hd y16 ff4 fs5 fc0 sc0 ls4 ws15">colónias dos micro<span class="blank _0"></span>rganismos </div><div class="t m0 xc hd y17 ff4 fs5 fc0 sc0 ls4 ws15">característicos. </div><div class="t m0 xd he y18 ff6 fs5 fc0 sc0 ls4 ws1">□<span class="ff7 ls1 ws15"> <span class="ff4 ls4">Execução de e<span class="blank _0"></span>sfregaços de </span></span></div><div class="t m0 xc hd y19 ff4 fs5 fc0 sc0 ls4 ws15">colónias. Colo<span class="blank _0"></span>ração pelo </div><div class="t m0 xc hd y1a ff4 fs5 fc0 sc0 ls4 ws15">método de G<span class="blank _0"></span>ram. Observação e </div><div class="t m0 xc hd y1b ff4 fs5 fc0 sc0 ls4 ws15">interpretação micro<span class="blank _0"></span>scópica. </div><div class="t m0 xd he y1c ff6 fs5 fc0 sc0 ls4 ws1">□<span class="ff7 ls1 ws15"> <span class="ff4 ls4">Sementeira de me<span class="blank _0"></span>io de K<span class="blank _0"></span>ligler. </span></span></div><div class="t m0 xc hd y1d ff4 fs5 fc0 sc0 ls4 ws15">Incubação, obser<span class="blank _0"></span>vação e </div><div class="t m0 xc hd y1e ff4 fs5 fc0 sc0 ls2 ws2">inter<span class="blank _0"></span>pretação<span class="blank _0"></span><span class="ls9 ws15">. <span class="ls4"> </span></span></div><div class="t m0 xe he yf ff6 fs5 fc0 sc0 ls4 ws1">□<span class="ff7 ls1 ws15"> <span class="ff4 ls4">Observação de <span class="blank _0"></span>provas de </span></span></div><div class="t m0 xf hd y10 ff4 fs5 fc0 sc0 ls4 ws15">identificação das<span class="blank _0"></span> bactérias mais </div><div class="t m0 xf hd y11 ff4 fs5 fc0 sc0 ls4 ws15">frequentes. </div><div class="t m0 x10 he y12 ff6 fs5 fc0 sc0 ls4 ws1">□<span class="ff7 ls0 ws15"> <span class="ff4 ls4">Interpre<span class="blank _0"></span>tar resultados de ex<span class="blank _0"></span>ames </span></span></div><div class="t m0 x11 hd y13 ff4 fs5 fc0 sc0 ls4 ws15">microbiológ<span class="blank _0"></span>icos de urina. </div><div class="t m0 x10 he y14 ff6 fs5 fc0 sc0 ls4 ws1">□<span class="ff7 ls0 ws15"> <span class="ff4 ls4">Realizar, le<span class="blank _0"></span>r e interpretar um </span></span></div><div class="t m0 x11 hd y15 ff4 fs5 fc0 sc0 ls4 ws15">antibiograma de <span class="ff8">Es<span class="blank _0"></span>cherichia coli<span class="ff4 ls9">. <span class="ls4"> </span></span></span></div><div class="t m0 x10 he y16 ff6 fs5 fc0 sc0 ls4 ws1">□<span class="ff7 ls0 ws15"> <span class="ff4 ls4">Conhecer o<span class="blank _0"></span> tempo de demor<span class="blank _0"></span>a </span></span></div><div class="t m0 x11 hd y17 ff4 fs5 fc0 sc0 ls4 ws15">médio da realiz<span class="blank _0"></span>ação do </div><div class="t m0 x11 hd y18 ff4 fs5 fc0 sc0 ls4 ws3">diagnóst<span class="ls2 ws15">ico <span class="blank _0"></span>micro<span class="blank _0"></span>biol<span class="blank _0"></span>ógico<span class="blank _0"></span> de </span></div><div class="t m0 x11 hd y19 ff4 fs5 fc0 sc0 ls4 ws15">uma infecção <span class="blank _0"></span>urinária. </div><div class="t m0 x10 he y1a ff6 fs5 fc0 sc0 ls4 ws1">□<span class="ff7 ls0 ws15"> <span class="ff4 ls4">Especificar a <span class="blank _0"></span>terapêutica </span></span></div><div class="t m0 x11 hd y1b ff4 fs5 fc0 sc0 ls4 ws15">etiológica das infe<span class="blank _0"></span>cções urinárias<span class="blank _0"></span>. </div><div class="t m0 x7 ha y1f ff5 fs4 fc1 sc0 ls4 ws15"> </div><div class="t m0 x7 ha y20 ff5 fs4 fc1 sc0 ls4 ws15"> </div><div class="t m0 x7 ha y21 ff5 fs4 fc1 sc0 ls4 ws15"> </div><div class="t m0 x12 hb y22 ff5 fs5 fc1 sc0 lsa ws15">LISTA D<span class="blank _0"></span>E CONTEÚDO<span class="blank _0"></span>S<span class="blank _1"> </span><span class="ls4"> </span></div><div class="t m0 x1 hc y23 ff4 fs6 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 hf y24 ff2 fs5 fc0 sc0 ls4 ws15">Infecção Urinár<span class="blank _0"></span>ia<span class="ff9 lsb ws4">…1 64</span> </div><div class="t m0 x1 he y25 ff4 fs5 fc0 sc0 ls4 ws3">Epidemiolog<span class="blank _0"></span>ia<span class="ffa">…164</span><span class="ws15"> </span></div><div class="t m0 x1 he y26 ff4 fs5 fc0 sc0 ls4 ws3">Etiologia<span class="ffa lsb ws4">…1564 </span><span class="ws15"> </span></div><div class="t m0 x1 he y27 ff4 fs5 fc0 sc0 ls4 ws3">Patogénese<span class="blank _0"></span><span class="ffa">…164<span class="ff4 ws15"> </span></span></div><div class="t m0 x1 he y28 ff4 fs5 fc0 sc0 ls4 ws15">Bacteriúria A<span class="blank _0"></span>ssintomática<span class="ffa lsb ws5">…166 </span> </div><div class="t m0 x1 he y29 ff4 fs5 fc0 sc0 ls2 ws2">Cistite<span class="blank _0"></span><span class="ffa lsb ws4">…16 6<span class="ff4 ls4 ws15"> </span></span></div><div class="t m0 x1 he y2a ff4 fs5 fc0 sc0 lsc ws6">Pielonefrite<span class="ffa ls4 ws3">…1</span><span class="lsd ws7">66<span class="ls4 ws15"> </span></span></div><div class="t m0 x1 hd y2b ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 hf y2c ff2 fs5 fc0 sc0 lse ws15">Colheit<span class="blank _1"> </span>a de Urina<span class="ff9 lsb ws4">…1 6 6</span><span class="ls4"> </span></div><div class="t m0 x1 he y2d ff4 fs5 fc0 sc0 lsf ws15">Técn<span class="blank _1"> </span>ica<span class="blank _1"> </span> do <span class="blank _1"> </span>Jact<span class="blank _1"> </span>o M<span class="blank _1"> </span>édio<span class="blank _1"> </span><span class="ffa ls4 ws3">…166<span class="blank _0"></span><span class="ff4 ws15"> </span></span></div><div class="t m0 x1 he y2e ff4 fs5 fc0 sc0 lsc ws15">Punção de Algália<span class="blank _1"> </span><span class="ffa ls4 ws3">…</span><span class="ls10 ws8">167</span><span class="ls4"> </span></div><div class="t m0 x1 he y2f ff4 fs5 fc0 sc0 lsc ws15">Punção Supra<span class="blank _1"> </span><span class="ls4 ws3">-</span><span class="ws6">Púbica<span class="ffa lsb ws9">…167 </span></span><span class="ls4"> </span></div><div class="t m0 x1 hd y30 ff4 fs5 fc0 sc0 ls4 ws15">Colheita por Dre<span class="blank _0"></span>nagem de </div><div class="t m0 x9 hd y31 ff4 fs5 fc0 sc0 ls4 ws15">Nefro<span class="blank _0"></span>stomia ou </div><div class="t m0 x9 he y32 ff4 fs5 fc0 sc0 ls4 ws3">Ureterostomia<span class="ffa lsb ws4">…167</span><span class="ws15"> </span></div><div class="t m0 x1 hd y33 ff4 fs5 fc0 sc0 ls4 ws15">Colheita em Cri<span class="blank _0"></span>anças...1<span class="ls10 ws8">67</span> </div><div class="t m0 x1 he y34 ff4 fs5 fc0 sc0 ls4 ws15">Volume de U<span class="blank _0"></span>rina<span class="ffa ws3">…</span><span class="ls11 wsa">167</span> </div><div class="t m0 x1 he y35 ff4 fs5 fc0 sc0 ls4 ws15">Número de A<span class="blank _0"></span>mostras <span class="ffa ws3">…167</span> </div><div class="t m0 x1 he y36 ff4 fs5 fc0 sc0 ls4 ws3">Transporte<span class="ffa">…168<span class="blank _0"></span><span class="ff4 ws15"> </span></span></div><div class="t m0 x1 hd y37 ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h10 y38 ff2 fs5 fc0 sc0 ls4 ws15">Diagnóstico Etiol<span class="blank _0"></span>ógico de Infecção<span class="blank _0"></span> </div><div class="t m0 x9 hf y39 ff2 fs5 fc0 sc0 lse wsb">Urinária<span class="blank _1"> </span><span class="ff9 lsb ws4">…168 </span><span class="ls4 ws15"> </span></div><div class="t m0 x1 he y3a ff4 fs5 fc0 sc0 ls4 ws15">Análise Sumária d<span class="blank _0"></span>a Urina<span class="ffa ws3">…16</span>8 </div><div class="t m0 x1 he y3b ff4 fs5 fc0 sc0 ls4 ws15">Exame Directo<span class="ffa ws3">…16<span class="blank _0"></span>8<span class="ff4 ws15"> </span></span></div><div class="t m0 x1 he y3c ff4 fs5 fc0 sc0 ls4 ws15">Exame Cultural<span class="ffa lsb ws4">…169</span> </div><div class="t m0 x1 he y3d ff4 fs5 fc0 sc0 ls4 ws15">Interpre<span class="blank _0"></span>tação dos Resultados<span class="ffa lsb ws4">…170 </span> </div><div class="t m0 x1 he y3e ff4 fs5 fc0 sc0 ls4 ws3">Hemoculturas<span class="ffa lsb ws4">…170</span><span class="ws15"> </span></div><div class="t m0 x13 hf y24 ff2 fs5 fc0 sc0 ls4 ws15">Ordem Enterob<span class="blank _0"></span>acterales<span class="ff9 ls12 wsc">…1</span><span class="ls10 ws8">70</span><span class="ff4"> </span></div><div class="t m0 x13 he y25 ff4 fs5 fc0 sc0 ls6 wsd">Morf<span class="blank _0"></span>olog<span class="blank _0"></span>ia<span class="ffa ls4 ws3">…171<span class="ff4 ws15"> </span></span></div><div class="t m0 x13 he y26 ff4 fs5 fc0 sc0 ls4 ws3">Estrutura<span class="ffa">…</span><span class="ls6 wsd">17<span class="blank _0"></span>1<span class="ls4 ws15"> </span></span></div><div class="t m0 x13 he y27 ff4 fs5 fc0 sc0 ls4 ws3">Classificação<span class="ffa">…</span><span class="ls6 wsd">17<span class="blank _0"></span>1<span class="ls4 ws15"> </span></span></div><div class="t m0 x13 he y28 ff4 fs5 fc0 sc0 lsf wse">Toxi n a s <span class="ffa ls4 ws3">…171<span class="ff4 ws15"> </span></span></div><div class="t m0 x13 he y29 ff4 fs5 fc0 sc0 ls4 ws3">Epidemiolog<span class="blank _0"></span>ia<span class="ffa">…171</span><span class="ws15"> </span></div><div class="t m0 x13 he y2a ff4 fs5 fc0 sc0 ls4 ws15">Doenças Asso<span class="blank _0"></span>ciadas<span class="ffa lsb ws4">…1 71</span> </div><div class="t m0 x13 he y2b ff4 fs5 fc0 sc0 ls4 ws3">Diagnóstico<span class="ffa lsb ws4">…172</span><span class="ws15"> </span></div><div class="t m0 x13 hd y3f ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x13 h10 y40 ff2 fs5 fc0 sc0 ls4 ws15">Identificação <span class="ls13 wsf">Bi<span class="blank _0"></span>oquím<span class="blank _0"></span>ica<span class="ls3 ws15"> <span class="ls14">de </span></span></span></div><div class="t m0 x14 hf y41 ff2 fs5 fc0 sc0 ls13 wsf">Enter<span class="blank _0"></span>obacter<span class="ls6 wsd">al<span class="blank _0"></span>e<span class="ls4 ws3">s<span class="ff9 lsb ws4">…172</span><span class="ws15"> </span></span></span></div><div class="t m0 x13 he y2f ff4 fs5 fc0 sc0 ls6 ws15">Meio <span class="blank _0"></span>de K<span class="blank _0"></span>lig<span class="blank _0"></span>ler<span class="ffa ls4 ws3">…173</span><span class="ls4"> </span></div><div class="t m0 x13 he y30 ff4 fs5 fc0 sc0 ls15 ws15">API<span class="blank _1"> </span> 2<span class="blank _1"> </span>0E<span class="blank _1"> </span><span class="ffa ls4 ws3">…173</span><span class="ls4"> </span></div><div class="t m0 x13 hd y31 ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x13 hf y42 ff9 fs5 fc0 sc0 ls4 ws15">Resistência aos<span class="blank _0"></span> β<span class="ff2 ws3">-<span class="ls13 ws15">Lactâm<span class="blank _0"></span>icos em<span class="blank _0"></span><span class="ls4"> </span></span></span></div><div class="t m0 x14 h10 y43 ff2 fs5 fc0 sc0 ls4 ws15">Enterobacterales.<span class="blank _0"></span>..175 </div><div class="t m0 x13 he y34 ffa fs5 fc0 sc0 ls4 ws3">β<span class="ff4 ws15">-Lactamases de<span class="blank _0"></span> <span class="ls15">Alt<span class="blank _1"> </span>o </span></span></div><div class="t m0 x14 hd y35 ff4 fs5 fc0 sc0 ls4 ws15">Espectro...175 </div><div class="t m0 x13 he y36 ffa fs5 fc0 sc0 ls4 ws3">β<span class="ff4 ws15">-Lactamases de<span class="blank _0"></span> Espectro </span></div><div class="t m0 x14 hd y37 ff4 fs5 fc0 sc0 lse ws10">Alargado. . .175 <span class="ls4 ws15"> </span></div><div class="t m0 x13 he y44 ffa fs5 fc0 sc0 ls4 ws3">β<span class="ff4 ws15">-Lactamases A<span class="blank _0"></span>mpC...175 </span></div><div class="t m0 x13 hd y45 ff4 fs5 fc0 sc0 ls4 ws15">Carbapenemase<span class="blank _0"></span>s...176 </div><div class="t m0 x13 hd y3a ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x13 h11 y46 ffb fs5 fc0 sc0 ls4 ws15">Escherichia col<span class="blank _0"></span>i<span class="ff9 lsb ws4">…1 77 </span><span class="ff2"> </span></div><div class="t m0 x13 he y3c ff4 fs5 fc0 sc0 ls4 ws3">Fímbrias<span class="ffa lsb ws4">…177 </span><span class="ws15"> </span></div><div class="t m0 x13 he y3d ff4 fs5 fc0 sc0 lsf wse">Toxi n a s <span class="ffa ls4 ws3">…177<span class="ff4 ws15"> </span></span></div><div class="t m0 x13 he y3e ff4 fs5 fc0 sc0 ls4 ws15">Doenças Asso<span class="blank _0"></span>ciadas<span class="ffa lsb ws4">…1 7</span>7 </div><div class="t m0 x10 he y47 ff4 fs5 fc0 sc0 ls4 ws3">Diagnóstico<span class="ffa lsb ws4">…17</span><span class="ws15">8 </span></div><div class="t m0 x10 he y25 ff4 fs5 fc0 sc0 ls4 ws3">Tratamento<span class="ffa lsb ws4">…17</span><span class="ws15">8 </span></div><div class="t m0 x10 h10 y48 ff2 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x10 h11 y49 ff2 fs5 fc0 sc0 ls4 ws15">Género <span class="ffb ls13 wsf">Klebs<span class="blank _0"></span>iell<span class="blank _0"></span>a<span class="ff9 ls12 ws11">…1<span class="ff2 ls4 ws15">78 </span></span></span></div><div class="t m0 x10 he y28 ff4 fs5 fc0 sc0 ls4 ws3">Estrutura<span class="ffa lsb ws4">…17</span><span class="ws15">8 </span></div><div class="t m0 x10 he y29 ff4 fs5 fc0 sc0 ls4 ws15">Doenças Asso<span class="blank _0"></span>ciadas<span class="ffa lsb ws4">…1 79</span> </div><div class="t m0 x10 he y2a ff4 fs5 fc0 sc0 ls4 ws3">Diagnóstico<span class="ffa lsb ws4">…179</span><span class="ws15"> </span></div><div class="t m0 x10 he y2b ff4 fs5 fc0 sc0 ls4 ws3">Tratamento<span class="ffa lsb ws4">…179</span><span class="ws15"> </span></div><div class="t m0 x10 hd y3f ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x10 h11 y40 ff2 fs5 fc0 sc0 ls4 ws15">Género <span class="ffb ws3">Proteus<span class="ff9 ls12 ws11">…1</span></span>79 </div><div class="t m0 x10 he y2e ff4 fs5 fc0 sc0 ls4 ws15">Doenças Asso<span class="blank _0"></span>ciadas<span class="ffa lsb ws12">…1 7 </span>9 </div><div class="t m0 x10 he y2f ff4 fs5 fc0 sc0 ls4 ws3">Diagnóstico<span class="ffa lsb ws4">…17</span><span class="ws15">9 </span></div><div class="t m0 x10 he y30 ff4 fs5 fc0 sc0 ls4 ws3">Tratamento<span class="ffa lsb ws4">…18</span><span class="ws15">0 </span></div><div class="t m0 x10 hd y31 ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x10 h10 y42 ff2 fs5 fc0 sc0 ls4 ws15">Tratament<span class="blank _0"></span>o das Infecções </div><div class="t m0 x11 hf y43 ff2 fs5 fc0 sc0 lse wsb">Urinária s <span class="ff9 lsb ws13">…1 8 </span><span class="ls4 ws15">0 </span></div><div class="t m0 x10 he y34 ff4 fs5 fc0 sc0 ls4 ws15">Bacteriúria A<span class="blank _0"></span>ssintomática<span class="ffa ls12 wsc">…1</span>81 </div><div class="t m0 x10 he y35 ff4 fs5 fc0 sc0 ls13 ws15">Cistite <span class="blank _0"></span>Não<span class="ls4 ws3">-</span><span class="wsf">Com<span class="blank _0"></span>plic<span class="blank _0"></span>ada<span class="ffa lsb ws4">…18</span><span class="ls4 ws15">1 </span></span></div><div class="t m0 x10 he y36 ff4 fs5 fc0 sc0 lsc ws15">Pielonefrite Não<span class="ls4 ws3">-Complicada<span class="ffa ls12 ws11">…1</span><span class="ws15">8<span class="blank _1"> </span>1 </span></span></div><div class="t m0 x10 he y37 ff4 fs5 fc0 sc0 ls4 ws15">ITU na <span class="ls16">Mulher <span class="blank _1"> </span>Grávida<span class="blank _1"> </span><span class="ffa lsb ws13">…18</span></span>1 </div><div class="t m0 x10 he y44 ff4 fs5 fc0 sc0 ls4 ws15">ITU Complica<span class="blank _0"></span>da<span class="ffa lsb ws14">…18 </span><span class="ws3">1</span><span class="ff8"> </span></div><div class="t m0 x10 hd y45 ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x10 hf y4a ff2 fs5 fc0 sc0 ls13 ws15">Leitu<span class="blank _0"></span>ra Com<span class="blank _0"></span>plem<span class="blank _0"></span>entar<span class="ff9 ls4 ws3">…18</span><span class="ls4">2 </span></div><div class="t m0 x10 h10 y46 ff2 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x10 hf y4b ff2 fs5 fc0 sc0 ls4 ws15">Referências Bib<span class="blank _0"></span>liográficas<span class="ff9 ls12 wsc">…1</span>82 </div><div class="t m0 x10 h10 y4c ff2 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h4 y4d ff2 fs1 fc0 sc0 ls4 ws15"> <span class="blank _2"> </span> </div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf2" class="pf w0 h0" data-page-no="2"><div class="pc pc2 w0 h0"><img class="bi x15 y4e w1 h12" alt src="https://files.passeidireto.com/e78ed9d7-0969-4804-95c1-3a92effc5fc9/bg2.png" alt="Pré-visualização de imagem de arquivo"><div class="c x16 y4f w5 h13"><div class="t m1 x17 h14 y50 ff2 fs7 fc1 sc0 ls4 ws15">Aula 6 </div></div><div class="c xb y51 w6 h15"><div class="t m0 x18 h16 y52 ff2 fs8 fc1 sc0 ls4 ws15">Infecção Urinária </div></div><div class="t m0 x19 h16 y53 ff2 fs8 fc0 sc0 lsd ws16">164<span class="ls4 ws15"> </span></div><div class="t m0 x1 h2 y54 ff1 fs0 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1a h14 y55 ff2 fs7 fc1 sc0 ls1e ws15">Caso Clínico<span class="blank _1"> </span><span class="ls4"> </span></div><div class="t m0 x1 h17 y56 ff2 fs6 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h10 y57 ff2 fs5 fc0 sc0 ls4 ws15">Doente com<span class="blank _0"></span> disúria, polaquiúr<span class="blank _0"></span>ia e tenesm<span class="blank _0"></span>o </div><div class="t m0 x1 h10 y58 ff2 fs5 fc0 sc0 lsc ws6">urinário<span class="ls4 ws15"> </span></div><div class="t m0 x1 hd y59 ff4 fs5 fc0 sc0 ls4 ws15">Uma <span class="blank _3"> </span>mulher <span class="blank _3"> </span>de <span class="blank _3"> </span>20 <span class="blank _3"> </span>anos <span class="blank _3"> </span>inicia <span class="blank _3"> </span>um <span class="blank _3"> </span>quadro <span class="blank _3"> </span>de <span class="blank _3"> </span>di<span class="blank _1"> </span>súria </div><div class="t m0 x1 hd y5a ff4 fs5 fc0 sc0 ls1f ws15">(ardor <span class="blank _4"> </span>ao <span class="blank _4"> </span>urinar)<span class="ls7">, p<span class="blank _1"> </span>ol<span class="blank _0"></span>aquiúria<span class="ls4"> (urinar em <span class="blank _4"> </span>pequenas<span class="blank _0"></span> </span></span></div><div class="t m0 x1 hd y5b ff4 fs5 fc0 sc0 ls4 ws15">quantidades <span class="blank _1"> </span>de <span class="blank _1"> </span>cada <span class="blank _3"> </span>ve<span class="blank _0"></span>z, <span class="blank _1"> </span>frequentemente <span class="blank _1"> </span>descrito <span class="blank _1"> </span>co<span class="blank _1"> </span>-</div><div class="t m0 x1 he y5c ffa fs5 fc0 sc0 ls4 ws15">mo <span class="blank _1"> </span>urinar <span class="blank _1"> </span>“às <span class="blank _1"> </span>pingas”<span class="ff4">) <span class="blank _1"> </span>e <span class="blank _1"> </span>tenesmo <span class="blank _1"> </span>urinário <span class="blank _1"> </span>(falsa <span class="blank _1"> </span>von-</span></div><div class="t m0 x1 hd y5d ff4 fs5 fc0 sc0 ls1d ws17">ta<span class="ls6 ws15">de<span class="blank _0"></span> de urinar)<span class="ls4">, sem outras queixas. À observação não </span></span></div><div class="t m0 x1 hd y5e ff4 fs5 fc0 sc0 ls4 ws15">se <span class="blank _5"> </span>encontra <span class="blank _5"> </span>qualquer <span class="blank _5"> </span>sinal <span class="blank _5"> </span>relevante. <span class="blank _5"> </span>Está <span class="blank _5"> </span>apirética. </div><div class="t m0 x1 hd y5f ff4 fs5 fc0 sc0 ls4 ws15">Na histó<span class="blank _0"></span>ria preg<span class="blank _0"></span>ressa <span class="blank _5"> </span>há a re<span class="blank _0"></span>ferir <span class="blank _5"> </span>q<span class="blank _1"> </span>ue, <span class="blank _5"> </span>nos últimos </div><div class="t m0 x1 hd y60 ff4 fs5 fc0 sc0 ls4 ws15">dois <span class="blank _3"> </span>anos, <span class="blank _3"> </span>teve <span class="blank _3"> </span>4 <span class="blank _6"> </span>episódios <span class="blank _3"> </span>de <span class="blank _3"> </span>infecção<span class="blank _0"></span> <span class="blank _3"> </span>urinária. <span class="blank _3"> </span>Fez </div><div class="t m0 x1 hd y61 ff4 fs5 fc0 sc0 ls4 ws15">sempre <span class="blank _3"> </span>terapêutica <span class="blank _6"> </span>com <span class="blank _6"> </span>co<span class="blank _1"> </span>-trimoxaz<span class="blank _0"></span>ol <span class="blank _6"> </span>por <span class="blank _6"> </span>indicação </div><div class="t m0 x1 hd y62 ff4 fs5 fc0 sc0 ls4 ws15">do seu médico e ficou assintomática após 48 horas e<span class="blank _0"></span>m </div><div class="t m0 x1 hd y63 ff4 fs5 fc0 sc0 ls4 ws15">todos <span class="blank _5"> </span>os <span class="blank _5"> </span>episódios an<span class="blank _0"></span>teriores. <span class="blank _5"> </span>O e<span class="blank _0"></span>xame <span class="blank _5"> </span>laboratorial </div><div class="t m0 x1 hd y64 ff4 fs5 fc0 sc0 ls4 ws15">revelou <span class="blank _4"> </span>a p<span class="blank _1"> </span>rese<span class="blank _0"></span>nça <span class="blank _4"> </span>de <span class="blank _4"> </span>muitos leucócitos <span class="blank _4"> </span>(>20 <span class="blank _4"> </span>por </div><div class="t m0 x1 hd y65 ff4 fs5 fc0 sc0 ls4 ws15">campo), eritróci<span class="blank _0"></span>tos (10 por campo) e<span class="blank _0"></span> bactérias. </div><div class="t m0 x9 hd y66 ff4 fs5 fc0 sc0 ls4 ws15">Este <span class="blank _3"> </span>episódio <span class="blank _3"> </span>de <span class="blank _3"> </span>cistite <span class="blank _3"> </span>não-complicada <span class="blank _3"> </span>foi <span class="blank _3"> </span>trata<span class="blank _0"></span>do </div><div class="t m0 x1 hd y67 ff4 fs5 fc0 sc0 ls4 ws15">com co-trimoxazo<span class="blank _0"></span>l com sucesso. 6 meses depois a d<span class="blank _1"> </span>o-</div><div class="t m0 x1 hd y68 ff4 fs5 fc0 sc0 ls4 ws15">ente regressa a<span class="blank _1"> </span>o serviço <span class="blank _1"> </span>de urgênc<span class="blank _1"> </span><span class="ls2 ws2">ia.</span> Há <span class="blank _1"> </span>4 <span class="blank _1"> </span>dias come-</div><div class="t m0 x1 hd y69 ff4 fs5 fc0 sc0 ls4 ws15">çou <span class="blank _3"> </span>com <span class="blank _1"> </span>náuseas <span class="blank _3"> </span>sem <span class="blank _1"> </span>vómitos. <span class="blank _3"> </span>Um <span class="blank _3"> </span>dia <span class="blank _1"> </span>d<span class="blank _1"> </span>epois <span class="blank _1"> </span>refere </div><div class="t m0 x1 hd y6a ff4 fs5 fc0 sc0 ls4 ws15">dor <span class="blank _1"> </span>na <span class="blank _1"> </span>região lombar <span class="blank _1"> </span>direita, <span class="blank _1"> </span>acompanhada <span class="blank _1"> </span>de <span class="blank _1"> </span>febre<span class="blank _0"></span> <span class="blank _1"> </span>e </div><div class="t m0 x1 hd y6b ff4 fs5 fc0 sc0 ls6 ws15">polaq<span class="blank _0"></span>uiúr<span class="blank _0"></span>ia. <span class="blank _6"> </span>Hoje <span class="blank _6"> </span>refere<span class="blank _0"></span> <span class="blank _5"> </span>t<span class="ls4">er <span class="blank _5"> </span>tido <span class="blank _6"> </span>arrepios, <span class="blank _5"> </span>tem <span class="blank _6"> </span>febre </span></div><div class="t m0 x1 hd y6c ff4 fs5 fc0 sc0 ls1f ws18">(38,<span class="ls4 ws15">8ºC) <span class="blank _3"> </span>e <span class="blank _3"> </span>dor <span class="blank _3"> </span>lombar. <span class="blank _3"> </span>O <span class="blank _3"> </span>exame <span class="blank _3"> </span>laboratorial <span class="blank _3"> </span>micros-</span></div><div class="t m0 x1 hd y6d ff4 fs5 fc0 sc0 ls4 ws15">cópico de uma amostra de u<span class="blank _1"> </span>rina revelou a presença de </div><div class="t m0 x1 hd y6e ff4 fs5 fc0 sc0 ls4 ws15">muitos leucócitos (>50 por<span class="blank _0"></span> campo), eritrócitos (10 por </div><div class="t m0 x1 hd y6f ff4 fs5 fc0 sc0 ls4 ws15">campo) e bactérias. F<span class="blank _0"></span>oi feito o diagnóstico de<span class="blank _0"></span> pielone-</div><div class="t m0 x1 hd y70 ff4 fs5 fc0 sc0 ls1f ws15">frite agud<span class="blank _1"> </span>a.<span class="ls4"> </span></div><div class="t m0 x1 h18 y71 ff4 fs9 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h14 y72 ff2 fs7 fc2 sc0 ls20 ws15">Infecçã<span class="blank _1"> </span>o Uriná<span class="blank _1"> </span>ria<span class="blank _1"> </span><span class="ls4"> </span></div><div class="t m0 x1 h17 y73 ff2 fs6 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 hd y74 ff4 fs5 fc0 sc0 ls4 ws15">A <span class="blank _3"> </span>infecção <span class="blank _3"> </span>do <span class="blank _6"> </span>tracto <span class="blank _3"> </span>urinário <span class="blank _3"> </span>(ITU) <span class="blank _3"> </span>é <span class="blank _3"> </span>uma <span class="blank _6"> </span>patologia </div><div class="t m0 x1 hd y75 ff4 fs5 fc0 sc0 ls4 ws15">frequente <span class="blank _4"> </span>e <span class="blank _4"> </span>dolo<span class="blank _0"></span>rosa, <span class="blank _4"> </span>qu<span class="blank _1"> </span>e <span class="blank _4"> </span>re<span class="blank _0"></span>sponde <span class="blank _4"> </span>rapidamente <span class="blank _4"> </span>à </div><div class="t m0 x1 hd y76 ff4 fs5 fc0 sc0 ls4 ws15">terapêutica <span class="blank _5"> </span>antimicrobia<span class="blank _0"></span>na. Po<span class="blank _0"></span>de se<span class="blank _0"></span>r sintomá<span class="blank _0"></span>tica o<span class="blank _0"></span>u </div><div class="t m0 x1 hd y77 ff4 fs5 fc0 sc0 ls4 ws15">assintomática, compre<span class="blank _0"></span>endendo uma variedade<span class="blank _0"></span> de <span class="blank _1"> </span>enti-</div><div class="t m0 x1 hd y78 ff4 fs5 fc0 sc0 ls4 ws15">dades <span class="blank _5"> </span>clínicas <span class="blank _6"> </span>i<span class="blank _1"> </span>ncluin<span class="blank _0"></span>do <span class="blank _5"> </span>a <span class="blank _5"> </span>bacteriúri<span class="blank _0"></span>a <span class="blank _5"> </span>assintomática<span class="ls21">, </span></div><div class="t m0 x1 hd y79 ff4 fs5 fc0 sc0 ls4 ws15">cistite, prostatite<span class="blank _0"></span> e pielone<span class="blank _0"></span>frite. </div><div class="t m0 x9 hd y7a ff4 fs5 fc0 sc0 lse wsb">Define<span class="ls4 ws15">-se <span class="blank _5"> </span>ITU <span class="blank _6"> </span>não-complicada <span class="blank _6"> </span>quando <span class="blank _5"> </span>oco<span class="blank _0"></span>rre <span class="blank _5"> </span><span class="lsd ws7">nu</span>-</span></div><div class="t m0 x1 hd y7b ff4 fs5 fc0 sc0 ls4 ws15">ma mulher<span class="blank _0"></span> não <span class="blank _5"> </span>grávida, não <span class="blank _5"> </span>internada, <span class="blank _5"> </span>sem instr<span class="blank _0"></span>u<span class="blank _1"> </span>-</div><div class="t m0 x1 hd y7c ff4 fs5 fc0 sc0 ls4 ws15">mentação do tracto<span class="blank _0"></span> urinário (por ex<span class="blank _0"></span>emplo, <span class="ls7 ws19">algaliação</span><span class="ls1f">), </span></div><div class="t m0 x1 hd y7d ff4 fs5 fc0 sc0 ls4 ws15">e s<span class="blank _1"> </span>em anomalias <span class="blank _1"> </span>anatómicas do <span class="blank _1"> </span>tracto urinário. <span class="blank _1"> </span>Todas </div><div class="t m0 x1 hd y7e ff4 fs5 fc0 sc0 ls4 ws15">as <span class="blank _3"> </span>outras <span class="blank _3"> </span>situações <span class="blank _3"> </span>são <span class="blank _3"> </span>classif<span class="blank _0"></span>icadas <span class="blank _3"> </span>como <span class="blank _3"> </span><span class="ls22">ITU <span class="blank _6"> </span>c<span class="blank _1"> </span>om</span>-</div><div class="t m0 x1 hd y7f ff4 fs5 fc0 sc0 ls6 wsd">plica<span class="blank _0"></span>da.<span class="ls4 ws15"> </span></div><div class="t m0 x9 h19 y80 ff4 fs8 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h11 y81 ffb fs5 fc2 sc0 ls4 ws15">EPIDEMIOLOGIA </div><div class="t m0 x1 hd y82 ff4 fs5 fc0 sc0 ls4 ws15">A <span class="blank _1"> </span>ITU <span class="blank _1"> </span>é <span class="blank _1"> </span>predominantemente <span class="blank _1"> </span>uma <span class="blank _1"> </span>doença <span class="blank _1"> </span>do <span class="blank _1"> </span>sexo <span class="blank _1"> </span>fe<span class="blank _1"> </span>-</div><div class="t m0 x1 hd y83 ff4 fs5 fc0 sc0 ls4 ws15">minino, <span class="blank _1"> </span>entre<span class="blank _0"></span> <span class="blank _1"> </span>as idades <span class="blank _1"> </span>de 1<span class="blank _1"> </span> ano <span class="blank _1"> </span>e 5<span class="blank _1"> </span>0 anos<span class="blank _1"> </span><span class="ls7">. Durante o </span></div><div class="t m0 x1 hd y84 ff4 fs5 fc0 sc0 ls4 ws15">período <span class="blank _5"> </span>neonatal, <span class="blank _5"> </span>a <span class="blank _5"> </span>incidê<span class="blank _0"></span>ncia é<span class="blank _0"></span> <span class="blank _5"> </span>ligeiramente <span class="blank _5"> </span>maior </div><div class="t m0 x1 hd y85 ff4 fs5 fc0 sc0 ls4 ws15">nos <span class="blank _1"> </span>rapazes <span class="blank _1"> </span>d<span class="blank _1"> </span>evido <span class="blank _1"> </span>à <span class="blank _3"> </span>m<span class="blank _0"></span>aior <span class="blank _1"> </span>p<span class="blank _1"> </span>rev<span class="blank _0"></span>alência <span class="blank _1"> </span>de <span class="blank _3"> </span>anomalias </div><div class="t m0 x1 hd y86 ff4 fs5 fc0 sc0 ls4 ws15">congénitas do <span class="blank _4"> </span>tracto urinário. Após os <span class="blank _4"> </span>50 <span class="blank _4"> </span>a<span class="blank _0"></span>nos, a </div><div class="t m0 x1 hd y87 ff4 fs5 fc0 sc0 ls4 ws15">maior <span class="blank _3"> </span>prevalê<span class="blank _0"></span>ncia <span class="blank _3"> </span>de <span class="blank _3"> </span>hipertrofia <span class="blank _3"> </span>da <span class="blank _3"> </span>pr<span class="blank _0"></span>óstata<span class="blank _1"> </span> <span class="blank _3"> </span><span class="ls7">col<span class="blank _0"></span>oca <span class="blank _3"> </span>a </span></div><div class="t m0 x1 hd y88 ff4 fs5 fc0 sc0 ls4 ws15">incidência de <span class="blank _3"> </span>I<span class="blank _0"></span>T<span class="blank _0"></span>U <span class="blank _1"> </span>dos <span class="blank _1"> </span>homens <span class="blank _1"> </span>em n<span class="blank _1"> </span>íve<span class="blank _0"></span>is <span class="blank _1"> </span>semelhantes </div><div class="t m0 x1 hd y89 ff4 fs5 fc0 sc0 ls4 ws15">aos <span class="blank _5"> </span>das <span class="blank _5"> </span>m<span class="blank _0"></span>ulheres. <span class="blank _5"> </span>A <span class="blank _6"> </span>mai<span class="blank _1"> </span>oria<span class="blank _0"></span> <span class="blank _5"> </span>dos <span class="blank _5"> </span>home<span class="blank _0"></span>ns <span class="blank _5"> </span>com <span class="blank _5"> </span>I<span class="blank _0"></span>TU </div><div class="t m0 x1 hd y8a ff4 fs5 fc0 sc0 ls4 ws15">tem <span class="blank _1"> </span>uma <span class="blank _1"> </span>anomalia, <span class="blank _1"> </span>funcional <span class="blank _1"> </span>ou <span class="blank _3"> </span>anat<span class="blank _0"></span>ómica, <span class="blank _1"> </span>do<span class="blank _1"> </span> <span class="blank _1"> </span><span class="ls2">tracto<span class="blank _0"></span> </span></div><div class="t m0 x1b hd y8b ff4 fs5 fc0 sc0 ls4 ws15">urinário, <span class="blank _1"> </span>mais <span class="blank _1"> </span>frequentemente <span class="blank _1"> </span>devida <span class="blank _1"> </span>a <span class="blank _1"> </span>obstrução <span class="blank _1"> </span>por </div><div class="t m0 x1b hd y8c ff4 fs5 fc0 sc0 ls4 ws15">hipertrofia da pró<span class="blank _0"></span>stata. </div><div class="t m0 x1c hd y8d ff4 fs5 fc0 sc0 ls4 ws15">A <span class="blank _3"> </span>maior <span class="blank _3"> </span>susceptibilidade <span class="blank _3"> </span>das <span class="blank _3"> </span>mulheres <span class="blank _3"> </span>às <span class="blank _6"> </span>ITU<span class="blank _0"></span> <span class="blank _3"> </span>de<span class="blank _1"> </span>-</div><div class="t m0 x1b hd y8e ff4 fs5 fc0 sc0 ls10 ws8">ve<span class="ls4 ws15">-se à uretra mais cur<span class="blank _0"></span>ta e à proximidade do <span class="blank _0"></span>ânus com </span></div><div class="t m0 x1b hd y8f ff4 fs5 fc0 sc0 ls4 ws15">o <span class="blank _5"> </span>v<span class="blank _0"></span>estíbulo <span class="blank _5"> </span>vaginal<span class="blank _0"></span> <span class="blank _5"> </span>e <span class="blank _6"> </span>a <span class="blank _5"> </span>uretra. <span class="blank _5"> </span>No<span class="blank _0"></span> <span class="blank _5"> </span>home<span class="blank _0"></span>m, <span class="blank _5"> </span>o <span class="blank _6"> </span>maior </div><div class="t m0 x1b hd y90 ff4 fs5 fc0 sc0 ls4 ws15">comprimento uretral, o maior <span class="blank _1"> </span>fluxo urinário e o <span class="blank _1"> </span>factor </div><div class="t m0 x1b hd y91 ff4 fs5 fc0 sc0 ls4 ws15">antibacteriano <span class="blank _3"> </span>prostático <span class="blank _3"> </span>são <span class="blank _3"> </span>protectore<span class="blank _0"></span>s. <span class="blank _6"> </span>A <span class="blank _3"> </span>circunci-</div><div class="t m0 x1b hd y92 ff4 fs5 fc0 sc0 ls4 ws15">são também proteg<span class="blank _0"></span>e contra ITU<span class="blank _0"></span> pela menor ligação de </div><div class="t m0 x1b hd y93 ff8 fs5 fc0 sc0 ls4 ws15">Escherichia coli<span class="ff4"> à m<span class="blank _0"></span>ucosa do prep<span class="blank _0"></span>úcio. </span></div><div class="t m0 x1c hd y94 ff4 fs5 fc0 sc0 ls13 ws15">Cerca de <span class="blank _1"> </span>50<span class="ls4">% <span class="blank _1"> </span>das mulheres <span class="blank _1"> </span>tem u<span class="blank _1"> </span>ma <span class="blank _1"> </span>IT<span class="blank _0"></span>U <span class="blank _1"> </span>ao <span class="blank _1"> </span>longo </span></div><div class="t m0 x1b hd y95 ff4 fs5 fc0 sc0 ls4 ws15">da vida, a maior par<span class="blank _0"></span>te dos casos correspon<span class="blank _0"></span>dendo a cis-</div><div class="t m0 x1b hd y96 ff4 fs5 fc0 sc0 ls4 ws15">tites não complicadas. <span class="lse">O <span class="blank _1"> </span>pico <span class="blank _1"> </span>da inc<span class="blank _1"> </span>idência <span class="blank _1"> </span>ocorre em<span class="blank _1"> </span> </span></div><div class="t m0 x1b hd y97 ff4 fs5 fc0 sc0 ls4 ws15">mulheres <span class="blank _5"> </span>jovens <span class="blank _5"> </span>sexualmente <span class="blank _5"> </span>activas. <span class="ls13">Cerca <span class="blank _5"> </span>de <span class="blank _5"> </span>20</span><span class="ws3">-</span><span class="ls7"> </span></div><div class="t m0 x1b hd y98 ff4 fs5 fc0 sc0 ls4 ws15">-30% das <span class="blank _1"> </span>mulhe<span class="blank _0"></span>res que t<span class="blank _1"> </span>iver<span class="blank _0"></span>am um <span class="blank _1"> </span>caso de ITU terão </div><div class="t m0 x1b hd y99 ff4 fs5 fc0 sc0 ls4 ws15">episódios <span class="blank _1"> </span>recorrentes. <span class="blank _1"> </span>A <span class="blank _1"> </span>p<span class="blank _1"> </span>robabilidad<span class="blank _0"></span>e <span class="blank _1"> </span>de <span class="blank _3"> </span>recorrê<span class="blank _0"></span>ncia </div><div class="t m0 x1b hd y9a ff4 fs5 fc0 sc0 ls4 ws15">diminui <span class="blank _3"> </span>à <span class="blank _1"> </span>medida <span class="blank _3"> </span>que <span class="blank _1"> </span>aumenta <span class="blank _3"> </span>o <span class="blank _3"> </span>te<span class="blank _0"></span>mpo <span class="blank _3"> </span>des<span class="blank _0"></span>de <span class="blank _3"> </span>a <span class="blank _3"> </span>últ<span class="blank _0"></span>i-</div><div class="t m0 x1b hd y9b ff4 fs5 fc0 sc0 ls4 ws15">ma infec<span class="ls7 ws19">ção.<span class="blank _0"></span><span class="ls4 ws15"> </span></span></div><div class="t m0 x1b hd y9c ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1b h11 y9d ffb fs5 fc2 sc0 ls4 ws15">ETIOLOGIA </div><div class="t m0 x1b hd y9e ff4 fs5 fc0 sc0 ls4 ws15">Os <span class="blank _7"> </span>principais <span class="blank _7"> </span>re<span class="blank _0"></span>sponsáveis <span class="blank _7"> </span>pelas <span class="blank _7"> </span>IT<span class="blank _0"></span>U <span class="blank _7"> </span>são <span class="blank _7"> </span>bacilos </div><div class="t m0 x1b h11 y9f ff4 fs5 fc0 sc0 ls15 ws1a">Gra m <span class="ls4 ws3">-<span class="ls6 wsd">negativo<span class="blank _0"></span><span class="ls17 ws15"> <span class="ls8 ws1b">ent éri c o s</span><span class="ls4"> <span class="blank _6"> </span>e <span class="blank _6"> </span>cocos <span class="blank _6"> </span>Gram-positivo<span class="ls21">. <span class="blank _3"> </span><span class="ffb ls23 ws1c">Es<span class="ls4">-</span></span></span></span></span></span></span></div><div class="t m0 x1b h11 ya0 ffb fs5 fc0 sc0 ls4 ws15">cherichia coli<span class="ff4"> é o agente predominant<span class="blank _0"></span>e, ocorrendo em </span></div><div class="t m0 x1b hd ya1 ff4 fs5 fc0 sc0 lsd ws7">75<span class="ls4 ws15">-90% d<span class="blank _1"> </span>os c<span class="blank _1"> </span>asos n<span class="blank _1"> </span>ão<span class="blank _0"></span> <span class="blank _1"> </span>complicados <span class="blank _1"> </span>de ci<span class="blank _1"> </span>stite <span class="blank _1"> </span>e <span class="blank _1"> </span><span class="ls6 wsd">piel<span class="blank _0"></span>o<span class="ls4">-</span></span></span></div><div class="t m0 x1b h11 ya2 ff4 fs5 fc0 sc0 ls6 ws15">nefr<span class="blank _0"></span>ite. <span class="blank _3"> </span>Se<span class="blank _0"></span>gue<span class="ls4 ws3">-</span><span class="ls24">se<span class="blank _0"></span> <span class="blank _3"> </span><span class="ffb ls4">Staphylococcus <span class="blank _3"> </span>saprophyticus<span class="ff4">, <span class="blank _3"> </span><span class="ls11">que </span></span></span></span></div><div class="t m0 x1b hd ya3 ff4 fs5 fc0 sc0 ls4 ws15">ocorre<span class="blank _0"></span> <span class="blank _3"> </span>em 5<span class="blank _1"> </span>-15% <span class="blank _1"> </span>dos <span class="blank _1"> </span>casos <span class="blank _1"> </span>e <span class="blank _1"> </span>pr<span class="blank _1"> </span>incipal<span class="blank _0"></span>mente <span class="blank _1"> </span>em <span class="blank _1"> </span>mu-</div><div class="t m0 x1b hd ya4 ff4 fs5 fc0 sc0 ls4 ws15">lheres jovens <span class="blank _4"> </span>sexualmente <span class="blank _4"> </span>activas. <span class="blank _4"> </span>Outros agentes, </div><div class="t m0 x1b hd ya5 ff4 fs5 fc0 sc0 ls4 ws15">dos <span class="blank _1"> </span>quais <span class="blank _1"> </span>os <span class="blank _1"> </span>mais <span class="blank _3"> </span>fr<span class="blank _0"></span>equentes <span class="blank _1"> </span>inclue<span class="blank _0"></span>m <span class="blank _3"> </span><span class="ff8 ls13 wsf">Klebs<span class="blank _0"></span>iell<span class="blank _0"></span>a<span class="ff4 ls18 ws15"> <span class="ls25">sp<span class="blank _1"> </span>p., </span></span></span></div><div class="t m0 x1b hd ya6 ff8 fs5 fc0 sc0 ls4 ws3">Proteus<span class="ff4 ws15"> <span class="blank _5"> </span>spp., <span class="blank _5"> </span></span>Enter<span class="blank _0"></span>ococcus<span class="ff4 ws15"> <span class="blank _5"> </span>spp. <span class="blank _5"> </span>e <span class="blank _6"> </span></span>C<span class="blank _1"> </span>itrob<span class="blank _0"></span>acter<span class="ff4 ls19 ws15"> <span class="ls25">sp<span class="blank _1"> </span>p.,<span class="blank _1"> </span> </span></span></div><div class="t m0 x1b hd ya7 ff4 fs5 fc0 sc0 ls4 ws15">ocorre<span class="blank _0"></span>m em 5-10% dos casos. </div><div class="t m0 x1c hd ya8 ff4 fs5 fc0 sc0 ls4 ws15">Nas <span class="blank _1"> </span>ITU <span class="blank _1"> </span>complicadas <span class="blank _1"> </span><span class="ff8">E. <span class="blank _3"> </span>coli</span> <span class="blank _1"> </span>permane<span class="blank _0"></span>ce <span class="blank _1"> </span>o <span class="blank _1"> </span>organis<span class="blank _1"> </span>-</div><div class="t m0 x1b hd ya9 ff4 fs5 fc0 sc0 ls4 ws15">mo <span class="blank _1"> </span>mais frequentemente <span class="blank _1"> </span>isolado,<span class="blank _0"></span> <span class="blank _1"> </span>mas <span class="blank _1"> </span>ganham impor-</div><div class="t m0 x1b hd yaa ff4 fs5 fc0 sc0 ls4 ws15">tância <span class="blank _5"> </span>outros <span class="blank _5"> </span>bac<span class="blank _0"></span>ilos <span class="blank _5"> </span>Gram-negativo, <span class="blank _5"> </span>como<span class="blank _0"></span> <span class="blank _5"> </span><span class="ff8 ws3">Pseudo-</span></div><div class="t m0 x1b hd yab ff8 fs5 fc0 sc0 lse ws10">monas<span class="ff4 ls1a ws15"> </span><span class="ls4 ws3">a<span class="blank _1"> </span>erugi<span class="blank _0"></span>nosa<span class="ff4 ls21 ws15">, <span class="blank _3"> </span></span><span class="ls13 wsf">Klebsie<span class="blank _0"></span>lla<span class="ff4 ls4 ws15"> <span class="blank _3"> </span>spp., <span class="blank _3"> </span><span class="ff8 ws3">Proteus</span> <span class="blank _3"> </span>spp., <span class="blank _3"> </span></span><span class="ls26 ws1d">Ci<span class="ls4">-</span></span></span></span></div><div class="t m0 x1b hd yac ff8 fs5 fc0 sc0 ls4 ws3">trobacter<span class="ff4 ls1a ws15"> <span class="ls25">spp.<span class="blank _1"> </span>, <span class="blank _3"> </span></span></span>Acinetobacter<span class="ff4 ls1a ws15"> <span class="ls25">spp<span class="blank _1"> </span>. <span class="blank _3"> </span>e <span class="blank _6"> </span></span></span><span class="ws1e">Morganella<span class="ff4 ws15"> <span class="blank _3"> </span>spp. </span></span></div><div class="t m0 x1b hd yad ff4 fs5 fc0 sc0 ls4 ws15">Os <span class="blank _6"> </span>cocos <span class="blank _5"> </span>G<span class="blank _0"></span>ram-positivo <span class="blank _6"> </span>e <span class="blank _6"> </span>as <span class="blank _5"> </span>leve<span class="blank _0"></span>duras <span class="blank _5"> </span>ta<span class="blank _0"></span>mbém <span class="blank _6"> </span>são </div><div class="t m0 x1b hd yae ff4 fs5 fc0 sc0 ls4 ws15">agentes importa<span class="blank _0"></span>ntes neste conte<span class="blank _0"></span>xto. </div><div class="t m0 x1c hd yaf ff4 fs5 fc0 sc0 ls4 ws15">Outros <span class="blank _3"> </span>agentes <span class="blank _3"> </span>re<span class="blank _0"></span>lativamente <span class="blank _3"> </span>comuns <span class="blank _3"> </span>incluem <span class="blank _3"> </span><span class="ff8 ls11 ws1f">Sta<span class="ls4">-</span></span></div><div class="t m0 x1b hd yb0 ff8 fs5 fc0 sc0 ls4 ws15">phylococcus <span class="blank _5"> </span>aureus<span class="ff4 ls3">,</span> Str<span class="blank _0"></span>eptococcus <span class="blank _5"> </span>pyogenes<span class="ff4 ls21">, <span class="blank _5"> </span></span><span class="ls6 wsd">Strep</span>. </div><div class="t m0 x1b hd yb1 ff8 fs5 fc0 sc0 ls6 wsd">agala<span class="blank _0"></span>ctia<span class="blank _0"></span>e<span class="ff4 ls1b ws15"> <span class="ls9">e </span></span><span class="ls13 ws20">Candi<span class="blank _0"></span>da<span class="ff4 ls1b ws15"> <span class="ls25 ws21">spp </span><span class="ls4">.. A<span class="blank _0"></span>gentes <span class="blank _5"> </span>menos <span class="blank _5"> </span>comuns </span></span></span></div><div class="t m0 x1b hd yb2 ff4 fs5 fc0 sc0 ls4 ws15">incluem <span class="blank _1"> </span><span class="ff8">Gardnerella <span class="blank _1"> </span>vaginalis</span><span class="ls21">, <span class="blank _3"> </span></span><span class="ff8">Ure<span class="blank _0"></span>aplasma <span class="blank _1"> </span>urealyti-</span></div><div class="t m0 x1b hd yb3 ff8 fs5 fc0 sc0 ls7 ws19">cum<span class="ff4 ls21 ws15">, <span class="blank _1"> </span><span class="ff8 ls4">Mycoplasma <span class="blank _3"> </span>hominis</span>, <span class="blank _1"> </span></span><span class="ls27 ws22">Mo bi lu n cu s <span class="ff4 ls4 ws15"> <span class="blank _3"> </span>spp., <span class="blank _3"> </span></span><span class="lsc ws23">Leptos<span class="ls4">-</span></span></span></div><div class="t m0 x1b hd yb4 ff8 fs5 fc0 sc0 ls6 ws15">pira <span class="ff4 ls4">spp., <span class="blank _1"> </span><span class="ff8 ws3">Mycobacterium</span><span class="ls1c"> <span class="ls25">spp.<span class="blank _1"> </span>, <span class="blank _3"> </span></span></span></span><span class="ls28">Chlamyd<span class="blank _1"> </span>ia <span class="blank _1"> </span>t<span class="blank _1"> </span>rachoma<span class="blank _1"> </span><span class="ls4">-</span></span></div><div class="t m0 x1b hd yb5 ff8 fs5 fc0 sc0 ls1d ws17">tis<span class="ff4 ls3 ws15"> <span class="ls9">e <span class="ff8 ls4">Haemophilus i<span class="blank _0"></span>nfluenzae<span class="ff4">. </span></span></span></span></div><div class="t m0 x1c hd yb6 ff4 fs5 fc0 sc0 ls4 ws15">Agentes qu<span class="blank _1"> </span>e cau<span class="blank _1"> </span>sam <span class="blank _1"> </span>I<span class="blank _0"></span>TU <span class="blank _1"> </span>predominanteme<span class="blank _0"></span>nte <span class="blank _1"> </span>asso-</div><div class="t m0 x1b hd y80 ff4 fs5 fc0 sc0 ls7 ws19">ciada<span class="ls4 ws15"> <span class="blank _1"> </span>a <span class="blank _3"> </span>doenças <span class="blank _1"> </span>multissistémicas <span class="blank _1"> </span>incluem <span class="blank _3"> </span><span class="ff8 ls6 wsd">Sa<span class="blank _0"></span>lmone<span class="blank _0"></span>lla<span class="ff4 ls4 ws15"> </span></span></span></div><div class="t m0 x1b hd yb7 ff4 fs5 fc0 sc0 ls4 ws15">spp., <span class="blank _5"> </span><span class="ff8 ls6">Schis<span class="blank _0"></span>tosom<span class="blank _0"></span>a <span class="blank _5"> </span>haem<span class="blank _0"></span>atob<span class="blank _0"></span>ium<span class="ff4 ls21">, <span class="blank _5"> </span></span><span class="ls4">Trichomonas <span class="blank _5"> </span>vagi-</span></span></div><div class="t m0 x1b hd yb8 ff8 fs5 fc0 sc0 ls6 wsd">nalis<span class="blank _0"></span><span class="ff4 ls7 ws15">, adenov<span class="blank _0"></span>í<span class="ls4">rus e vírus<span class="blank _0"></span> Herpes simple<span class="blank _0"></span>x. </span></span></div><div class="t m0 x1c hd yb9 ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1b h11 y84 ffb fs5 fc2 sc0 ls4 ws15">PATOGÉNESE </div><div class="t m0 x1b hd yba ff4 fs5 fc0 sc0 ls4 ws15">As <span class="blank _6"> </span>bactérias <span class="blank _6"> </span>podem <span class="blank _6"> </span>atingir <span class="blank _6"> </span>o <span class="blank _5"> </span>tracto <span class="blank _3"> </span>urinário <span class="blank _6"> </span>por <span class="blank _6"> </span>via </div><div class="t m0 x1b hd ybb ff4 fs5 fc0 sc0 ls4 ws15">ascendente <span class="blank _1"> </span>ou <span class="blank _3"> </span>por <span class="blank _3"> </span>via <span class="blank _1"> </span>hematogénea <span class="blank _3"> </span><span class="ff2 fc2">(Fig. <span class="blank _1"> </span>6<span class="blank _1"> </span>-<span class="lsd ws7">1)</span></span>. <span class="blank _1"> </span><span class="ls15">A <span class="blank _6"> </span>vi<span class="blank _1"> </span>a </span></div><div class="t m0 x1b hd ybc ff4 fs5 fc0 sc0 ls29 ws24">as<span class="ls7 ws15">cende<span class="blank _0"></span>nte é <span class="ls4">de lo<span class="blank _0"></span>nge a mais freq<span class="blank _0"></span>uente. </span></span></div><div class="t m0 x1b hd ybd ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1b h11 ybe ffb fs5 fc2 sc0 ls4 ws15">Via <span class="blank _1"> </span>ascendente. <span class="blank _1"> </span><span class="ff4 fc0">Desde <span class="blank _1"> </span>o <span class="blank _1"> </span>cólon <span class="blank _1"> </span>os <span class="blank _3"> </span>organismos u<span class="blank _1"> </span>ropa-</span></div><div class="t m0 x1b hd ybf ff4 fs5 fc0 sc0 ls2 ws2">togé<span class="blank _0"></span>nicos<span class="ls4 ws15"> p<span class="blank _1"> </span>o<span class="blank _0"></span>dem <span class="blank _1"> </span>colonizar o <span class="blank _1"> </span>períneo <span class="blank _1"> </span>e, n<span class="blank _1"> </span>as mulheres, </span></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf3" class="pf w0 h0" data-page-no="3"><div class="pc pc3 w0 h0"><img fetchpriority="low" loading="lazy" class="bi x0 yc0 w7 h1a" alt src="https://files.passeidireto.com/e78ed9d7-0969-4804-95c1-3a92effc5fc9/bg3.png" alt="Pré-visualização de imagem de arquivo"><div class="c x1d yc1 w8 h1b"><div class="t m2 x1e h1c yc2 ff2 fs7 fc1 sc0 ls4 ws15">Aula 6<span class="ff4"> </span></div></div><div class="c x0 yc3 w9 h15"><div class="t m0 x1f h19 yc4 ff2 fs8 fc1 sc0 ls4 ws15">Infecção Urinária<span class="ff4"> </span></div></div><div class="t m0 x20 h2 y53 ff1 fs0 fc0 sc0 ls2a ws15"> <span class="ff2 fs8 lsd ws16">165</span><span class="ls4"> <span class="blank _8"> </span> </span></div><div class="t m0 x1 h2 y54 ff1 fs0 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 hd yc5 ff4 fs5 fc0 sc0 ls7 ws15">a <span class="blank _3"> </span>re<span class="blank _0"></span>gião <span class="blank _1"> </span>periuretral.<span class="ls4"> <span class="blank _3"> </span>Em <span class="blank _1"> </span>condi<span class="blank _1"> </span>ções <span class="blank _1"> </span>normais, <span class="blank _3"> </span>estes <span class="blank _1"> </span>or-</span></div><div class="t m0 x1 hd yc6 ff4 fs5 fc0 sc0 ls4 ws15">ganismos c<span class="blank _1"> </span>om<span class="blank _0"></span>petem com <span class="blank _1"> </span>a <span class="blank _1"> </span>micro<span class="blank _0"></span>biota <span class="blank _1"> </span>da <span class="blank _1"> </span>vagi<span class="blank _0"></span>na <span class="blank _1"> </span>e do </div><div class="t m0 x1 hd yc7 ff4 fs5 fc0 sc0 ls4 ws15">períneo, <span class="blank _1"> </span>mas <span class="blank _3"> </span>estes <span class="blank _3"> </span>or<span class="blank _0"></span>ganismos <span class="blank _3"> </span>est<span class="blank _0"></span>ão <span class="blank _1"> </span>em <span class="blank _3"> </span>vantagem <span class="blank _3"> </span>se </div><div class="t m0 x1 hd yc8 ff4 fs5 fc0 sc0 ls4 ws15">tiverem a <span class="blank _1"> </span>capacidade de <span class="blank _1"> </span>ascender pelo t<span class="blank _1"> </span><span class="ls1f">racto <span class="blank _1"> </span>urinári<span class="blank _1"> </span>o. </span></div><div class="t m0 x1 hd yc9 ff4 fs5 fc0 sc0 ls4 ws15">De <span class="blank _3"> </span>facto, <span class="blank _3"> </span>na<span class="blank _1"> </span> <span class="blank _3"> </span>maioria <span class="blank _3"> </span>dos <span class="blank _3"> </span>ca<span class="blank _1"> </span>sos <span class="blank _3"> </span>ocorre<span class="blank _0"></span> <span class="blank _3"> </span>ascensão <span class="blank _6"> </span>pela </div><div class="t m0 x1 hd yca ff4 fs5 fc0 sc0 ls4 ws15">uretra <span class="blank _3"> </span>at<span class="blank _1"> </span>é <span class="blank _3"> </span>à <span class="blank _6"> </span>bexiga. <span class="blank _6"> </span>A <span class="blank _3"> </span>continuação <span class="blank _6"> </span>da <span class="blank _6"> </span>ascensão <span class="blank _6"> </span>pelo </div><div class="t m0 x1 hd ycb ff4 fs5 fc0 sc0 ls4 ws15">uretero <span class="blank _3"> </span>até <span class="blank _6"> </span>a<span class="blank _1"> </span>o <span class="blank _6"> </span>rim <span class="blank _6"> </span>é <span class="blank _5"> </span>a <span class="blank _3"> </span>via <span class="blank _5"> </span>usada <span class="blank _3"> </span>p<span class="blank _1"> </span>ara <span class="blank _3"> </span>a <span class="blank _5"> </span>maioria <span class="blank _3"> </span>das </div><div class="t m0 x1 hd ycc ff4 fs5 fc0 sc0 ls4 ws15">infecções pare<span class="blank _0"></span>nquimatosas rena<span class="blank _0"></span>is. </div><div class="t m0 x9 hd ycd ff4 fs5 fc0 sc0 ls4 ws15">As <span class="blank _1"> </span>bac<span class="blank _1"> </span>téri<span class="blank _0"></span>as <span class="blank _3"> </span>podem <span class="blank _1"> </span>efectuar <span class="blank _1"> </span>esta <span class="blank _3"> </span>deslo<span class="blank _0"></span>cação <span class="blank _3"> </span>por <span class="blank _1"> </span>si </div><div class="t m0 x1 hd yce ff4 fs5 fc0 sc0 ls4 ws15">próprias, <span class="blank _6"> </span>alternando <span class="blank _6"> </span>entre <span class="blank _6"> </span>períodos <span class="blank _6"> </span>de <span class="blank _3"> </span>ad<span class="blank _1"> </span>esão <span class="blank _3"> </span>e <span class="blank _5"> </span>mo-</div><div class="t m0 x1 hd ycf ff4 fs5 fc0 sc0 ls4 ws15">vimento, <span class="blank _5"> </span>mas <span class="blank _5"> </span>tal <span class="blank _5"> </span>deslocação <span class="blank _5"> </span>é <span class="blank _5"> </span>facilitada <span class="blank _5"> </span>por <span class="blank _5"> </span>outros </div><div class="t m0 x1 hd yd0 ff4 fs5 fc0 sc0 ls4 ws15">factores, <span class="blank _6"> </span>como <span class="blank _6"> </span>a <span class="blank _5"> </span>instr<span class="blank _0"></span>umentação <span class="blank _6"> </span>do <span class="blank _6"> </span>tracto <span class="blank _5"> </span>urol<span class="blank _0"></span>ógico </div><div class="t m0 x1 hd yd1 ff4 fs5 fc0 sc0 ls4 ws15">ou a <span class="blank _1"> </span>rel<span class="blank _0"></span>ação sexual. Na <span class="blank _1"> </span>relação sexual, a expressã<span class="ls11">o <span class="blank _1"> </span>da<span class="blank _1"> </span> </span></div><div class="t m0 x1 hd yd2 ff4 fs5 fc0 sc0 ls4 ws15">uretra <span class="blank _1"> </span>contra <span class="blank _1"> </span>a<span class="blank _1"> </span> <span class="blank _1"> </span>vagina <span class="blank _3"> </span>ge<span class="blank _0"></span>ra <span class="blank _1"> </span>u<span class="blank _1"> </span>m <span class="blank _1"> </span>movimento <span class="blank _1"> </span>ascenden-</div><div class="t m0 x1 hd yd3 ff4 fs5 fc0 sc0 ls4 ws15">te, <span class="blank _5"> </span>fac<span class="blank _0"></span>ilitando <span class="blank _5"> </span>a <span class="blank _6"> </span>inoculação <span class="blank _6"> </span>das <span class="blank _5"> </span>bacté<span class="blank _0"></span>rias <span class="blank _5"> </span>na <span class="blank _6"> </span>b<span class="blank _1"> </span>ex<span class="blank _0"></span>iga. </div><div class="t m0 x1 hd yd4 ff4 fs5 fc0 sc0 ls4 ws15">De <span class="blank _6"> </span>facto, <span class="blank _6"> </span>após <span class="blank _6"> </span>a <span class="blank _5"> </span>re<span class="blank _0"></span>lação <span class="blank _6"> </span>sexual <span class="blank _6"> </span>é <span class="blank _6"> </span>muito <span class="blank _6"> </span>frequente <span class="blank _6"> </span>a </div><div class="t m0 x1 hd yd5 ff4 fs5 fc0 sc0 ls4 ws15">chegada <span class="blank _3"> </span>de <span class="blank _1"> </span>bactérias <span class="blank _3"> </span>à <span class="blank _3"> </span>bexiga <span class="blank _1"> </span>da <span class="blank _3"> </span>mulher, <span class="blank _3"> </span>que <span class="blank _1"> </span>no <span class="blank _3"> </span>en<span class="blank _1"> </span>-</div><div class="t m0 x1 hd yd6 ff4 fs5 fc0 sc0 ls2 ws15">tanto <span class="ls4">na <span class="blank _1"> </span>maior<span class="blank _0"></span>ia <span class="blank _1"> </span>das vezes n<span class="blank _1"> </span>ão causam <span class="blank _1"> </span>infecç<span class="ls7">ão. Nes</span>-</span></div><div class="t m0 x1b hd y8b ff4 fs5 fc0 sc0 ls4 ws15">te contexto a infecção pode ser fav<span class="blank _0"></span>orecida se a mulher </div><div class="t m0 x1b hd y8c ff4 fs5 fc0 sc0 ls4 ws15">não urinar após a relação sexual. No homem tal <span class="blank _1"> </span>movi-</div><div class="t m0 x1b hd y8d ff4 fs5 fc0 sc0 ls4 ws15">mento <span class="blank _1"> </span>também <span class="blank _3"> </span>ex<span class="blank _0"></span>iste, <span class="blank _1"> </span>mas <span class="blank _3"> </span>a <span class="blank _1"> </span>protecção <span class="blank _1"> </span>natural <span class="blank _1"> </span>contra </div><div class="t m0 x1b hd y8e ff4 fs5 fc0 sc0 ls4 ws15">a I<span class="blank _0"></span>TU <span class="blank _5"> </span>prevalece<span class="blank _0"></span> <span class="blank _5"> </span>na maioria <span class="blank _5"> </span>dos <span class="blank _5"> </span>caso<span class="blank _0"></span>s. F<span class="blank _0"></span>actores <span class="blank _5"> </span>de </div><div class="t m0 x1b hd y8f ff4 fs5 fc0 sc0 ls4 ws15">risco <span class="blank _1"> </span>p<span class="blank _1"> </span>ara <span class="blank _1"> </span>o <span class="blank _3"> </span>homem <span class="blank _1"> </span>incluem <span class="blank _1"> </span>sexo <span class="blank _3"> </span>anal <span class="blank _1"> </span>e <span class="blank _3"> </span><span class="ls7">coloniz<span class="blank _0"></span>ação </span></div><div class="t m0 x1b hd y90 ff4 fs5 fc0 sc0 ls4 ws15">vaginal da parce<span class="blank _0"></span>ira sexual por <span class="ff8">E. coli</span>.<span class="blank _0"></span> </div><div class="t m0 x1c hd y91 ff4 fs5 fc0 sc0 ls4 ws15">A <span class="blank _1"> </span>in<span class="blank _1"> </span>teracção <span class="blank _1"> </span>entre <span class="blank _3"> </span>o <span class="blank _3"> </span>hospedeiro<span class="blank _0"></span>, <span class="blank _3"> </span>o <span class="blank _3"> </span>age<span class="blank _0"></span>nte <span class="blank _3"> </span>uropato-</div><div class="t m0 x1b hd y92 ff4 fs5 fc0 sc0 ls4 ws15">génico <span class="blank _6"> </span>e <span class="blank _5"> </span>o<span class="blank _0"></span>s <span class="blank _5"> </span>f<span class="blank _0"></span>actores <span class="blank _6"> </span>ambientais <span class="blank _6"> </span>determina <span class="blank _5"> </span>se<span class="blank _0"></span> <span class="blank _6"> </span>ocorre </div><div class="t m0 x1b hd y93 ff4 fs5 fc0 sc0 ls2 ws15">infecç<span class="blank _0"></span>ão ou não<span class="ls4">. <span class="blank _1"> </span>A in<span class="blank _1"> </span>fecção é p<span class="blank _1"> </span>romovida por <span class="blank _1"> </span>factores </span></div><div class="t m0 x1b hd y94 ff4 fs5 fc0 sc0 ls4 ws15">que <span class="blank _3"> </span>promov<span class="blank _0"></span>am <span class="blank _3"> </span>a <span class="blank _3"> </span>entrada <span class="blank _3"> </span>e <span class="blank _3"> </span>a <span class="blank _3"> </span>permanê<span class="blank _0"></span>ncia <span class="blank _3"> </span>das <span class="blank _3"> </span>bacté-</div><div class="t m0 x1b hd y95 ff4 fs5 fc0 sc0 ls4 ws15">rias <span class="blank _5"> </span>na bexiga, <span class="blank _5"> </span>como <span class="blank _5"> </span>um volume<span class="blank _0"></span> re<span class="blank _0"></span>sidual de <span class="blank _5"> </span>urina </div><div class="t m0 x1b hd y96 ff4 fs5 fc0 sc0 ls6 wsd">pós<span class="ls4 ws15">-mic<span class="blank _0"></span>cional <span class="blank _3"> </span>sign<span class="blank _0"></span>ificativo, <span class="blank _1"> </span>um <span class="blank _3"> </span>corpo <span class="blank _1"> </span>estranho <span class="blank _1"> </span>(caté-</span></div><div class="t m0 x1b hd y97 ff4 fs5 fc0 sc0 ls4 ws15">ter <span class="blank _3"> </span>vesical <span class="blank _3"> </span>ou <span class="blank _6"> </span>litíase) <span class="blank _3"> </span>ou <span class="blank _6"> </span>uma <span class="blank _3"> </span>obstrução. <span class="blank _6"> </span>Existe <span class="blank _3"> </span>ta<span class="blank _1"> </span>m-</div><div class="t m0 x1b hd y98 ff4 fs5 fc0 sc0 ls4 ws15">bém influência de <span class="blank _1"> </span>factores genéticos qu<span class="blank _1"> </span>e podem gerar </div><div class="t m0 x1b hd y99 ff4 fs5 fc0 sc0 ls4 ws15">propriedades <span class="blank _6"> </span>no <span class="blank _5"> </span>urotélio <span class="blank _6"> </span>qu<span class="blank _1"> </span>e <span class="blank _6"> </span>predisponham <span class="blank _5"> </span>à <span class="blank _6"> </span>infec<span class="blank _1"> </span>-</div><div class="t m0 x1b hd y9a ff4 fs5 fc0 sc0 ls7 ws15">ção, <span class="blank _3"> </span>o<span class="blank _0"></span> <span class="blank _3"> </span>q<span class="blank _0"></span>ue <span class="blank _3"> </span>e<span class="blank _0"></span>xplica <span class="blank _1"> </span>a <span class="blank _3"> </span>maior<span class="blank _0"></span> <span class="blank _1"> </span>p<span class="blank _1"> </span>ro<span class="blank _0"></span>babilida<span class="blank _0"></span>de <span class="blank _3"> </span>de<span class="blank _0"></span> <span class="blank _3"> </span>infe<span class="blank _0"></span>cção </div><div class="t m0 x1b hd y9b ff4 fs5 fc0 sc0 ls4 ws15">quando há história<span class="blank _0"></span> familiar. </div><div class="t m0 x1c hd y9c ff4 fs5 fc0 sc0 ls4 ws15">A <span class="blank _3"> </span>partir <span class="blank _6"> </span>da <span class="blank _6"> </span>bexiga <span class="blank _3"> </span>as <span class="blank _3"> </span>b<span class="blank _1"> </span>actér<span class="blank _0"></span>ias <span class="blank _6"> </span>podem <span class="blank _3"> </span>continuar <span class="blank _3"> </span>a </div><div class="t m0 x1b hd yd7 ff4 fs5 fc0 sc0 ls4 ws15">ascender <span class="blank _1"> </span>até <span class="blank _3"> </span>alcançar <span class="blank _1"> </span>o <span class="blank _1"> </span>rim. <span class="blank _3"> </span>Os <span class="blank _1"> </span>mesmos <span class="blank _1"> </span>mecani<span class="blank _1"> </span>smos<span class="blank _0"></span> </div><div class="t m0 x1b hd y9e ff4 fs5 fc0 sc0 ls4 ws15">de <span class="blank _6"> </span>alternância <span class="blank _6"> </span>entre <span class="blank _6"> </span>adesão <span class="blank _6"> </span>e <span class="blank _6"> </span>movimento <span class="blank _6"> </span>podem <span class="blank _6"> </span>ser </div><div class="t m0 x1b hd y9f ff4 fs5 fc0 sc0 ls4 ws15">aplicados, mas a infecção renal é facilitada pela estase </div><div class="t m0 x1b hd ya0 ff4 fs5 fc0 sc0 ls4 ws15">urinária. <span class="blank _1"> </span>Esta <span class="blank _3"> </span>é<span class="blank _0"></span> <span class="blank _3"> </span>obse<span class="blank _0"></span>rvada<span class="ls7">, <span class="blank _1"> </span>por <span class="blank _1"> </span>exemplo,</span> <span class="blank _1"> </span>em <span class="blank _3"> </span>casos <span class="blank _1"> </span>de </div><div class="t m0 x1b hd ya1 ff4 fs5 fc0 sc0 ls4 ws15">obstrução do <span class="blank _1"> </span>tracto urinário (por <span class="blank _1"> </span>exemplo, hiperplasia </div><div class="t m0 x1b hd ya2 ff4 fs5 fc0 sc0 ls4 ws15">benigna da pró<span class="blank _0"></span>stata) e diabetes <span class="ff8 lse wsb">mellitus </span> (com uma </div><div class="t m0 x1b hd ya3 ff4 fs5 fc0 sc0 ls2 ws2">ten<span class="ls4 ws15">dênci<span class="blank _0"></span>a <span class="blank _3"> </span>aumenta<span class="blank _0"></span>da <span class="blank _3"> </span>para <span class="blank _1"> </span>disfunção <span class="blank _1"> </span>vesical <span class="blank _3"> </span>neuro<span class="blank _0"></span>gé-</span></div><div class="t m0 x1b hd ya4 ff4 fs5 fc0 sc0 ls6 wsd">nica<span class="ls4 ws15">). Em <span class="blank _4"> </span>crianças <span class="blank _4"> </span>é particularmente i<span class="blank _1"> </span>mport<span class="blank _0"></span>ante <span class="blank _4"> </span>o </span></div><div class="t m0 x1b hd ya5 ff4 fs5 fc0 sc0 ls4 ws15">refluxo vésico-ure<span class="blank _0"></span>teral, causado por incompetência do </div><div class="t m0 x1b hd ya6 ff4 fs5 fc0 sc0 ls4 ws15">orifício vésico-ureteral, que permite a <span class="blank _1"> </span>permanência de </div><div class="t m0 x1b hd ya7 ff4 fs5 fc0 sc0 ls4 ws15">um <span class="blank _1"> </span>volume residual <span class="blank _1"> </span>pós-miccional importante. <span class="blank _1"> </span>É pos-</div><div class="t m0 x1b hd ya8 ff4 fs5 fc0 sc0 ls4 ws15">sível o <span class="blank _1"> </span>refluxo até <span class="blank _1"> </span>ao pa<span class="blank _1"> </span>rênquima renal (refluxo i<span class="blank _1"> </span><span class="ls6 wsd">ntra</span>-</div><div class="t m0 x1b hd ya9 ff4 fs5 fc0 sc0 ls4 ws15">renal). <span class="blank _1"> </span>O <span class="blank _3"> </span>refluxo <span class="blank _1"> </span>vésico-ureteral <span class="blank _3"> </span>está <span class="blank _1"> </span>presente <span class="blank _3"> </span>em <span class="blank _1"> </span>at<span class="blank _1"> </span>é </div><div class="t m0 x1b hd yaa ff4 fs5 fc0 sc0 ls4 ws15">40% das crianças com ITU e é geralmente conse<span class="blank _0"></span>quên<span class="blank _1"> </span>-</div><div class="t m0 x1b hd yab ff4 fs5 fc0 sc0 ls4 ws15">cia de uma malf<span class="blank _0"></span>ormação congénita, m<span class="blank _0"></span>as também pode </div><div class="t m0 x1b hd yac ff4 fs5 fc0 sc0 ls4 ws15">ser <span class="blank _6"> </span>ad<span class="blank _1"> </span>quirido <span class="blank _6"> </span>em <span class="blank _5"> </span>adultos, <span class="blank _6"> </span>por <span class="blank _5"> </span>exe<span class="blank _0"></span>mplo <span class="blank _5"> </span>por <span class="blank _6"> </span>diabetes </div><div class="t m0 x1b hd yad ff8 fs5 fc0 sc0 lse wsb">mellitu s <span class="ff4 ls4 ws15"> ou lesão da medula e<span class="blank _0"></span>spinhal. </span></div><div class="t m0 x1b hd yae ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1b h11 yaf ffb fs5 fc2 sc0 ls2d ws15">Via<span class="blank _1"> </span> <span class="blank _7"> </span>he<span class="ls2e ws25">matogé<span class="blank _0"></span>ne<span class="blank _0"></span>a.<span class="ff4 fc0 ls4 ws15"> <span class="blank _4"> </span>As <span class="blank _4"> </span>bac<span class="blank _0"></span>térias <span class="blank _4"> </span>pode<span class="blank _0"></span>m <span class="blank _4"> </span>alcançar <span class="blank _4"> </span>o </span></span></div><div class="t m0 x1b hd yb0 ff4 fs5 fc0 sc0 ls2 ws15">tracto<span class="blank _0"></span> <span class="blank _3"> </span>ur<span class="blank _0"></span>inário<span class="blank _0"></span> <span class="blank _3"> </span>a<span class="blank _0"></span> <span class="blank _3"> </span>par<span class="blank _0"></span>tir <span class="blank _1"> </span>da <span class="blank _1"> </span>circulação<span class="blank _0"></span>. <span class="blank _3"> </span><span class="ls4">Esta <span class="blank _1"> </span>via <span class="blank _3"> </span>c<span class="ls11 ws26">orres</span>-</span></div><div class="t m0 x1b hd yb1 ff4 fs5 fc0 sc0 ls4 ws15">ponde <span class="blank _3"> </span>a <span class="blank _3"> </span>menos <span class="blank _1"> </span>d<span class="blank _1"> </span>e <span class="blank _3"> </span>2% <span class="blank _3"> </span>dos <span class="blank _3"> </span>caso<span class="blank _0"></span>s <span class="blank _3"> </span>de <span class="blank _3"> </span>ITU<span class="blank _0"></span>, <span class="blank _3"> </span>e <span class="blank _3"> </span>em <span class="blank _3"> </span>geral </div><div class="t m0 x1b hd yb2 ff4 fs5 fc0 sc0 ls4 ws15">ocorre<span class="blank _0"></span> <span class="blank _1"> </span>secundariamente a <span class="blank _1"> </span>bacteriémia p<span class="blank _1"> </span>or organismos </div><div class="t m0 x1b hd yb3 ff4 fs5 fc0 sc0 ls4 ws15">relativamente virulentos, c<span class="blank _1"> </span>omo <span class="ff8 ls6 ws27">Salmonel<span class="blank _0"></span>la<span class="ff4 ls4 ws15"> <span class="blank _4"> </span>spp. ou </span></span></div><div class="t m0 x1b hd yb4 ff8 fs5 fc0 sc0 ls6 wsd">Staph<span class="blank _0"></span>ylo<span class="ls4 ws15">coc<span class="blank _0"></span>cus aureus<span class="ff4">, <span class="blank _1"> </span>por vezes no <span class="blank _1"> </span>contexto de uma </span></span></div><div class="t m0 x1b hd yb5 ff4 fs5 fc0 sc0 ls4 ws15">outra <span class="blank _3"> </span>infecção <span class="blank _3"> </span>como <span class="blank _3"> </span>endocardite <span class="blank _3"> </span>infe<span class="blank _0"></span>cciosa. <span class="blank _6"> </span>O <span class="blank _3"> </span>isola-</div><div class="t m0 x1b hd yb6 ff4 fs5 fc0 sc0 ls4 ws15">mento <span class="blank _5"> </span>de<span class="blank _0"></span>ste <span class="blank _6"> </span>t<span class="blank _1"> </span>ipo <span class="blank _6"> </span>de <span class="blank _5"> </span>age<span class="blank _0"></span>ntes <span class="blank _6"> </span>n<span class="blank _1"> </span>a <span class="blank _6"> </span>urina <span class="blank _5"> </span>de <span class="blank _6"> </span>um <span class="blank _5"> </span>doen<span class="blank _0"></span>te </div><div class="t m0 x1b hd y80 ff4 fs5 fc0 sc0 ls4 ws15">não alg<span class="blank _0"></span>aliado <span class="blank _5"> </span>ou sem <span class="blank _5"> </span>outro <span class="blank _5"> </span>tipo de<span class="blank _0"></span> instrume<span class="blank _0"></span>ntação </div><div class="t m0 x1b hd yb7 ff4 fs5 fc0 sc0 ls4 ws15">obriga <span class="blank _3"> </span>à<span class="blank _1"> </span> <span class="blank _3"> </span>pesquisa <span class="blank _3"> </span>de <span class="blank _6"> </span>uma <span class="blank _6"> </span>fonte <span class="blank _3"> </span>p<span class="blank _1"> </span>ara<span class="blank _0"></span> <span class="blank _6"> </span>a <span class="blank _6"> </span>corrente <span class="blank _3"> </span>san<span class="blank _1"> </span>-</div><div class="t m0 x1b hd yb8 ff4 fs5 fc0 sc0 ls11 ws15">guín<span class="blank _1"> </span>ea. <span class="blank _1"> </span>A<span class="ls4">s <span class="blank _1"> </span>infecções hematogéneas podem <span class="blank _1"> </span>causar <span class="blank _1"> </span>ab-</span></div><div class="t m0 x1b hd yb9 ff4 fs5 fc0 sc0 ls4 ws15">cessos focais ou <span class="blank _1"> </span>focos de pielonefr<span class="blank _0"></span>ite. As bac<span class="blank _1"> </span>térias al-</div><div class="t m0 x1b hd yd8 ff4 fs5 fc0 sc0 ls4 ws15">cançam a urin<span class="blank _0"></span>a, pelo que as uroc<span class="blank _0"></span>ulturas são posi<span class="blank _0"></span>tivas. </div><div class="t m0 x1c hd yba ff4 fs5 fc0 sc0 ls15 ws15">A <span class="blank _3"> </span>p<span class="blank _1"> </span>res<span class="blank _1"> </span>en<span class="blank _1"> </span>ça<span class="blank _1"> </span> <span class="blank _3"> </span>de<span class="blank _1"> </span> <span class="blank _3"> </span><span class="ff8 ls28 ws28">Ca nd ida </span><span class="ls4"> <span class="blank _3"> </span>spp. <span class="blank _3"> </span>na <span class="blank _3"> </span>urina <span class="blank _1"> </span>merece <span class="blank _3"> </span>aten-</span></div><div class="t m0 x1b hd ybb ff4 fs5 fc0 sc0 ls4 ws15">ção especial. A <span class="blank _1"> </span>via hematogénea é freq<span class="blank _1"> </span>uente para este </div><div class="t m0 x1b hd ybc ff4 fs5 fc0 sc0 ls10 ws8">or<span class="ls4 ws15">ganismo. Quando se detecta <span class="ls11">na <span class="blank _1"> </span>urocultu<span class="blank _1"> </span>ra de u<span class="blank _1"> </span>m in<span class="blank _1"> </span></span>-</span></div><div class="t m0 x1b hd ybd ff4 fs5 fc0 sc0 ls4 ws15">divíduo <span class="blank _1"> </span>imunocompete<span class="blank _0"></span>nte <span class="blank _1"> </span>a <span class="blank _1"> </span>sua <span class="blank _1"> </span>presença <span class="blank _1"> </span>significa <span class="blank _1"> </span><span class="ls10">ou </span></div><div class="t m0 x1b hd ybe ff4 fs5 fc0 sc0 ls7 ws19">con<span class="ls4 ws15">taminação <span class="blank _3"> </span>v<span class="blank _0"></span>aginal <span class="blank _3"> </span>ou <span class="blank _3"> </span>infecção <span class="blank _1"> </span>visceral <span class="blank _3"> </span>potencial-</span></div><div class="t m0 x1b hd ybf ff4 fs5 fc0 sc0 ls4 ws15">mente disseminad<span class="blank _0"></span>a. </div><div class="c x1 yd9 wa h1d"><div class="t m0 x0 h1e yda ff5 fsa fc2 sc0 ls4 ws15">Figura 6-<span class="ls2c ws29">1.</span><span class="ff7 fc0 ls2b"> </span><span class="fc0">Vias para infecção urinária<span class="ff7 ls2b">. <span class="ls4">BGN, bacil<span class="blank _1"> </span>os Gram-<span class="ls2c">ne</span>-</span></span></span></div><div class="t m0 x0 h1f ydb ff7 fsa fc0 sc0 ls4 ws15">gativo. <span class="blank _4"> </span>Repare <span class="blank _4"> </span>na <span class="blank _4"> </span>d<span class="blank _0"></span>iferença <span class="blank _4"> </span>m<span class="blank _0"></span>orfológica <span class="blank _4"> </span>entre <span class="blank _4"> </span>a <span class="blank _4"> </span>p<span class="blank _0"></span>ielonefrite </div><div class="t m0 x0 h1f ydc ff7 fsa fc0 sc0 ls4 ws15">causada <span class="blank _3"> </span>por <span class="blank _1"> </span>via <span class="blank _1"> </span>ascendente <span class="blank _3"> </span>e <span class="blank _1"> </span>a <span class="blank _3"> </span>causada <span class="blank _1"> </span>por <span class="blank _1"> </span>via <span class="blank _3"> </span>hematogénea. </div><div class="t m0 x0 h1f ydd ff7 fsa fc0 sc0 ls4 ws15">Veja o texto para mais pormenores. </div></div><div class="c xa yde wb h20"><div class="t m0 x0 hb ydf ff5 fs5 fc0 sc0 ls4 ws15">INFECÇÃ<span class="blank _0"></span>O HEMATOGÉNEA </div></div><div class="c x1a ye0 wc h20"><div class="t m0 x0 hb ydf ff5 fs5 fc0 sc0 ls4 ws15">INFECÇÃ<span class="blank _0"></span>O <span class="blank _1"> </span><span class="ls2f ws2a">AS C E N D E N<span class="blank _1"> </span>T E<span class="blank _3"> </span></span> </div></div><div class="c x1 y8f wd h21"><div class="t m0 x0 h22 ye1 ff7 fs4 fc0 sc0 ls4 ws15">Agentes comuns<span class="blank _1"> </span> </div><div class="t m0 x0 h23 ye2 ffc fs4 fc0 sc0 ls4 ws15">Staphylococcus a<span class="blank _1"> </span>ureus </div><div class="t m0 x0 h23 ye3 ffc fs4 fc0 sc0 ls4 ws15">Salmonella<span class="blank _1"> </span> </div><div class="t m0 x0 h23 ye4 ffc fs4 fc0 sc0 ls4 ws15">Candida </div></div><div class="c x21 ye5 we h24"><div class="t m0 x0 h22 ye6 ff7 fs4 fc0 sc0 ls4 ws15">Agentes comuns<span class="blank _1"> </span> </div><div class="t m0 x0 h23 ye7 ffc fs4 fc0 sc0 ls4 ws15">Escherichia coli<span class="blank _1"> </span> </div><div class="t m0 x0 h23 ye8 ffc fs4 fc0 sc0 ls4 ws15">Staphylococcus sa<span class="blank _1"> </span>prophyticus </div><div class="t m0 x0 h22 ye4 ff7 fs4 fc0 sc0 ls4 ws15">Outros BGN entérico<span class="blank _1"> </span>s </div></div><div class="c x22 ye9 wf h25"><div class="t m0 x15 h22 ye8 ff7 fs4 fc0 sc0 ls4 ws15">Colonização do <span class="blank _1"> </span> </div><div class="t m0 x23 h22 yea ff7 fs4 fc0 sc0 ls4 ws15">períneo e ascensão<span class="blank _1"> </span> </div></div><div class="c x24 yeb w10 h26"><div class="t m0 x0 h22 ye3 ff7 fs4 fc0 sc0 ls4 ws15">Entrada na be<span class="blank _1"> </span>xiga </div><div class="t m0 x0 ha yea ff7 fs4 fc0 sc0 ls4 ws15">Possível <span class="ff5 ws2b">CISTITE </span> </div></div><div class="c x25 yec w11 h27"><div class="t m0 x0 h22 ye2 ff7 fs4 fc0 sc0 ls4 ws15">Junção </div><div class="t m0 x0 h22 ye3 ff7 fs4 fc0 sc0 ls4 ws15">vésico-ureteral </div><div class="t m0 x0 h22 ye4 ff7 fs4 fc0 sc0 ls4 ws15">incompetente </div></div><div class="c x26 yed w12 h28"><div class="t m0 x0 h22 ye3 ff7 fs4 fc0 sc0 ls4 ws15">Refluxo </div><div class="t m0 x0 h22 ye4 ff7 fs4 fc0 sc0 ls4 ws2c">vésico-<span class="ls30 ws2d">urete<span class="blank _0"></span>ral<span class="ls4 ws15"> </span></span></div></div><div class="c x27 y61 w13 h29"><div class="t m0 x0 ha yea ff5 fs4 fc0 sc0 ls4 ws15">PIELONEFRITE<span class="blank _1"> </span> </div></div><div class="c x28 yee w14 h2a"><div class="t m0 x0 h22 ye4 ff7 fs4 fc0 sc0 ls4 ws15">Aorta abdominal<span class="blank _1"> </span> </div></div><div class="c x22 yef w15 h2b"><div class="t m0 x17 h22 yea ff7 fs4 fc0 sc0 ls4 ws15">Bacteriémia </div></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf4" class="pf w0 h0" data-page-no="4"><div class="pc pc4 w0 h0"><img fetchpriority="low" loading="lazy" class="bi x15 yf0 w1 h2c" alt src="https://files.passeidireto.com/e78ed9d7-0969-4804-95c1-3a92effc5fc9/bg4.png" alt="Pré-visualização de imagem de arquivo"><div class="c x16 y4f w5 h13"><div class="t m1 x17 h14 y50 ff2 fs7 fc1 sc0 ls4 ws15">Aula 6 </div></div><div class="c xb y51 w6 h15"><div class="t m0 x18 h16 y52 ff2 fs8 fc1 sc0 ls4 ws15">Infecção Urinária </div></div><div class="t m0 x19 h16 y53 ff2 fs8 fc0 sc0 lsd ws16">166<span class="ls4 ws15"> </span></div><div class="t m0 x1 h2 y54 ff1 fs0 fc0 sc0 ls4 ws15"> </div><div class="t m0 x9 hd y8b ff4 fs5 fc0 sc0 ls4 ws15">Os <span class="blank _1"> </span>bacilos <span class="blank _1"> </span>Gram-negativo <span class="blank _1"> </span>entéricos <span class="blank _1"> </span>raramente <span class="blank _1"> </span>cau-</div><div class="t m0 x1 hd y8c ff4 fs5 fc0 sc0 ls4 ws15">sam <span class="blank _1"> </span>infecção por esta <span class="blank _1"> </span>via, mesmo <span class="blank _1"> </span>quan<span class="blank _0"></span>do <span class="blank _1"> </span>existem em </div><div class="t m0 x1 hd y8d ff4 fs5 fc0 sc0 ls7 ws19">circulação<span class="blank _0"></span>.<span class="ls4 ws15"> </span></div><div class="t m0 x1 h2d yf1 ffb fsa fc2 sc0 ls4 ws15"> </div><div class="t m0 x1 h11 yf2 ffb fs5 fc2 sc0 ls4 ws15">BACTERIÚRIA <span class="ls23 ws1c">AS<span class="blank _0"></span><span class="ls4 ws15">SINTOMÁTI<span class="blank _0"></span>CA </span></span></div><div class="t m0 x1 hd yf3 ff4 fs5 fc0 sc0 ls4 ws15">Existem <span class="blank _3"> </span>bac<span class="blank _0"></span>térias <span class="blank _1"> </span>n<span class="blank _1"> </span>o <span class="blank _1"> </span>tracto <span class="blank _3"> </span>urinário<span class="blank _0"></span>, <span class="blank _3"> </span>objectiv<span class="blank _0"></span>áveis <span class="blank _3"> </span>na </div><div class="t m0 x1 hd yf4 ff4 fs5 fc0 sc0 ls4 ws15">urina, <span class="blank _1"> </span>geralmente <span class="blank _1"> </span>acompanh<span class="blank _0"></span>adas <span class="blank _1"> </span>de <span class="blank _1"> </span>leucócitos <span class="blank _1"> </span>e <span class="blank _1"> </span>cito<span class="blank _1"> </span>-</div><div class="t m0 x1 hd yf5 ff4 fs5 fc0 sc0 ls4 ws15">cinas na urina, mas não existe qualquer sintoma. Estes </div><div class="t m0 x1 hd yf6 ff4 fs5 fc0 sc0 ls4 ws15">casos geralme<span class="blank _0"></span>nte não precisam <span class="blank _0"></span>de tratamento. </div><div class="t m0 x9 hd yf7 ff4 fs5 fc0 sc0 ls4 ws15">Um a <span class="blank _5"> </span>3% das <span class="blank _5"> </span>mulhere<span class="blank _0"></span>s jov<span class="blank _0"></span>ens não-<span class="blank _0"></span>grávidas <span class="blank _5"> </span>te<span class="ls34">m </span></div><div class="t m0 x1 hd yf8 ff4 fs5 fc0 sc0 ls4 ws15">bacteriúria <span class="blank _5"> </span>assintomática, m<span class="blank _0"></span>as este <span class="blank _5"> </span>achado é <span class="blank _5"> </span>irrele-</div><div class="t m0 x1 hd yf9 ff4 fs5 fc0 sc0 ls11 ws15">vant<span class="blank _1"> </span>e. <span class="blank _1"> </span><span class="ls4">Em <span class="blank _3"> </span><span class="ff2">m<span class="blank _0"></span>ulheres <span class="blank _1"> </span>grávidas<span class="ff4"> <span class="blank _1"> </span>esta <span class="blank _1"> </span>condição <span class="blank _1"> </span>tem <span class="blank _3"> </span>sig-</span></span></span></div><div class="t m0 x1 hd yfa ff4 fs5 fc0 sc0 ls4 ws15">nificado <span class="blank _1"> </span>clínico, <span class="blank _1"> </span>já <span class="blank _1"> </span>que <span class="blank _1"> </span>está <span class="blank _1"> </span>associada <span class="blank _1"> </span>a <span class="blank _1"> </span>parto <span class="blank _1"> </span>pré-<span class="ls2 ws2">ter</span>-</div><div class="t m0 x1 hd yfb ff4 fs5 fc0 sc0 ls4 ws15">mo, morte <span class="blank _1"> </span>perin<span class="ls7">atal do <span class="blank _1"> </span>fe<span class="blank _0"></span>to e <span class="blank _1"> </span>pielo<span class="blank _0"></span>nefrite na <span class="blank _1"> </span>mãe<span class="blank _0"></span>. Por </span></div><div class="t m0 x1 hd yfc ff4 fs5 fc0 sc0 ls4 ws15">estes motivos, a <span class="blank _4"> </span>bacter<span class="blank _0"></span>iúria assintomática deve ser </div><div class="t m0 x1 hd yfd ff4 fs5 fc0 sc0 ls4 ws15">pesquisada e tra<span class="blank _0"></span>tada na grávida. </div><div class="t m0 x1 h2e yfe ff4 fsa fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h11 yff ffb fs5 fc2 sc0 ls4 ws15">CISTITE </div><div class="t m0 x1 hd y100 ff4 fs5 fc0 sc0 ls4 ws15">Os <span class="blank _1"> </span>sintomas <span class="blank _1"> </span>típicos de <span class="blank _1"> </span>cistite <span class="blank _1"> </span>são <span class="blank _1"> </span>a <span class="blank _1"> </span><span class="ff2">disúria, <span class="blank _1"> </span>frequên-</span></div><div class="t m0 x1 hd y101 ff2 fs5 fc0 sc0 ls7 ws15">cia urinária e <span class="blank _4"> </span>urgên<span class="blank _0"></span>cia<span class="ff4">. <span class="blank _4"> </span>N<span class="blank _0"></span>ictúria<span class="ls4"> (necessidade de </span></span></div><div class="t m0 x1 hd y102 ff4 fs5 fc0 sc0 ls6 ws15">urinar<span class="blank _0"></span> durant<span class="blank _0"></span>e a noite<span class="blank _0"></span>)<span class="ls4">, t<span class="blank _1"> </span>enesmo<span class="blank _0"></span>, hematúria macroscó-</span></div><div class="t m0 x1 hd y103 ff4 fs5 fc0 sc0 ls6 wsd">pica<span class="ls4 ws15"> <span class="blank _3"> </span>(pre<span class="blank _0"></span>sença <span class="blank _3"> </span>de <span class="blank _3"> </span>sangue<span class="blank _0"></span> <span class="blank _3"> </span>na <span class="blank _3"> </span>urina, <span class="blank _3"> </span>v<span class="blank _0"></span>isível <span class="blank _3"> </span>a <span class="blank _3"> </span>olho <span class="blank _3"> </span>nu, </span></div><div class="t m0 x1 hd y104 ff4 fs5 fc0 sc0 ls4 ws15">em <span class="blank _6"> </span>c<span class="blank _1"> </span>ontraste<span class="blank _0"></span> <span class="blank _5"> </span>com <span class="blank _6"> </span>a <span class="blank _5"> </span>hematúr<span class="blank _0"></span>ia <span class="blank _5"> </span>micr<span class="blank _0"></span>oscópica) <span class="blank _5"> </span><span class="ls8">e <span class="blank _5"> </span>des</span>-</div><div class="t m0 x1 hd y105 ff4 fs5 fc0 sc0 ls4 ws15">conforto supra<span class="blank _0"></span>púbico também são <span class="blank _0"></span>queixas fre<span class="blank _0"></span>quentes. </div><div class="t m0 x1 h2e y106 ff4 fsa fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h11 y107 ffb fs5 fc2 sc0 ls4 ws15">PIELONEFRITE </div><div class="t m0 x1 hd y108 ff4 fs5 fc0 sc0 ls15 ws15">A <span class="blank _1"> </span>p<span class="blank _1"> </span>ie<span class="blank _1"> </span>lon<span class="blank _1"> </span>ef<span class="blank _1"> </span>ri<span class="blank _1"> </span>te <span class="blank _3"> </span>ab<span class="blank _1"> </span><span class="ls4">range desde <span class="blank _1"> </span>casos <span class="blank _1"> </span>lige<span class="blank _0"></span>iros <span class="blank _1"> </span>com <span class="blank _1"> </span>febre </span></div><div class="t m0 x1 hd y109 ff4 fs5 fc0 sc0 ls4 ws15">baixa, <span class="blank _6"> </span>com <span class="blank _6"> </span>ou <span class="blank _6"> </span>sem <span class="blank _6"> </span>d<span class="blank _1"> </span>or <span class="blank _6"> </span>lombar <span class="blank _6"> </span>ou <span class="blank _6"> </span>do <span class="blank _6"> </span>â<span class="blank _1"> </span>ngulo <span class="blank _3"> </span>costo<span class="blank _1"> </span>-<span class="ls21"> </span></div><div class="t m0 x1 hd y10a ff4 fs5 fc0 sc0 ls4 ws15">-verte<span class="blank _0"></span>bral, <span class="blank _3"> </span>até <span class="blank _3"> </span>casos <span class="blank _1"> </span>graves <span class="blank _3"> </span>com <span class="blank _3"> </span><span class="ff2 ls35">febr<span class="blank _0"></span>e <span class="blank _1"> </span>alta<span class="ff4 ls7">, <span class="blank _3"> </span>arr<span class="blank _0"></span>epios<span class="blank _0"></span>, </span></span></div><div class="t m0 x1 hd y10b ff4 fs5 fc0 sc0 ls4 ws15">náuseas, <span class="blank _1"> </span><span class="ff2 ls11 wsa">vómitos </span><span class="ls1c"> <span class="ls9">e <span class="blank _3"> </span><span class="ff2 lsc">dor <span class="blank _1"> </span>lom<span class="blank _0"></span>bar<span class="ff4 ls4"> <span class="blank _3"> </span>o<span class="blank _0"></span>u <span class="blank _1"> </span>no <span class="blank _1"> </span>flanco. Os <span class="blank _1"> </span>sin-</span></span></span></span></div><div class="t m0 x1 hd y10c ff4 fs5 fc0 sc0 ls4 ws15">tomas <span class="blank _1"> </span>são <span class="blank _1"> </span>de <span class="blank _1"> </span>instalação <span class="blank _1"> </span>aguda <span class="blank _3"> </span>e<span class="blank _0"></span> <span class="blank _1"> </span>tipicamente <span class="blank _1"> </span>acompa-</div><div class="t m0 x1 hd y10d ff4 fs5 fc0 sc0 ls6 wsd">nha<span class="ls4 ws3">m-<span class="ls36 ws2e">se</span><span class="ws15"> <span class="blank _1"> </span>de <span class="blank _3"> </span>sintomas <span class="blank _1"> </span>de <span class="blank _3"> </span>cistite, <span class="blank _1"> </span>embora <span class="blank _3"> </span>estes <span class="blank _1"> </span>possam </span></span></div><div class="t m0 x1 hd y10e ff4 fs5 fc0 sc0 ls4 ws15">estar <span class="blank _1"> </span>ausentes. <span class="blank _1"> </span>Os sintomas <span class="blank _1"> </span>de <span class="blank _1"> </span>cistite <span class="blank _1"> </span>podem p<span class="blank _1"> </span>rece<span class="blank _0"></span>der </div><div class="t m0 x1 hd y10f ff4 fs5 fc0 sc0 ls4 ws15">os <span class="blank _7"> </span>sintomas <span class="blank _4"> </span>de <span class="blank _7"> </span>pielonef<span class="blank _0"></span>rite. <span class="blank _7"> </span>A <span class="blank _7"> </span>princ<span class="blank _0"></span>ipal <span class="blank _7"> </span>distinção </div><div class="t m0 x1 hd y110 ff4 fs5 fc0 sc0 ls4 ws15">entre cistite e pi<span class="blank _1"> </span>el<span class="blank _0"></span>onefrite faz-<span class="ls24">se pe<span class="blank _0"></span>l<span class="blank _0"></span>a feb<span class="blank _0"></span>re<span class="blank _0"></span>. <span class="ls4">Ao exame </span></span></div><div class="t m0 x1 hd y111 ff4 fs5 fc0 sc0 ls4 ws15">objectivo p<span class="blank _1"> </span>ode haver <span class="blank _1"> </span>sinal <span class="blank _1"> </span>de Murphy renal <span class="blank _1"> </span>positi<span class="blank _1"> </span><span class="ls10">vo</span></div><div class="c x0 y112 w16 h2f"><div class="t m0 x29 h30 y113 ff4 fsb fc0 sc0 ls4">1</div></div><div class="t m0 x2a hd y111 ff4 fs5 fc0 sc0 ls21 ws15">, </div><div class="t m0 x1 hd y114 ff4 fs5 fc0 sc0 ls4 ws15">mas <span class="blank _1"> </span>a <span class="blank _3"> </span>sua <span class="blank _1"> </span>utilidade <span class="blank _1"> </span>é <span class="blank _1"> </span>controversa. <span class="blank _3"> </span>Princi<span class="blank _0"></span>palmente <span class="blank _1"> </span>em </div><div class="t m0 x1 hd y115 ff4 fs5 fc0 sc0 ls4 ws15">doentes <span class="blank _4"> </span>idosos p<span class="blank _1"> </span>o<span class="blank _0"></span>de <span class="blank _4"> </span>haver alteração <span class="blank _4"> </span>do <span class="blank _4"> </span>estado <span class="blank _4"> </span>de </div><div class="t m0 x1 hd y116 ff4 fs5 fc0 sc0 ls4 ws15">consciência. </div><div class="t m0 x9 hd y117 ff4 fs5 fc0 sc0 ls4 ws15">A p<span class="blank _1"> </span>ielo<span class="blank _0"></span>nefrite <span class="blank _1"> </span>pode d<span class="blank _1"> </span>iminu<span class="blank _0"></span>ir <span class="blank _1"> </span>a <span class="blank _1"> </span>filtração glomerular, </div><div class="t m0 x1 hd y118 ff4 fs5 fc0 sc0 ls4 ws15">mas <span class="blank _1"> </span>este efeito <span class="blank _1"> </span>é <span class="blank _1"> </span>geralmente ligeiro <span class="blank _1"> </span>e, <span class="blank _1"> </span>como <span class="blank _1"> </span>a doença </div><div class="t m0 x1 hd y119 ff4 fs5 fc0 sc0 ls4 ws15">é ti<span class="blank _1"> </span>picamente<span class="blank _0"></span> <span class="blank _4"> </span>unilater<span class="blank _0"></span>al, <span class="blank _4"> </span>raramente tem <span class="blank _4"> </span>significa<span class="blank _0"></span>do </div><div class="t m0 x1 hd y11a ff4 fs5 fc0 sc0 ls4 ws15">clínico. <span class="blank _1"> </span>A doença <span class="blank _1"> </span>é <span class="blank _1"> </span>em <span class="blank _1"> </span>geral <span class="blank _1"> </span>benigna e <span class="blank _1"> </span>aut<span class="blank _1"> </span>o-limitada, </div><div class="t m0 x1 hd y11b ff4 fs5 fc0 sc0 ls4 ws15">mas <span class="blank _3"> </span>a <span class="blank _3"> </span>infe<span class="blank _0"></span>cção <span class="blank _3"> </span>pode <span class="blank _3"> </span>ca<span class="blank _0"></span>usar <span class="blank _3"> </span>dano <span class="blank _1"> </span>renal <span class="blank _3"> </span>progre<span class="blank _0"></span>ssivo <span class="blank _3"> </span>e </div><div class="t m0 x1 hd y11c ff4 fs5 fc0 sc0 ls4 ws15">irreversível<span class="blank _0"></span>, pelo que deve se<span class="blank _0"></span>r tratada. </div><div class="t m0 x9 hd y11d ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x2b h14 y38 ff2 fs7 fc1 sc0 ls37 ws15">Men<span class="blank _0"></span>s<span class="blank _0"></span>ag<span class="blank _0"></span>en<span class="blank _0"></span>s<span class="blank _0"></span> a<span class="blank _0"></span> R<span class="blank _0"></span>et<span class="blank _0"></span>er<span class="ls4"> </span></div><div class="t m0 x1 h17 y11e ff2 fs6 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h10 y11f ff2 fs5 fc0 sc0 ls4 ws15">Infecção urinár<span class="blank _0"></span>ia </div><div class="t m0 x1 he y46 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">É um termo que<span class="blank _0"></span> inclui várias pa<span class="blank _0"></span>tologias, entre<span class="blank _0"></span> elas </span></span></div><div class="t m0 x9 hd y120 ff4 fs5 fc0 sc0 ls4 ws15">a bacterúria ass<span class="blank _0"></span>intomática, a cis<span class="blank _0"></span>tite, a pielonef<span class="blank _0"></span>rite e </div><div class="t m0 x9 hd y4c ff4 fs5 fc0 sc0 ls4 ws15">a prostatite. </div><div class="c x0 y112 w16 h2f"><div class="t m0 x1 h2 y121 ff1 fs0 fc0 sc0 ls33 ws15"> </div></div><div class="t m0 x2c h2 y121 ff1 fs0 fc0 sc0 ls4 ws15"> </div><div class="c x0 y112 w16 h2f"><div class="t m0 x1 h31 y122 ff7 fsc fc0 sc0 ls4">1</div></div><div class="t m0 x2d h1f y123 ff7 fsa fc0 sc0 ls4 ws15"> Uma pancada seca no ângulo costo-vertebral sobre o rim </div><div class="t m0 x1 h1f y124 ff7 fsa fc0 sc0 ls4 ws15">afectado desencadeia dor severa, devido à extensão da cápsula </div><div class="t m0 x1 h32 y125 ff7 fsa fc0 sc0 ls4 ws15">renal causada, neste caso, pela inflamação renal.<span class="fs7"> </span></div><div class="t m0 x1b he y126 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">Ocorre principal<span class="blank _0"></span>mente em mul<span class="blank _0"></span>heres, nas quais é </span></span></div><div class="t m0 x1c hd y127 ff4 fs5 fc0 sc0 ls4 ws15">muito frequente, pel<span class="blank _0"></span>a sua maior pre<span class="blank _0"></span>disposição </div><div class="t m0 x1c hd y128 ff4 fs5 fc0 sc0 ls4 ws15">anatómica. Nos home<span class="blank _0"></span>ns associa-se m<span class="blank _0"></span>uitas vezes à </div><div class="t m0 x1c hd y129 ff4 fs5 fc0 sc0 ls4 ws15">existência de anomal<span class="blank _0"></span>ias funcio<span class="blank _0"></span>nais ou anatómicas<span class="blank _0"></span> </div><div class="t m0 x1c hd y12a ff4 fs5 fc0 sc0 ls4 ws15">do tracto urinár<span class="blank _0"></span>io, como malf<span class="blank _0"></span>ormações congénitas </div><div class="t m0 x1c hd y12b ff4 fs5 fc0 sc0 ls4 ws15">(nas crianças) ou<span class="blank _0"></span> obstruções (por e<span class="blank _0"></span>xemplo por </div><div class="t m0 x1c hd y12c ff4 fs5 fc0 sc0 ls4 ws15">hiperplasia be<span class="blank _0"></span>nigna da próstata, <span class="blank _0"></span>nos idosos)<span class="blank _0"></span>. </div><div class="t m0 x1b he y12d ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff8 ls4">Escherichia coli<span class="ff4"> é o age<span class="blank _0"></span>nte mais fre<span class="blank _0"></span>quente em </span></span></span></div><div class="t m0 x1c hd y12e ff4 fs5 fc0 sc0 ls6 ws15">qualq<span class="blank _0"></span>uer<span class="blank _0"></span> con<span class="ls2 ws2">tex<span class="blank _0"></span>to<span class="ls4 ws15">, seguido <span class="blank _0"></span>de <span class="ff8 ls11">Staph<span class="blank _1"> </span>ylococcus </span></span></span></div><div class="t m0 x1c hd y12f ff8 fs5 fc0 sc0 ls4 ws15">saprophyticus <span class="ff4">e dos o<span class="blank _0"></span>utros bacilos G<span class="blank _0"></span>ram-<span class="ls6">negativ<span class="blank _0"></span>o </span></span></div><div class="t m0 x1c hd y130 ff4 fs5 fc0 sc0 ls4 ws15">entéricos. <span class="ff8 lsf ws2f">Ente ro co c cu s </span> também é um<span class="blank _0"></span> agente </div><div class="t m0 x1c hd y131 ff4 fs5 fc0 sc0 ls4 ws15">relativamente fr<span class="blank _0"></span>equente. </div><div class="t m0 x1b he y132 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">A ITU pode o<span class="blank _0"></span>correr por v<span class="blank _0"></span>ia hematogénea ou por via<span class="blank _0"></span> </span></span></div><div class="t m0 x1c hd y133 ff4 fs5 fc0 sc0 ls4 ws15">ascendente (muito <span class="blank _0"></span>mais frequente<span class="blank _0"></span>). <span class="ls15">A <span class="blank _1"> </span>in<span class="blank _1"> </span>fec<span class="blank _1"> </span>çã<span class="blank _1"> </span>o p<span class="blank _1"> </span>or<span class="blank _1"> </span> </span></div><div class="t m0 x1c hd y134 ff4 fs5 fc0 sc0 ls11 ws15">via <span class="blank _1"> </span>ascendente <span class="blank _1"> </span><span class="ls4">é promov<span class="blank _0"></span>ida por factore<span class="blank _0"></span>s que </span></div><div class="t m0 x1c hd y135 ff4 fs5 fc0 sc0 ls4 ws15">promovam a entra<span class="blank _0"></span>da e a permanê<span class="blank _0"></span>ncia das bactér<span class="blank _0"></span>ias </div><div class="t m0 x1c hd y136 ff4 fs5 fc0 sc0 ls4 ws15">na bexiga, como<span class="blank _0"></span> um volume r<span class="blank _0"></span>esidual de urina </div><div class="t m0 x1c hd y137 ff4 fs5 fc0 sc0 ls6 wsd">pós<span class="ls4 ws15">-mic<span class="blank _0"></span>cional significativo<span class="blank _0"></span>, um corpo estran<span class="blank _0"></span>ho ou </span></div><div class="t m0 x1c hd y138 ff4 fs5 fc0 sc0 ls4 ws15">uma obstrução. A<span class="blank _0"></span> chegada ao rim é<span class="blank _0"></span> favore<span class="blank _0"></span>cida pela </div><div class="t m0 x1c hd y139 ff4 fs5 fc0 sc0 ls4 ws15">estase urinária. Esta é<span class="blank _0"></span> a via de infe<span class="blank _0"></span>cção principal </div><div class="t m0 x1c hd y13a ff4 fs5 fc0 sc0 ls4 ws15">para bacilos G<span class="blank _0"></span>ram-negativo entér<span class="blank _0"></span>icos e </div><div class="t m0 x1c hd y13b ff8 fs5 fc0 sc0 ls4 ws15">Staphylococcus<span class="blank _0"></span> saprophyticus<span class="ff4">. </span></div><div class="t m0 x1b he y13c ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">A via hematogé<span class="blank _0"></span>nea ocorre quan<span class="blank _0"></span>do uma bacte<span class="blank _0"></span>riémia </span></span></div><div class="t m0 x1c hd y13d ff4 fs5 fc0 sc0 ls4 ws15">origina focos de i<span class="blank _0"></span>nfecção renal<span class="blank _0"></span>. Esta é a via <span class="blank _0"></span>de </div><div class="t m0 x1c hd y13e ff4 fs5 fc0 sc0 ls2 ws15">infecç<span class="blank _0"></span>ão pr<span class="blank _0"></span>inci<span class="blank _0"></span>pal par<span class="blank _0"></span>a <span class="ff8 ls11 wsb">Staphyloc oc cus <span class="ls4 ws15"> aureus</span></span><span class="ls9">, </span></div><div class="t m0 x1c hd y108 ff8 fs5 fc0 sc0 ls6 wsd">Salmo<span class="blank _0"></span>nell<span class="blank _0"></span>a<span class="ff4 ls3 ws15"> <span class="ls25">spp<span class="blank _1"> </span>. <span class="blank _1"> </span>e </span></span><span class="ls13 wsf">Candi<span class="blank _0"></span>da<span class="ff4 ls4 ws15"> spp., mas <span class="blank _0"></span>é uma via rara </span></span></div><div class="t m0 x1c hd y109 ff4 fs5 fc0 sc0 ls4 ws15">para os bacilo<span class="blank _0"></span>s Gram-negativo e<span class="blank _0"></span>ntéricos, mesmo<span class="blank _0"></span> </div><div class="t m0 x1c hd y10a ff4 fs5 fc0 sc0 ls4 ws15">que existam em c<span class="blank _0"></span>irculação. </div><div class="t m0 x1b he y13f ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">A bacteriúria<span class="blank _0"></span> assintomática carac<span class="blank _0"></span>teriza-se pela </span></span></div><div class="t m0 x1c hd y140 ff4 fs5 fc0 sc0 ls4 ws15">presença de bac<span class="blank _0"></span>térias e leucóci<span class="blank _0"></span>tos na urina, mas </div><div class="t m0 x1c hd y141 ff4 fs5 fc0 sc0 ls4 ws15">sem sintomas. É <span class="blank _0"></span>um achado <span class="ls1f">relativamente </span></div><div class="t m0 x1c hd y142 ff4 fs5 fc0 sc0 ls4 ws15">frequente, mas <span class="blank _0"></span>na maioria dos c<span class="blank _0"></span>asos irre<span class="blank _0"></span>levante. Em </div><div class="t m0 x1c hd y143 ff4 fs5 fc0 sc0 ls4 ws15">mulheres gr<span class="blank _0"></span>ávidas pode evol<span class="blank _0"></span>uir para ITU<span class="blank _0"></span> e </div><div class="t m0 x1c hd y144 ff4 fs5 fc0 sc0 ls4 ws15">associa-se a parto <span class="blank _0"></span>pré-termo e<span class="blank _0"></span> morte fetal perinatal. </div><div class="t m0 x1b he y145 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">A cistite caracter<span class="blank _0"></span>iza-se tipicamente po<span class="blank _0"></span>r disúria, </span></span></div><div class="t m0 x1c hd y146 ff4 fs5 fc0 sc0 ls4 ws15">frequência uri<span class="blank _0"></span>nária e urgência<span class="blank _0"></span>. Também po<span class="ls6">de ha<span class="blank _0"></span>ver<span class="blank _0"></span> </span></div><div class="t m0 x1c hd y147 ff4 fs5 fc0 sc0 ls4 ws15">nictúria, tene<span class="blank _0"></span>smo, hematúria e <span class="blank _0"></span>desconfor<span class="blank _0"></span>to </div><div class="t m0 x1c hd y148 ff4 fs5 fc0 sc0 ls4 ws15">suprapúbico. </div><div class="t m0 x1b he y149 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls15">A p<span class="blank _1"> </span>ie<span class="blank _1"> </span>lon<span class="blank _1"> </span>efr<span class="blank _1"> </span>it<span class="blank _1"> </span>e <span class="blank _1"> </span>ca<span class="blank _1"> </span>rac<span class="blank _1"> </span>te<span class="blank _1"> </span>ri<span class="blank _1"> </span>za<span class="blank _1"> </span><span class="ls4">-se por f<span class="blank _0"></span>ebre, náuseas, </span></span></span></div><div class="t m0 x1c hd y14a ff4 fs5 fc0 sc0 ls4 ws15">vómitos e dor lo<span class="blank _0"></span>mbar. Pode have<span class="blank _0"></span>r sintomas de </div><div class="t m0 x1c hd y14b ff4 fs5 fc0 sc0 ls4 ws15">cistite. Ao ex<span class="blank _0"></span>ame objectivo pode h<span class="blank _0"></span>aver sinal de </div><div class="t m0 x1c hd y14c ff4 fs5 fc0 sc0 ls4 ws15">Murphy positivo. </div><div class="t m0 x1b hd y14d ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1b h14 y14e ff2 fs7 fc2 sc0 ls1e ws15">Colheita de <span class="blank _1"> </span>Urina<span class="ls4"> </span></div><div class="t m0 x1b h17 y14f ff2 fs6 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1b hd y150 ff4 fs5 fc0 sc0 lse ws15">Na <span class="blank _1"> </span>colheit<span class="ls4">a <span class="blank _1"> </span>de urina é da<span class="blank _1"> </span> maior importância a <span class="blank _1"> </span>preve<span class="blank _0"></span>n-</span></div><div class="t m0 x1b hd y151 ff4 fs5 fc0 sc0 ls4 ws15">ção <span class="blank _1"> </span>d<span class="blank _1"> </span>a <span class="blank _1"> </span>contaminação <span class="blank _1"> </span>com <span class="blank _3"> </span>a <span class="blank _1"> </span>microbiota <span class="blank _1"> </span>vaginal, <span class="blank _1"> </span>peri<span class="blank _1"> </span>-</div><div class="t m0 x1b hd y152 ff4 fs5 fc0 sc0 ls4 ws15">neal <span class="blank _3"> </span>e <span class="blank _3"> </span>uretral <span class="blank _6"> </span>distal. <span class="blank _3"> </span>Vários <span class="blank _6"> </span>métodos<span class="blank _0"></span> <span class="blank _3"> </span>p<span class="blank _1"> </span>odem <span class="blank _3"> </span>ser <span class="blank _3"> </span>usa<span class="blank _1"> </span>-</div><div class="t m0 x1b hd y153 ff4 fs5 fc0 sc0 ls4 ws15">dos para colhe<span class="blank _0"></span>r amostras de urin<span class="blank _0"></span>a. </div><div class="t m0 x1b h33 y154 ff4 fsc fc0 sc0 ls4 ws15"> </div><div class="t m0 x1b h11 y155 ffb fs5 fc2 sc0 ls4 ws15">TÉCNICA DO J<span class="blank _0"></span>ACTO MÉDIO </div><div class="t m0 x1b hd y156 ff4 fs5 fc0 sc0 ls4 ws15">Nesta técnica, a<span class="blank _1"> </span> mais u<span class="blank _1"> </span>sad<span class="blank _0"></span>a n<span class="blank _1"> </span>a prática clínica <span class="blank _1"> </span><span class="ls6">diária<span class="blank _0"></span>, é </span></div><div class="t m0 x1b hd y157 ff4 fs5 fc0 sc0 ls4 ws15">o d<span class="blank _1"> </span>oe<span class="blank _0"></span>nte <span class="blank _1"> </span>que colhe <span class="blank _1"> </span>a a<span class="blank _1"> </span>mostra de <span class="blank _1"> </span>urina. <span class="blank _1"> </span><span class="lse">O <span class="blank _1"> </span>doente <span class="blank _1"> </span>deve </span></div><div class="t m0 x1b hd y158 ff4 fs5 fc0 sc0 ls4 ws15">lavar <span class="blank _1"> </span>as <span class="blank _1"> </span>mãos <span class="blank _1"> </span>com <span class="blank _1"> </span>água <span class="blank _1"> </span>e <span class="blank _1"> </span>sabão <span class="blank _3"> </span>e<span class="blank _0"></span> <span class="blank _1"> </span>secá<span class="blank _1"> </span>-las <span class="blank _1"> </span><span class="ls8 ws30">adequ ad a </span>-</div><div class="t m0 x1b hd y159 ff4 fs5 fc0 sc0 ls4 ws15">mente. </div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf5" class="pf w0 h0" data-page-no="5"><div class="pc pc5 w0 h0"><img fetchpriority="low" loading="lazy" class="bi x0 y15a w7 h34" alt src="https://files.passeidireto.com/e78ed9d7-0969-4804-95c1-3a92effc5fc9/bg5.png" alt="Pré-visualização de imagem de arquivo"><div class="c x1d yc1 w8 h1b"><div class="t m2 x1e h1c yc2 ff2 fs7 fc1 sc0 ls4 ws15">Aula 6<span class="ff4"> </span></div></div><div class="c x0 yc3 w9 h15"><div class="t m0 x1f h19 yc4 ff2 fs8 fc1 sc0 ls4 ws15">Infecção Urinária<span class="ff4"> </span></div></div><div class="t m0 x20 h2 y53 ff1 fs0 fc0 sc0 ls2a ws15"> <span class="ff2 fs8 lsd ws16">167</span><span class="ls4"> <span class="blank _8"> </span> </span></div><div class="t m0 x1 h2 y54 ff1 fs0 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h11 y8b ffb fs5 fc2 sc0 ls4 ws15">Na <span class="blank _6"> </span>mulher.<span class="ff4 fc0"> <span class="blank _5"> </span>Com <span class="blank _6"> </span>compressas <span class="blank _6"> </span>embebidas <span class="blank _6"> </span>em <span class="blank _5"> </span>ág<span class="blank _0"></span>ua <span class="blank _6"> </span>e </span></div><div class="t m0 x1 hd y8c ff4 fs5 fc0 sc0 ls4 ws15">sabão (nunca <span class="blank _5"> </span>se deve<span class="blank _0"></span> usar antissé<span class="blank _0"></span>pticos), a m<span class="blank _0"></span>ulher </div><div class="t m0 x1 hd y8d ff4 fs5 fc0 sc0 ls6 ws15">deve<span class="blank _0"></span> <span class="blank _3"> </span><span class="ls4">proceder <span class="blank _3"> </span>à <span class="blank _3"> </span>lavagem <span class="blank _3"> </span>d<span class="blank _1"> </span>a <span class="blank _3"> </span>vulva, <span class="blank _3"> </span>sem</span>pre <span class="blank _3"> </span>de <span class="blank _3"> </span>fr<span class="blank _0"></span>ente </div><div class="t m0 x1 hd y8e ff4 fs5 fc0 sc0 ls6 ws15">para <span class="ls2">trás<span class="blank _0"></span>, com<span class="ls4"> uma compressa de cada vez e desperdi-</span></span></div><div class="t m0 x1 hd y8f ff4 fs5 fc0 sc0 ls7 ws19">çando<span class="ls4 ws3">-<span class="ls29 ws15">a <span class="ls4">em <span class="blank _1"> </span>seg<span class="blank _0"></span>uida. <span class="blank _1"> </span>O processo d<span class="blank _1"> </span>ev<span class="blank _0"></span>e <span class="blank _1"> </span>ser repetido <span class="blank _1"> </span>pe-</span></span></span></div><div class="t m0 x1 hd y90 ff4 fs5 fc0 sc0 ls4 ws15">lo menos três vezes. Em <span class="blank _1"> </span>seguida, <span class="ls7">a vulva é enx<span class="blank _0"></span>aguada<span class="ls4"> </span></span></div><div class="t m0 x1 hd y91 ff4 fs5 fc0 sc0 ls4 ws15">com <span class="blank _3"> </span>água <span class="blank _6"> </span>limpa <span class="blank _3"> </span>para <span class="blank _6"> </span>retirar <span class="blank _3"> </span>o <span class="blank _3"> </span>sabão.<span class="blank _1"> </span> <span class="blank _3"> </span>Os <span class="blank _3"> </span>grandes <span class="blank _6"> </span>lá-</div><div class="t m0 x1 hd y92 ff4 fs5 fc0 sc0 ls6 wsd">bios<span class="ls4 ws15"> <span class="blank _3"> </span>deve<span class="blank _0"></span>m <span class="blank _3"> </span>ser <span class="blank _3"> </span>afastados <span class="blank _6"> </span>com <span class="blank _3"> </span>uma <span class="blank _3"> </span>das <span class="blank _3"> </span>mãos, <span class="blank _3"> </span>e <span class="blank _6"> </span>essa </span></div><div class="t m0 x1 hd y93 ff4 fs5 fc0 sc0 ls4 ws15">posição mantida d<span class="blank _0"></span>urante toda a colhe<span class="blank _0"></span>ita. </div><div class="t m0 x1 h2e y15b ff4 fsa fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h11 yf8 ffb fs5 fc2 sc0 lse ws15">No <span class="blank _1"> </span>hom<span class="blank _1"> </span>em.<span class="ff4 fc0 ls4"> <span class="blank _1"> </span>O <span class="blank _1"> </span>homem <span class="blank _1"> </span>deve<span class="blank _0"></span> <span class="blank _1"> </span>retrair <span class="blank _1"> </span>o <span class="blank _1"> </span>prepúcio <span class="blank _1"> </span>e <span class="blank _1"> </span>man-</span></div><div class="t m0 x1 hd yf9 ff4 fs5 fc0 sc0 ls2 ws15">ter <span class="ls4">e<span class="blank _0"></span>sta posição durante toda a <span class="blank _0"></span>colheita. A <span class="ls11 wsa">glande</span><span class="ls3"> <span class="ls6">deve </span></span></span></div><div class="t m0 x1 hd yfa ff4 fs5 fc0 sc0 ls4 ws15">ser <span class="blank _3"> </span>limpa <span class="blank _6"> </span>com <span class="blank _3"> </span>compressas <span class="blank _3"> </span>embebidas <span class="blank _3"> </span>em <span class="blank _3"> </span>água <span class="blank _3"> </span>e <span class="blank _6"> </span>sa-</div><div class="t m0 x1 hd yfb ff4 fs5 fc0 sc0 ls4 ws15">bão, <span class="blank _5"> </span>e <span class="blank _5"> </span>de seguid<span class="ls7">a <span class="blank _5"> </span>enxag<span class="blank _0"></span>uada<span class="ls4"> <span class="blank _5"> </span>com <span class="blank _5"> </span>água l<span class="blank _0"></span>impa <span class="blank _5"> </span>para </span></span></div><div class="t m0 x1 hd yfc ff4 fs5 fc0 sc0 ls4 ws15">retirar o sabão.<span class="fsa"> </span></div><div class="t m0 x1 h2e y15c ff4 fsa fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h11 y15d ffb fs5 fc2 sc0 ls13 ws15">Colhei<span class="blank _0"></span>ta <span class="blank _6"> </span>do <span class="blank _5"> </span>jac<span class="blank _0"></span>to <span class="blank _6"> </span>médio.<span class="ff4 ls38"> <span class="fc0 ls4">O <span class="blank _6"> </span>primeiro <span class="blank _5"> </span>te<span class="blank _0"></span>rço <span class="blank _5"> </span>do <span class="blank _6"> </span>jacto </span></span></div><div class="t m0 x1 hd y15e ff4 fs5 fc0 sc0 ls4 ws15">urinário é <span class="blank _1"> </span>desperdiça<span class="blank _0"></span>do <span class="blank _1"> </span>para evitar a <span class="blank _1"> </span>contaminação da </div><div class="t m0 x1 hd y100 ff4 fs5 fc0 sc0 ls4 ws15">amostra <span class="blank _1"> </span>pelas <span class="blank _1"> </span>bactérias <span class="blank _1"> </span>da<span class="blank _1"> </span> <span class="blank _1"> </span>uretra <span class="blank _1"> </span>distal. <span class="blank _1"> </span>De <span class="blank _3"> </span>se<span class="blank _0"></span>guida <span class="blank _3"> </span>o </div><div class="t m0 x1 hd y101 ff4 fs5 fc0 sc0 ls4 ws15">doente <span class="blank _3"> </span>dev<span class="blank _0"></span>e <span class="blank _3"> </span>colher, <span class="blank _1"> </span>s<span class="blank _1"> </span>em <span class="blank _1"> </span>int<span class="blank _1"> </span>err<span class="blank _0"></span>omper <span class="blank _3"> </span>a <span class="blank _3"> </span>micção, <span class="blank _3"> </span>cer<span class="blank _0"></span>ca </div><div class="t m0 x1 hd y102 ff4 fs5 fc0 sc0 ls4 ws15">de <span class="blank _3"> </span>10 <span class="blank _1"> </span>mL <span class="blank _3"> </span>para <span class="blank _3"> </span>um <span class="blank _1"> </span>recipiente <span class="blank _1"> </span>estéril. <span class="blank _1"> </span>O <span class="blank _3"> </span>restante <span class="blank _3"> </span>jacto </div><div class="t m0 x1 hd y103 ff4 fs5 fc0 sc0 ls6 ws15">de uri<span class="blank _0"></span>na de<span class="blank _0"></span>ve<span class="blank _0"></span> s<span class="ls4">er desperdiçado. </span></div><div class="t m0 x1 h2e y15f ff4 fsa fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h11 y160 ffb fs5 fc2 sc0 ls4 ws15">PUNÇÃO DE ALG<span class="blank _0"></span>ÁLIA </div><div class="t m0 x1 hd y13d ff4 fs5 fc0 sc0 ls4 ws15">O <span class="blank _1"> </span>sist<span class="blank _1"> </span>ema <span class="blank _1"> </span>de <span class="blank _1"> </span>drenagem <span class="blank _1"> </span>da<span class="blank _1"> </span> <span class="blank _1"> </span>urina <span class="blank _1"> </span>para <span class="blank _1"> </span>o <span class="blank _3"> </span>saco <span class="blank _1"> </span>colector </div><div class="t m0 x1 hd y13e ff4 fs5 fc0 sc0 ls4 ws15">deve <span class="blank _1"> </span>ser <span class="blank _1"> </span>clampado <span class="blank _1"> </span>a <span class="blank _1"> </span>jusante <span class="blank _1"> </span>do <span class="blank _1"> </span>local d<span class="blank _1"> </span>e <span class="blank _1"> </span>colheita. <span class="blank _1"> </span><span class="ls39 ws31">De</span>-</div><div class="t m0 x1 hd y108 ff4 fs5 fc0 sc0 ls10 ws8">ve<span class="ls4 ws15">-se acumular volume de urina su<span class="blank _1"> </span>f<span class="blank _0"></span>iciente para o <span class="blank _1"> </span>exa-</span></div><div class="t m0 x1 hd y109 ff4 fs5 fc0 sc0 ls4 ws15">me <span class="blank _3"> </span>microbiológico: <span class="blank _3"> </span>num <span class="blank _3"> </span>indivíduo <span class="blank _6"> </span>com <span class="blank _3"> </span>diurese <span class="blank _3"> </span>nor<span class="blank _1"> </span>-</div><div class="t m0 x1 hd y10a ff4 fs5 fc0 sc0 ls4 ws15">mal o <span class="blank _1"> </span>tempo d<span class="blank _1"> </span>e clampagem é <span class="blank _1"> </span>de cerca <span class="blank _1"> </span>de 15 <span class="blank _1"> </span>minutos. </div><div class="t m0 x1 hd y10b ff4 fs5 fc0 sc0 ls4 ws15">O <span class="blank _4"> </span>local<span class="blank _0"></span> <span class="blank _4"> </span>do <span class="blank _4"> </span>sistema colector <span class="blank _4"> </span>a p<span class="blank _1"> </span>uncionar<span class="blank _0"></span> <span class="blank _4"> </span>deve ser </div><div class="t m0 x1 hd y10c ff4 fs5 fc0 sc0 ls4 ws15">desinfectado <span class="blank _1"> </span>com <span class="blank _1"> </span>soluto <span class="blank _1"> </span>antisséptico <span class="blank _1"> </span>e <span class="blank _1"> </span>deixado <span class="blank _1"> </span>secar. </div><div class="t m0 x1 hd y10d ff4 fs5 fc0 sc0 ls4 ws15">Alguns <span class="blank _3"> </span>sistemas <span class="blank _6"> </span>têm <span class="blank _3"> </span>local <span class="blank _6"> </span>específico <span class="blank _3"> </span>para <span class="blank _6"> </span>a <span class="blank _3"> </span>punção. </div><div class="t m0 x1 hd y10e ff4 fs5 fc0 sc0 ls4 ws15">A punção deve ser feita com agulha e seringa estéreis, </div><div class="t m0 x1 hd y10f ff4 fs5 fc0 sc0 ls4 ws15">em <span class="blank _3"> </span>ângulo <span class="blank _1"> </span>agudo <span class="blank _3"> </span>em <span class="blank _3"> </span>relação <span class="blank _1"> </span>ao <span class="blank _3"> </span>eixo <span class="blank _3"> </span>longitudinal <span class="blank _1"> </span>do </div><div class="t m0 x1 hd y110 ff4 fs5 fc0 sc0 ls7 ws19">catéter<span class="blank _0"></span>.<span class="ls4 ws15"> </span></div><div class="t m0 x9 hd y111 ff4 fs5 fc0 sc0 ls4 ws15">A u<span class="blank _1"> </span>rina <span class="blank _1"> </span>pode <span class="blank _1"> </span>ser enviada <span class="blank _1"> </span>na <span class="blank _1"> </span>própria <span class="blank _1"> </span>seringa, <span class="blank _1"> </span>fecha-</div><div class="t m0 x1 hd y114 ff4 fs5 fc0 sc0 ls4 ws15">da com tampa este<span class="blank _0"></span>rilizada após re<span class="blank _0"></span>moção da ag<span class="blank _0"></span>ulha. </div><div class="t m0 x9 hd y115 ff4 fs5 fc0 sc0 ls4 ws15">Esta <span class="blank _1"> </span>técnica <span class="blank _1"> </span>pode <span class="blank _1"> </span>ser <span class="blank _1"> </span>utilizada <span class="blank _1"> </span>em doentes <span class="blank _1"> </span>não <span class="blank _1"> </span>p<span class="blank _1"> </span>re-</div><div class="t m0 x1 hd y116 ff4 fs5 fc0 sc0 ls4 ws15">viamente <span class="blank _1"> </span>algaliados <span class="blank _1"> </span>para <span class="blank _1"> </span>obter <span class="blank _1"> </span>amostras <span class="blank _1"> </span>de <span class="blank _1"> </span>qualidade </div><div class="t m0 x1 hd y117 ff4 fs5 fc0 sc0 ls4 ws15">superior <span class="blank _1"> </span>às <span class="blank _1"> </span>da <span class="blank _1"> </span>técnica do <span class="blank _1"> </span>jacto <span class="blank _1"> </span>médio. <span class="blank _1"> </span>Os <span class="blank _1"> </span>exames mi-</div><div class="t m0 x1 hd y118 ff4 fs5 fc0 sc0 ls4 ws15">crobiológicos <span class="blank _1"> </span>de <span class="blank _1"> </span>u<span class="blank _1"> </span>rina <span class="blank _1"> </span>por <span class="blank _3"> </span>ro<span class="blank _0"></span>tina <span class="blank _3"> </span>não <span class="blank _1"> </span>estão <span class="blank _1"> </span>indicados </div><div class="t m0 x1 hd y119 ff4 fs5 fc0 sc0 ls4 ws15">nos <span class="blank _1"> </span>doentes <span class="blank _1"> </span>algaliados. <span class="blank _1"> </span>A <span class="blank _1"> </span>urina <span class="blank _1"> </span>nunca <span class="blank _1"> </span>deve <span class="blank _1"> </span>ser <span class="blank _1"> </span>colhi-</div><div class="t m0 x1 hd y11a ff4 fs5 fc0 sc0 ls4 ws15">da <span class="blank _3"> </span>d<span class="blank _1"> </span>o <span class="blank _3"> </span>saco <span class="blank _3"> </span>colector <span class="blank _3"> </span>ou <span class="blank _3"> </span>d<span class="blank _1"> </span>a <span class="blank _3"> </span>sua <span class="blank _6"> </span>junção <span class="blank _3"> </span>com <span class="blank _3"> </span>a <span class="blank _3"> </span>a<span class="blank _1"> </span>lgália. </div><div class="t m0 x1 hd y11b ff4 fs5 fc0 sc0 ls4 ws15">As <span class="blank _3"> </span>pontas <span class="blank _3"> </span>da <span class="blank _6"> </span>algália <span class="blank _3"> </span>nunca <span class="blank _3"> </span>devem <span class="blank _3"> </span>ser <span class="blank _6"> </span>enviadas <span class="blank _6"> </span>para </div><div class="t m0 x1 hd y11c ff4 fs5 fc0 sc0 ls4 ws15">cultura, <span class="blank _3"> </span>pois <span class="blank _3"> </span>estão <span class="blank _1"> </span>invariavelmente <span class="blank _1"> </span>contaminadas <span class="blank _3"> </span>por </div><div class="t m0 x1 hd y11d ff4 fs5 fc0 sc0 ls4 ws15">bactérias da <span class="blank _0"></span>uretra. </div><div class="t m0 x1 h2d y161 ffb fsa fc2 sc0 ls4 ws15"> </div><div class="t m0 x1 h11 y82 ffb fs5 fc2 sc0 ls4 ws15">PUNÇÃO SUPRA-PÚ<span class="blank _0"></span>BICA </div><div class="t m0 x1 hd yb9 ff4 fs5 fc0 sc0 ls4 ws15">Quando <span class="blank _3"> </span>a <span class="blank _3"> </span>bexiga <span class="blank _3"> </span>se <span class="blank _3"> </span>encontra <span class="blank _3"> </span>cheia, <span class="blank _3"> </span>a <span class="blank _6"> </span>pele <span class="blank _3"> </span>da <span class="blank _3"> </span>região </div><div class="t m0 x1 hd yd8 ff4 fs5 fc0 sc0 ls4 ws15">supra-púbica deve <span class="blank _1"> </span>recebe<span class="blank _0"></span>r <span class="blank _1"> </span>desinfecção ci<span class="blank _1"> </span>rúrgi<span class="blank _0"></span>ca <span class="blank _1"> </span>antes </div><div class="t m0 x1 hd yba ff4 fs5 fc0 sc0 ls4 ws15">do procedimento. A urina é então colhida com ser<span class="ls3a">in<span class="blank _1"> </span>ga </span></div><div class="t m0 x1 hd ybb ff4 fs5 fc0 sc0 ls4 ws15">e <span class="blank _1"> </span>agulha <span class="blank _1"> </span>estére<span class="blank _0"></span>is, <span class="blank _1"> </span>e <span class="blank _1"> </span>enviada <span class="blank _1"> </span>ao <span class="blank _1"> </span>L<span class="blank _0"></span>aboratório <span class="blank _1"> </span>na própria </div><div class="t m0 x1 hd ybc ff4 fs5 fc0 sc0 ls4 ws15">seringa. </div><div class="t m0 x9 hd ybd ff4 fs5 fc0 sc0 ls4 ws15">A <span class="blank _3"> </span>punção <span class="blank _6"> </span>supra-púbica <span class="blank _6"> </span>é <span class="blank _3"> </span>p<span class="blank _1"> </span>rimar<span class="blank _0"></span>iamente <span class="blank _3"> </span>usada <span class="blank _6"> </span>em </div><div class="t m0 x1 hd ybe ff4 fs5 fc0 sc0 ls4 ws15">crianças <span class="blank _1"> </span>nas <span class="blank _1"> </span>quais foi <span class="blank _1"> </span>impossível c<span class="blank _1"> </span>olher urina <span class="blank _1"> </span>p<span class="blank _1"> </span>or ou<span class="blank _1"> </span>-</div><div class="t m0 x1 hd ybf ff4 fs5 fc0 sc0 ls4 ws15">tros métodos e doentes, p<span class="blank _1"> </span>rincipalme<span class="blank _0"></span>nte algaliados, em </div><div class="t m0 x1b hd y8b ff4 fs5 fc0 sc0 ls4 ws15">que <span class="blank _3"> </span>a <span class="blank _3"> </span>interpretação<span class="blank _0"></span> <span class="blank _3"> </span>dos <span class="blank _3"> </span>resultados <span class="blank _3"> </span>obtidos <span class="blank _1"> </span>p<span class="blank _1"> </span>or <span class="blank _3"> </span>outr<span class="blank _0"></span>as </div><div class="t m0 x1b hd y8c ff4 fs5 fc0 sc0 ls4 ws15">técnicas é difícil. É também o único método adequado </div><div class="t m0 x1b hd y8d ff4 fs5 fc0 sc0 ls4 ws15">para obter uma c<span class="blank _0"></span>ultura de anae<span class="blank _0"></span>robiose. </div><div class="t m0 x1c hd y8e ff4 fs5 fc0 sc0 ls4 ws15">Este <span class="blank _5"> </span>é <span class="blank _5"> </span>o <span class="blank _6"> </span>m<span class="blank _1"> </span>elhor <span class="blank _5"> </span>mé<span class="blank _0"></span>todo <span class="blank _5"> </span>para <span class="blank _5"> </span>obter <span class="blank _5"> </span>amostras <span class="blank _5"> </span>não </div><div class="t m0 x1b hd y8f ff4 fs5 fc0 sc0 ls7 ws19">con<span class="ls4 ws15">taminadas, embora a algaliação para <span class="blank _1"> </span>punção da al<span class="blank _1"> </span>-</span></div><div class="t m0 x1b hd y90 ff4 fs5 fc0 sc0 ls11 ws15">gália <span class="blank _3"> </span>tamb<span class="ls4">ém <span class="blank _1"> </span>seja <span class="blank _1"> </span>uma <span class="blank _1"> </span>opção <span class="blank _1"> </span>válida. <span class="blank _1"> </span>Apesar <span class="blank _1"> </span>de <span class="blank _1"> </span>tudo, </span></div><div class="t m0 x1b hd y91 ff4 fs5 fc0 sc0 ls4 ws15">a <span class="blank _3"> </span>colonização <span class="blank _3"> </span>transitória <span class="blank _3"> </span>da <span class="blank _3"> </span>bexiga <span class="blank _3"> </span>é <span class="blank _3"> </span>p<span class="blank _1"> </span>ossíve<span class="blank _0"></span>l, <span class="blank _3"> </span>o <span class="blank _3"> </span>q<span class="blank _1"> </span>ue </div><div class="t m0 x1b hd y92 ff4 fs5 fc0 sc0 ls4 ws15">significa <span class="blank _5"> </span>que <span class="blank _6"> </span>n<span class="blank _1"> </span>em <span class="blank _6"> </span>todos <span class="blank _5"> </span>os <span class="blank _5"> </span>organismos <span class="blank _6"> </span>encontrados </div><div class="t m0 x1b hd y93 ff4 fs5 fc0 sc0 ls4 ws15">são necessariame<span class="blank _0"></span>nte clinicame<span class="blank _0"></span>nte significativos. </div><div class="t m0 x1b h2d y162 ffb fsa fc2 sc0 ls4 ws15"> </div><div class="t m0 x1b h11 y163 ffb fs5 fc2 sc0 ls4 ws15">COLHEITA POR<span class="blank _0"></span> DRENAGEM D<span class="blank _0"></span>E </div><div class="t m0 x1b h11 y164 ffb fs5 fc2 sc0 ls4 ws15">NEFROSTOMI<span class="blank _0"></span>A OU URETEROST<span class="blank _0"></span>OMIA </div><div class="t m0 x1b hd yfa ff4 fs5 fc0 sc0 lse ws10">Quand <span class="ls4 ws15">o <span class="blank _6"> </span>há <span class="blank _6"> </span>um <span class="blank _6"> </span>catéter <span class="blank _6"> </span>inserido <span class="blank _3"> </span>através <span class="blank _6"> </span>do <span class="blank _6"> </span>flanco <span class="blank _6"> </span>do </span></div><div class="t m0 x1b hd yfb ff4 fs5 fc0 sc0 ls4 ws15">doente <span class="blank _6"> </span>directamente <span class="blank _6"> </span>na <span class="blank _6"> </span>pelve <span class="blank _6"> </span>renal <span class="blank _5"> </span>ou <span class="blank _6"> </span>no <span class="blank _6"> </span>uretero, <span class="blank _6"> </span>a </div><div class="t m0 x1b hd yfc ff4 fs5 fc0 sc0 ls4 ws15">colheita <span class="blank _3"> </span>é <span class="blank _1"> </span>feita <span class="blank _3"> </span>directame<span class="blank _0"></span>nte <span class="blank _3"> </span>do <span class="blank _1"> </span>catéter <span class="blank _3"> </span>para <span class="blank _1"> </span>um <span class="blank _3"> </span>reci<span class="blank _1"> </span>-</div><div class="t m0 x1b hd yfd ff4 fs5 fc0 sc0 ls4 ws15">piente ester<span class="blank _0"></span>ilizado. </div><div class="t m0 x1b h2e yfe ff4 fsa fc0 sc0 ls4 ws15"> </div><div class="t m0 x1b h11 yff ffb fs5 fc2 sc0 ls4 ws15">COLHEITA EM <span class="blank _0"></span>CRIANÇAS </div><div class="t m0 x1b hd y100 ff4 fs5 fc0 sc0 ls4 ws15">As <span class="blank _1"> </span>crianças <span class="blank _3"> </span>que <span class="blank _1"> </span>usam <span class="blank _3"> </span>fraldas <span class="blank _1"> </span>ainda <span class="blank _3"> </span>não<span class="blank _0"></span> <span class="blank _3"> </span>têm <span class="blank _1"> </span>controlo </div><div class="t m0 x1b hd y101 ff4 fs5 fc0 sc0 ls4 ws15">dos esfíncteres, p<span class="blank _1"> </span>elo<span class="blank _0"></span> <span class="blank _1"> </span>que a <span class="blank _1"> </span>técnica do <span class="blank _1"> </span>jacto médio não </div><div class="t m0 x1b hd y102 ff4 fs5 fc0 sc0 ls4 ws15">pode <span class="blank _5"> </span>ser <span class="blank _5"> </span>usada. <span class="blank _5"> </span>Um <span class="blank _5"> </span>dos <span class="blank _5"> </span>mé<span class="blank _0"></span>todos <span class="blank _5"> </span>pre<span class="blank _0"></span>feridos <span class="blank _5"> </span>é <span class="blank _5"> </span>uma </div><div class="t m0 x1b he y103 ffa fs5 fc0 sc0 ls4 ws15">variante <span class="blank _7"> </span>da <span class="blank _9"> </span>técnica <span class="blank _7"> </span>do <span class="blank _7"> </span>j<span class="blank _1"> </span>acto <span class="blank _7"> </span>médio <span class="blank _7"> </span>(“<span class="ff8 ls7 ws19">clean<span class="ls4 ws3">-<span class="ls8 ws15">catc<span class="blank _1"> </span>h </span></span></span></div><div class="t m0 x1b hd y104 ffe fs5 fc0 sc0 ls4 ws1">sample”<span class="ff4 ws15">), <span class="blank _1"> </span>em <span class="blank _1"> </span>q<span class="blank _1"> </span>ue <span class="blank _1"> </span>a <span class="blank _3"> </span>fr<span class="blank _0"></span>alda <span class="blank _3"> </span>é <span class="blank _1"> </span>removid<span class="blank _0"></span>a <span class="blank _3"> </span>e <span class="blank _1"> </span>se <span class="blank _1"> </span>aguarda <span class="blank _1"> </span>a<span class="blank _1"> </span> </span></div><div class="t m0 x1b hd y105 ff4 fs5 fc0 sc0 ls4 ws15">micção <span class="blank _1"> </span>para <span class="blank _1"> </span>u<span class="blank _1"> </span>m <span class="blank _1"> </span>recipiente <span class="blank _1"> </span>estéril. <span class="blank _1"> </span>Este <span class="blank _1"> </span>método <span class="blank _3"> </span>tem <span class="blank _1"> </span>a </div><div class="t m0 x1b hd y165 ff4 fs5 fc0 sc0 ls4 ws15">desvantagem <span class="blank _6"> </span>d<span class="blank _1"> </span>e <span class="blank _5"> </span>r<span class="blank _0"></span>equerer <span class="blank _5"> </span>a <span class="blank _5"> </span>pre<span class="blank _0"></span>sença <span class="blank _5"> </span>de <span class="blank _5"> </span>pesso<span class="blank _0"></span>al <span class="blank _5"> </span>por </div><div class="t m0 x1b hd y166 ff4 fs5 fc0 sc0 ls4 ws15">tempo <span class="blank _4"> </span>ind<span class="blank _1"> </span>eter<span class="blank _0"></span>minado, <span class="blank _7"> </span>ma<span class="blank _0"></span>s <span class="blank _7"> </span>per<span class="blank _0"></span>mite <span class="blank _4"> </span>obter <span class="blank _7"> </span>amostras </div><div class="t m0 x1b hd y167 ff4 fs5 fc0 sc0 ls4 ws15">relativamente l<span class="blank _0"></span>impas. </div><div class="t m0 x1c hd y168 ff4 fs5 fc0 sc0 ls4 ws15">Outra alternativa é a colheita para um saco colector. </div><div class="t m0 x1b hd y169 ff4 fs5 fc0 sc0 ls4 ws15">Toda a zona <span class="blank _1"> </span>genital deve ser devidamente lavada com </div><div class="t m0 x1b hd y16a ff4 fs5 fc0 sc0 ls4 ws15">água <span class="blank _3"> </span>e <span class="blank _3"> </span>sabão. <span class="blank _3"> </span>De <span class="blank _3"> </span>seg<span class="blank _0"></span>uida <span class="blank _3"> </span>aplica<span class="blank _1"> </span>-se <span class="blank _1"> </span>um <span class="blank _3"> </span>saco <span class="blank _3"> </span>colector </div><div class="t m0 x1b hd y16b ff4 fs5 fc0 sc0 ls4 ws15">estéril, <span class="blank _5"> </span>autocolante, <span class="blank _5"> </span>e vigia-se <span class="blank _5"> </span>a criança <span class="blank _5"> </span>até que <span class="blank _5"> </span>se </div><div class="t m0 x1b hd y16c ff4 fs5 fc0 sc0 ls4 ws15">produza <span class="blank _3"> </span>a <span class="blank _3"> </span>micção. <span class="blank _3"> </span>Se <span class="blank _3"> </span>ao <span class="blank _3"> </span>fim <span class="blank _3"> </span>de <span class="blank _3"> </span>meia <span class="blank _3"> </span>hora <span class="blank _3"> </span>a <span class="blank _3"> </span>c<span class="blank _1"> </span><span class="ls1f">riança </span></div><div class="t m0 x1b hd y16d ff4 fs5 fc0 sc0 ls4 ws15">ainda não urino<span class="blank _0"></span>u o saco deve se<span class="blank _0"></span>r removido e o proce<span class="blank _0"></span>s-</div><div class="t m0 x1b hd y16e ff4 fs5 fc0 sc0 ls4 ws15">so in<span class="blank _1"> </span>iciado de <span class="blank _1"> </span>novo. Colhida <span class="blank _1"> </span>a u<span class="blank _1"> </span>rina, o p<span class="blank _1"> </span>róprio saco <span class="blank _1"> </span>é </div><div class="t m0 x1b hd y16f ff4 fs5 fc0 sc0 ls4 ws15">enviado ao <span class="blank _1"> </span>L<span class="blank _0"></span>aboratório. A probabilidade de <span class="blank _1"> </span>a amostra </div><div class="t m0 x1b hd y170 ff4 fs5 fc0 sc0 ls4 ws15">estar contaminad<span class="blank _0"></span>a é relativamen<span class="blank _0"></span>te elevada. </div><div class="t m0 x1c hd y171 ff4 fs5 fc0 sc0 ls4 ws15">Tal <span class="blank _6"> </span>como <span class="blank _6"> </span>nos <span class="blank _5"> </span>adultos, <span class="blank _6"> </span>pode-se <span class="blank _6"> </span>recorrer <span class="blank _6"> </span>à <span class="blank _5"> </span>colh<span class="ls8">eita<span class="blank _1"> </span> </span></div><div class="t m0 x1b hd y172 ff4 fs5 fc0 sc0 ls4 ws15">por algaliação <span class="blank _1"> </span>ou <span class="blank _1"> </span>punç<span class="blank _0"></span>ão <span class="blank _1"> </span>supra-púbica, especialmente </div><div class="t m0 x1b hd y173 ff4 fs5 fc0 sc0 ls4 ws15">quando é necessário <span class="blank _0"></span>um diagnós<span class="blank _0"></span>tico rápido. </div><div class="t m0 x1c hd y174 ff4 fs5 fc0 sc0 ls4 ws15">Nas <span class="blank _3"> </span>crianças <span class="blank _3"> </span>com <span class="blank _3"> </span>control<span class="blank _0"></span>o <span class="blank _3"> </span>de <span class="blank _3"> </span>esfíncter<span class="blank _0"></span>es <span class="blank _3"> </span>a <span class="blank _3"> </span>técnica </div><div class="t m0 x1b hd y175 ff4 fs5 fc0 sc0 ls4 ws15">do <span class="blank _4"> </span>jacto médio <span class="blank _4"> </span>é<span class="blank _0"></span> <span class="blank _4"> </span>a preferida. <span class="blank _4"> </span>Os métodos são <span class="blank _4"> </span>os </div><div class="t m0 x1b hd y176 ff4 fs5 fc0 sc0 ls4 ws15">mesmos usados nos <span class="blank _0"></span>adultos. </div><div class="t m0 x1b h2e y177 ff4 fsa fc0 sc0 ls4 ws15"> </div><div class="t m0 x1b h11 y178 ffb fs5 fc2 sc0 ls4 ws15">VOLUME DE URIN<span class="blank _0"></span>A </div><div class="t m0 x1b hd y11c ff4 fs5 fc0 sc0 ls4 ws15">O <span class="blank _1"> </span>volume<span class="blank _0"></span> <span class="blank _1"> </span>é <span class="blank _1"> </span>raramente <span class="blank _1"> </span>um <span class="blank _1"> </span>proble<span class="blank _0"></span>ma <span class="blank _1"> </span>para <span class="blank _1"> </span>a <span class="blank _1"> </span>cultura de </div><div class="t m0 x1b hd y11d ff4 fs5 fc0 sc0 ls1f ws15">rotina. <span class="blank _3"> </span><span class="ls4">Na <span class="blank _3"> </span>suspeita <span class="blank _1"> </span>d<span class="blank _1"> </span>e <span class="blank _1"> </span>micobactérias <span class="blank _1"> </span>ou <span class="blank _3"> </span>fungos <span class="blank _3"> </span>o <span class="blank _3"> </span>vo-</span></div><div class="t m0 x1b hd y179 ff4 fs5 fc0 sc0 ls4 ws15">lume mínimo <span class="blank _1"> </span>necessário é <span class="blank _1"> </span>de 2<span class="blank _1"> </span>0 m<span class="blank _1"> </span>L<span class="blank _0"></span> <span class="blank _1"> </span>para <span class="blank _1"> </span>obter<span class="blank _0"></span> <span class="blank _1"> </span>cultu<span class="blank _1"> </span>-</div><div class="t m0 x1b hd y17a ff4 fs5 fc0 sc0 ls4 ws15">ras positivas. Para a <span class="blank _4"> </span>pesq<span class="blank _0"></span>uisa de micobactérias no </div><div class="t m0 x1b hd y17b ff4 fs5 fc0 sc0 ls4 ws15">HSM <span class="blank _3"> </span>reco<span class="blank _0"></span>menda-se <span class="blank _3"> </span>a <span class="blank _1"> </span>colheita <span class="blank _3"> </span>de <span class="blank _1"> </span>u<span class="blank _1"> </span>m <span class="blank _1"> </span>mínimo <span class="blank _3"> </span>de <span class="blank _1"> </span>três </div><div class="t m0 x1b hd y17c ff4 fs5 fc0 sc0 ls4 ws15">amostras de 30-40 mL<span class="blank _0"></span>, colhidas e<span class="blank _0"></span>m dias sucessivos. </div><div class="t m0 x1b h2e y17d ff4 fsa fc0 sc0 ls4 ws15"> </div><div class="t m0 x1b h11 y17e ffb fs5 fc2 sc0 ls4 ws15">NÚMERO DE A<span class="blank _0"></span>MOSTRAS </div><div class="t m0 x1b hd ybc ff4 fs5 fc0 sc0 ls4 ws15">Em <span class="blank _6"> </span>geral, <span class="blank _6"> </span>u<span class="blank _1"> </span>ma <span class="blank _6"> </span>única <span class="blank _6"> </span>amostra <span class="blank _6"> </span>é <span class="blank _5"> </span>suficie<span class="blank _0"></span>nte <span class="blank _6"> </span>para <span class="blank _5"> </span>uma<span class="blank _0"></span> </div><div class="t m0 x1b hd ybd ff4 fs5 fc0 sc0 ls4 ws15">cultura <span class="blank _5"> </span>posi<span class="blank _0"></span>tiva <span class="blank _5"> </span>e <span class="blank _5"> </span>ide<span class="blank _0"></span>ntificação <span class="blank _5"> </span>de <span class="blank _6"> </span>piúria. <span class="lsc wsb">Pre<span class="blank _0"></span>fere<span class="ls4 ws3">-<span class="ls24 ws15">se </span></span></span></div><div class="t m0 x1b hd ybe ff4 fs5 fc0 sc0 ls4 ws15">sempre <span class="blank _1"> </span>a <span class="blank _3"> </span>primeira <span class="blank _3"> </span>urina <span class="blank _3"> </span>da <span class="blank _1"> </span>manhã. <span class="blank _3"> </span>Caso <span class="blank _3"> </span>tal <span class="blank _3"> </span>não <span class="blank _3"> </span>se<span class="blank _0"></span>ja </div><div class="t m0 x1b hd ybf ff4 fs5 fc0 sc0 ls4 ws15">possível, d<span class="blank _1"> </span>ev<span class="blank _0"></span>e-se <span class="blank _1"> </span>aguardar <span class="blank _1"> </span>pelo <span class="blank _1"> </span>menos 3<span class="blank _1"> </span> <span class="blank _1"> </span>horas <span class="blank _1"> </span>após <span class="blank _1"> </span>a </div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf6" class="pf w0 h0" data-page-no="6"><div class="pc pc6 w0 h0"><img fetchpriority="low" loading="lazy" class="bi x15 y17f w1 h35" alt src="https://files.passeidireto.com/e78ed9d7-0969-4804-95c1-3a92effc5fc9/bg6.png" alt="Pré-visualização de imagem de arquivo"><div class="c x16 y4f w5 h13"><div class="t m1 x17 h14 y50 ff2 fs7 fc1 sc0 ls4 ws15">Aula 6 </div></div><div class="c xb y51 w6 h15"><div class="t m0 x18 h16 y52 ff2 fs8 fc1 sc0 ls4 ws15">Infecção Urinária </div></div><div class="t m0 x19 h16 y53 ff2 fs8 fc0 sc0 lsd ws16">168<span class="ls4 ws15"> </span></div><div class="t m0 x1 h2 y54 ff1 fs0 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 hd y8b ff4 fs5 fc0 sc0 ls4 ws15">última <span class="blank _1"> </span>micção <span class="blank _1"> </span>antes <span class="blank _1"> </span>de <span class="blank _1"> </span>fazer <span class="blank _1"> </span>a <span class="blank _1"> </span>c<span class="blank _1"> </span>olhe<span class="blank _0"></span>ita<span class="blank _1"> </span>, <span class="blank _1"> </span>para <span class="blank _1"> </span>permitir </div><div class="t m0 x1 hd y8c ff4 fs5 fc0 sc0 ls4 ws15">a incubação das <span class="blank _4"> </span>b<span class="blank _0"></span>actérias na bexiga e <span class="blank _4"> </span>aumen<span class="blank _0"></span>tar a </div><div class="t m0 x1 hd y8d ff4 fs5 fc0 sc0 ls4 ws15">densidade bacte<span class="blank _0"></span>riana. </div><div class="t m0 x1 h33 y180 ff4 fsc fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h11 y181 ffb fs5 fc2 sc0 ls4 ws15">TRANSPORTE<span class="blank _0"></span> </div><div class="t m0 x1 hd y182 ff4 fs5 fc0 sc0 ls4 ws15">Após <span class="blank _1"> </span>a <span class="blank _3"> </span>colhe<span class="blank _0"></span>ita, <span class="blank _3"> </span>a <span class="blank _1"> </span>u<span class="blank _1"> </span>r<span class="blank _0"></span>ina <span class="blank _3"> </span>dev<span class="blank _0"></span>e <span class="blank _1"> </span>ser <span class="blank _3"> </span>transportada <span class="blank _1"> </span>ao <span class="blank _3"> </span>L<span class="blank _0"></span>a<span class="blank _1"> </span>-</div><div class="t m0 x1 hd y183 ff4 fs5 fc0 sc0 ls6 wsd">borat<span class="ls11 ws1f">ório<span class="ls4 ws15"> <span class="blank _3"> </span>o <span class="blank _6"> </span>mais <span class="blank _6"> </span>rapidame<span class="blank _0"></span>nte <span class="blank _6"> </span>possível<span class="blank _0"></span>, <span class="blank _6"> </span>uma <span class="blank _6"> </span>vez <span class="blank _3"> </span>que </span></span></div><div class="t m0 x1 hd y184 ff4 fs5 fc0 sc0 ls4 ws15">deverá <span class="blank _1"> </span>s<span class="blank _1"> </span>er <span class="blank _1"> </span>semeada <span class="blank _3"> </span>até <span class="blank _3"> </span>uma <span class="blank _3"> </span>hora <span class="blank _1"> </span>após <span class="blank _3"> </span>a <span class="blank _3"> </span>colhe<span class="blank _0"></span>ita. <span class="blank _3"> </span>Se </div><div class="t m0 x1 hd y185 ff4 fs5 fc0 sc0 ls4 ws15">não <span class="blank _3"> </span>for <span class="blank _3"> </span>possível, <span class="blank _3"> </span>deverá <span class="blank _3"> </span>ser <span class="blank _6"> </span>refrigerada <span class="blank _3"> </span>a <span class="blank _3"> </span>4<span class="blank _1"> </span>ºC <span class="blank _3"> </span>e <span class="blank _3"> </span>pro<span class="blank _1"> </span>-</div><div class="t m0 x1 hd y186 ff4 fs5 fc0 sc0 ls4 ws15">cessada <span class="blank _5"> </span>até às <span class="blank _5"> </span>24 <span class="blank _5"> </span>horas a<span class="blank _0"></span>pós <span class="blank _5"> </span>a col<span class="blank _0"></span>heita. Q<span class="blank _0"></span>uando <span class="blank _5"> </span>a </div><div class="t m0 x1 hd y187 ff4 fs5 fc0 sc0 ls4 ws15">refrigeração não <span class="blank _1"> </span>é possível, a <span class="blank _1"> </span>urina deverá ser <span class="blank _1"> </span>colhida </div><div class="t m0 x1 hd y188 ff4 fs5 fc0 sc0 ls6 wsd">par<span class="ls4 ws15">a um recipien<span class="blank _0"></span>te com preserv<span class="blank _0"></span>ante, como o ácido bó-</span></div><div class="t m0 x1 hd y189 ff4 fs5 fc0 sc0 ls4 ws15">rico, <span class="blank _1"> </span>e <span class="blank _1"> </span>colocada <span class="blank _1"> </span>à <span class="blank _3"> </span>tempe<span class="blank _0"></span>ratura <span class="blank _1"> </span>ambiente, <span class="blank _1"> </span>e <span class="blank _1"> </span>poderá <span class="blank _1"> </span>ser </div><div class="t m0 x1 hd y18a ff4 fs5 fc0 sc0 ls4 ws15">processada <span class="blank _6"> </span>até <span class="blank _6"> </span>24 <span class="blank _5"> </span>hor<span class="blank _0"></span>as <span class="blank _5"> </span>a<span class="blank _0"></span>pós <span class="blank _6"> </span>a <span class="blank _5"> </span>colh<span class="blank _0"></span>eita. <span class="blank _5"> </span>N<span class="blank _0"></span>este <span class="blank _6"> </span>caso </div><div class="t m0 x1 hd y18b ff4 fs5 fc0 sc0 ls4 ws15">deve <span class="blank _1"> </span>haver <span class="blank _3"> </span>particular <span class="blank _3"> </span>atenção <span class="blank _1"> </span>à<span class="blank _1"> </span> <span class="blank _3"> </span>raz<span class="blank _0"></span>ão <span class="blank _1"> </span>d<span class="blank _1"> </span>e <span class="blank _1"> </span>volume <span class="blank _3"> </span>uri<span class="blank _1"> </span>-</div><div class="t m0 x1 hd y18c ff4 fs5 fc0 sc0 ls4 ws15">na/preserv<span class="blank _0"></span>ante, <span class="blank _3"> </span>pela <span class="blank _1"> </span>possibilidade <span class="blank _1"> </span>de <span class="blank _1"> </span>falsos <span class="blank _3"> </span>neg<span class="blank _0"></span>a<span class="ls2">tivos </span></div><div class="t m0 x1 hd y15d ff4 fs5 fc0 sc0 ls4 ws15">quando o volume<span class="blank _0"></span> de urina é m<span class="blank _0"></span>uito pequeno. </div><div class="t m0 x9 h36 y18d ff4 fs4 fc0 sc0 ls4 ws15"> </div><div class="t m0 x2b h14 y18e ff2 fs7 fc1 sc0 ls37 ws15">Men<span class="blank _0"></span>s<span class="blank _0"></span>ag<span class="blank _0"></span>en<span class="blank _0"></span>s<span class="blank _0"></span> a<span class="blank _0"></span> R<span class="blank _0"></span>et<span class="blank _0"></span>er<span class="ls4"> </span></div><div class="t m0 x1 h17 y18f ff2 fs6 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h10 y190 ff2 fs5 fc0 sc0 lse ws15">Colheit<span class="blank _1"> </span>a de urina<span class="ls4"> </span></div><div class="t m0 x1 he y191 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">É extremame<span class="blank _0"></span>nte importante ev<span class="blank _0"></span>itar a contaminaç<span class="blank _0"></span>ão </span></span></div><div class="t m0 x9 hd y192 ff4 fs5 fc0 sc0 ls4 ws15">com a flora come<span class="blank _0"></span>nsal das reg<span class="blank _0"></span>iões adjacentes, <span class="blank _0"></span>por </div><div class="t m0 x9 hd y193 ff4 fs5 fc0 sc0 ls4 ws15">isso a técnica re<span class="blank _0"></span>quer cuidado ta<span class="blank _0"></span>nto na técnica<span class="blank _0"></span> de </div><div class="t m0 x9 hd y194 ff4 fs5 fc0 sc0 ls4 ws15">colheita como n<span class="blank _0"></span>a assépsia dessas re<span class="blank _0"></span>giões. </div><div class="t m0 x1 he y195 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">A técnica do ja<span class="blank _0"></span>cto médio é a mais<span class="blank _0"></span> utilizada. </span></span></div><div class="t m0 x9 hd y196 ff4 fs5 fc0 sc0 ls4 ws15">Desperdiça-se uma <span class="blank _0"></span>porção inicial <span class="blank _0"></span>de <span class="ls11">urin<span class="blank _1"> </span>a para </span></div><div class="t m0 x9 hd y197 ff4 fs5 fc0 sc0 ls8 ws15">evit<span class="blank _1"> </span>ar c<span class="blank _1"> </span>ontami<span class="blank _1"> </span>nação <span class="blank _1"> </span>e ap<span class="blank _1"> </span>roveit<span class="blank _1"> </span>a<span class="ls4">-se o vol<span class="blank _0"></span>ume </span></div><div class="t m0 x9 hd y198 ff4 fs5 fc0 sc0 ls4 ws15">suficiente para o<span class="blank _0"></span> exame, desperd<span class="blank _0"></span>içando-se o resto. </div><div class="t m0 x1 he y199 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">A punção de al<span class="blank _0"></span>gália é uma técnic<span class="blank _0"></span>a eficaz par<span class="ls7">a obte<span class="blank _0"></span>r </span></span></span></div><div class="t m0 x9 hd y19a ff4 fs5 fc0 sc0 ls4 ws15">amostras menos con<span class="blank _0"></span>taminadas em <span class="blank _0"></span>doentes não </div><div class="t m0 x9 hd y19b ff4 fs5 fc0 sc0 ls4 ws15">previamente alg<span class="blank _0"></span>aliados, mas tam<span class="blank _0"></span>bém pode ser<span class="blank _0"></span> </div><div class="t m0 x9 hd y19c ff4 fs5 fc0 sc0 ls4 ws15">usada em doentes al<span class="blank _0"></span>galiados. </div><div class="t m0 x1 he y19d ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls15">A p<span class="blank _1"> </span>un<span class="blank _1"> </span>çã<span class="blank _1"> </span>o <span class="blank _1"> </span>sup<span class="blank _1"> </span>ra<span class="blank _1"> </span><span class="ls4">-púbica é a <span class="blank _0"></span>melhor técnica <span class="blank _0"></span>para </span></span></span></div><div class="t m0 x9 hd y19e ff4 fs5 fc0 sc0 ls4 ws15">obter amostras n<span class="blank _0"></span>ão contaminadas<span class="blank _0"></span>. É <span class="ls11">uti<span class="blank _1"> </span>lizada </span></div><div class="t m0 x9 hd y19f ff4 fs5 fc0 sc0 ls4 ws15">principalme<span class="blank _0"></span>nte em casos em que é <span class="blank _0"></span>difícil <span class="ls7">colhe<span class="blank _0"></span>r </span></div><div class="t m0 x9 hd y1a0 ff4 fs5 fc0 sc0 ls4 ws15">amostras estére<span class="blank _0"></span>is por outras téc<span class="blank _0"></span>nicas. </div><div class="t m0 x1 he y1a1 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">Em crianças se<span class="blank _0"></span>m controlo de e<span class="blank _0"></span>sfíncteres pode se<span class="blank _0"></span>r </span></span></div><div class="t m0 x9 hd y1a2 ff4 fs5 fc0 sc0 ls4 ws15">usado um saco col<span class="blank _0"></span>ector, aplicado <span class="blank _0"></span>à volta da região </div><div class="t m0 x9 hd y1a3 ff4 fs5 fc0 sc0 ls4 ws15">genital devidamen<span class="blank _0"></span>te desinfectada<span class="blank _0"></span>, mas nesta téc<span class="blank _0"></span>nica </div><div class="t m0 x9 hd y1a4 ff4 fs5 fc0 sc0 ls4 ws15">é frequente a <span class="blank _0"></span>contaminação da<span class="blank _0"></span> amostra. Esperar </div><div class="t m0 x9 hd y1a5 ff4 fs5 fc0 sc0 ls4 ws15">uma micção espont<span class="blank _0"></span>ânea para um reci<span class="blank _0"></span>piente estéril<span class="blank _0"></span> é </div><div class="t m0 x9 hd y1a6 ff4 fs5 fc0 sc0 ls4 ws15">uma alternativa<span class="blank _0"></span> mais limpa. </div><div class="t m0 x1 he y1a7 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">Em doentes com <span class="blank _0"></span>nefrostomia ou ure<span class="blank _0"></span>terostomia a </span></span></div><div class="t m0 x9 hd y1a8 ff4 fs5 fc0 sc0 ls4 ws15">urina pode ser col<span class="blank _0"></span>hida directame<span class="blank _0"></span>nte <span class="ls11">do <span class="blank _1"> </span>catéter.</span> </div><div class="t m0 x1 he y1a9 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">O volume<span class="blank _0"></span> de urina colhida é rar<span class="blank _0"></span>amente um </span></span></div><div class="t m0 x9 hd y1aa ff4 fs5 fc0 sc0 ls4 ws15">problema para <span class="blank _0"></span>a cultura de ro<span class="blank _0"></span>tina. </div><div class="t m0 x1 he y1ab ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">Uma amostra é g<span class="blank _0"></span>eralmente suficiente. </span></span></div><div class="t m0 x1 he y1ac ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">Em geral é<span class="blank _0"></span> preferida a primeira<span class="blank _0"></span> urina da ma<span class="blank _0"></span>nhã, </span></span></div><div class="t m0 x9 hd y1ad ff4 fs5 fc0 sc0 ls4 ws15">mas pode-se col<span class="blank _0"></span>her noutra altura <span class="blank _0"></span>depois de e<span class="blank _0"></span>sperar </div><div class="t m0 x9 hd y1ae ff4 fs5 fc0 sc0 ls4 ws15">pelo meno<span class="blank _0"></span>s 3 horas desde a úl<span class="blank _0"></span>tima micção. </div><div class="t m0 x1 he y1af ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">O transporte ao L<span class="blank _0"></span>aboratório de<span class="blank _0"></span>ve ser o mais rápido </span></span></div><div class="t m0 x9 hd y1b0 ff4 fs5 fc0 sc0 ls4 ws15">possível. Se<span class="blank _0"></span> isso não for possíve<span class="blank _0"></span>l a urina deve ser </div><div class="t m0 x9 hd y1b1 ff4 fs5 fc0 sc0 ls4 ws15">refrigerada ou col<span class="blank _0"></span>ocada num re<span class="blank _0"></span>cipiente com um </div><div class="t m0 x9 hd y1b2 ff4 fs5 fc0 sc0 ls4 ws15">preserv<span class="blank _0"></span>ante. </div><div class="t m0 x1b h14 y1b3 ff2 fs7 fc2 sc0 ls1e ws15">Diagnóstico Etiológico<span class="blank _1"> </span><span class="ls3b"> <span class="ls3d">de <span class="blank _1"> </span>Infec<span class="blank _1"> </span>ção </span></span></div><div class="t m0 x1b h14 y1b4 ff2 fs7 fc2 sc0 ls1e ws32">Urinária <span class="ls4 ws15"> </span></div><div class="t m0 x1b hc y1b5 ff4 fs6 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1b hd y1b6 ff4 fs5 fc0 sc0 ls4 ws15">A <span class="blank _1"> </span>valorização <span class="blank _1"> </span>dos <span class="blank _1"> </span>resultados <span class="blank _1"> </span>do <span class="blank _1"> </span>exame <span class="blank _1"> </span>microbiológi-</div><div class="t m0 x1b hd y1b7 ff4 fs5 fc0 sc0 ls4 ws15">co <span class="blank _4"> </span>da <span class="blank _4"> </span>urina <span class="blank _4"> </span>nem <span class="blank _4"> </span>sempre <span class="blank _4"> </span>é <span class="blank _4"> </span>fácil. <span class="blank _4"> </span>Classic<span class="blank _0"></span>amente <span class="blank _4"> </span><span class="ls29">a </span></div><div class="t m0 x1b hd y1b8 ff4 fs5 fc0 sc0 ls7 ws19">con<span class="ls4 ws15">tagem <span class="blank _6"> </span>de <span class="blank _6"> </span>colónias <span class="blank _5"> </span>fo<span class="blank _0"></span>i <span class="blank _6"> </span>utilizada <span class="blank _5"> </span>p<span class="blank _0"></span>ara <span class="blank _5"> </span>def<span class="blank _0"></span>inir <span class="blank _6"> </span>se <span class="blank _5"> </span>o </span></div><div class="t m0 x1b hd y1b9 ff4 fs5 fc0 sc0 ls4 ws15">doente tem <span class="blank _1"> </span>uma ITU tratável <span class="blank _1"> </span>ou não, <span class="blank _1"> </span>mas esta <span class="blank _1"> </span>quanti-</div><div class="t m0 x1b hd y1ba ff4 fs5 fc0 sc0 ls4 ws15">ficação <span class="blank _1"> </span>não p<span class="blank _1"> </span>o<span class="blank _0"></span>de <span class="blank _1"> </span>ser <span class="blank _1"> </span>usada <span class="blank _1"> </span>como único <span class="blank _1"> </span>meio <span class="blank _1"> </span>de <span class="blank _1"> </span>deci-</div><div class="t m0 x1b hd y1bb ff4 fs5 fc0 sc0 ls4 ws15">são; <span class="blank _3"> </span>o <span class="blank _1"> </span>resultado <span class="blank _3"> </span>deve<span class="blank _0"></span> <span class="blank _3"> </span>ser <span class="blank _1"> </span>in<span class="blank _1"> </span>terpre<span class="blank _0"></span>tado <span class="blank _3"> </span>de <span class="blank _1"> </span>ac<span class="blank _1"> </span>ordo <span class="blank _1"> </span>com </div><div class="t m0 x1b hd y1bc ff4 fs5 fc0 sc0 ls4 ws15">o ti<span class="blank _1"> </span>po de <span class="blank _1"> </span>doente. Muitas vezes nem <span class="blank _1"> </span>sequer há <span class="blank _1"> </span>queixas </div><div class="t m0 x1b hd y1bd ff4 fs5 fc0 sc0 ls4 ws15">urinárias, a <span class="blank _1"> </span>urocultura sendo pedida <span class="blank _1"> </span>por exemplo para </div><div class="t m0 x1b hd y1be ff4 fs5 fc0 sc0 ls4 ws15">despistar <span class="blank _4"> </span>bacteriúria <span class="blank _4"> </span>assintomátic<span class="blank _0"></span>a <span class="blank _4"> </span>em <span class="blank _7"> </span>grávidas <span class="blank _4"> </span>ou </div><div class="t m0 x1b hd y1bf ff4 fs5 fc0 sc0 ls4 ws15">para verificar se a<span class="blank _0"></span> doente está cura<span class="blank _0"></span>da <span class="ls6">da I<span class="blank _0"></span>TU.<span class="ls4"> </span></span></div><div class="t m0 x1c hd y1c0 ff4 fs5 fc0 sc0 ls4 ws15">A <span class="blank _3"> </span>urocultura <span class="blank _3"> </span>prévia <span class="blank _3"> </span>ao <span class="blank _3"> </span>tratamento <span class="blank _3"> </span>da <span class="blank _3"> </span>infecção <span class="blank _3"> </span>uri-</div><div class="t m0 x1b hd y1c1 ff4 fs5 fc0 sc0 ls4 ws15">nária está recomendada nas grávi<span class="blank _0"></span>das, nas crianças, </div><div class="t m0 x1b hd y1c2 ff4 fs5 fc0 sc0 ls4 ws15">nos homens, na <span class="blank _1"> </span>pielonefr<span class="blank _0"></span>ite e <span class="blank _1"> </span>nas inf<span class="blank _1"> </span>ecções complica-</div><div class="t m0 x1b hd y1c3 ff4 fs5 fc0 sc0 ls4 ws15">das o<span class="blank _0"></span>u re<span class="blank _0"></span>cidivantes <span class="blank _5"> </span>na mulhe<span class="blank _0"></span>r adul<span class="blank _0"></span>ta. Numa<span class="blank _0"></span> cisti<span class="blank _0"></span>te </div><div class="t m0 x1b hd y1c4 ff4 fs5 fc0 sc0 ls6 wsd">não<span class="ls4 ws15">-compli<span class="blank _0"></span>cada, como <span class="blank _5"> </span>a larga ma<span class="blank _0"></span>ioria dos <span class="blank _5"> </span>casos é </span></div><div class="t m0 x1b hd y1c5 ff4 fs5 fc0 sc0 ls4 ws15">causada <span class="blank _1"> </span>p<span class="blank _1"> </span>or <span class="blank _1"> </span><span class="ff8 lsf">E.<span class="blank _1"> </span> <span class="blank _3"> </span>coli<span class="blank _1"> </span></span> <span class="blank _3"> </span>e <span class="blank _1"> </span>tratável <span class="blank _1"> </span>c<span class="blank _1"> </span>om <span class="blank _1"> </span>antibioterapia <span class="blank _3"> </span>em-</div><div class="t m0 x1b hd y1c6 ff4 fs5 fc0 sc0 ls4 ws15">pírica, <span class="blank _1"> </span>em <span class="blank _3"> </span>ge<span class="blank _0"></span>ral <span class="blank _1"> </span>nã<span class="blank _1"> </span>o <span class="blank _1"> </span>é <span class="blank _1"> </span>n<span class="blank _1"> </span>ece<span class="blank _0"></span>ssária <span class="blank _1"> </span>a <span class="blank _3"> </span>realização <span class="blank _1"> </span>de <span class="blank _3"> </span><span class="ls6 wsd">uro</span>-</div><div class="t m0 x1b hd y1c7 ff4 fs5 fc0 sc0 ls7 ws15">cultura.<span class="blank _0"></span> <span class="blank _3"> </span><span class="ls4">Os <span class="blank _3"> </span>doentes <span class="blank _3"> </span>com <span class="blank _3"> </span>alg<span class="blank _0"></span>aliação <span class="blank _3"> </span>de<span class="blank _0"></span> <span class="blank _3"> </span>longa <span class="blank _3"> </span>duração </span></div><div class="t m0 x1b hd y1c8 ff4 fs5 fc0 sc0 ls4 ws15">apresentam quase <span class="blank _1"> </span>invari<span class="blank _0"></span>avelme<span class="blank _0"></span>nte <span class="blank _1"> </span>bacteriúria assinto-</div><div class="t m0 x1b hd y1c9 ff4 fs5 fc0 sc0 ls4 ws15">mática, <span class="blank _3"> </span>pel<span class="blank _0"></span>o <span class="blank _3"> </span>que <span class="blank _3"> </span>a <span class="blank _3"> </span>urocultura <span class="blank _1"> </span>por <span class="blank _3"> </span>rotina <span class="blank _3"> </span>também <span class="blank _3"> </span>não<span class="blank _0"></span> </div><div class="t m0 x1b hd y1ca ff4 fs5 fc0 sc0 ls4 ws15">está recome<span class="blank _0"></span>ndada. </div><div class="t m0 x1b h36 y1cb ff4 fs4 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1b h11 y1cc ffb fs5 fc2 sc0 ls4 ws15">ANÁLISE SU<span class="blank _0"></span>MÁRIA DA URINA </div><div class="t m0 x1b hd y1cd ff4 fs5 fc0 sc0 ls4 ws15">A <span class="blank _3"> </span>análise <span class="blank _3"> </span>sumária <span class="blank _3"> </span>da <span class="blank _3"> </span>urina, <span class="blank _3"> </span>um <span class="blank _3"> </span>teste <span class="blank _1"> </span>frequentemente<span class="blank _1"> </span> </div><div class="t m0 x1b hd y1ce ff4 fs5 fc0 sc0 ls4 ws15">chamado <span class="blank _1"> </span>Urina <span class="blank _1"> </span>II<span class="blank _0"></span>, <span class="blank _1"> </span>permite avaliar <span class="blank _1"> </span>ra<span class="blank _1"> </span>pidamente<span class="blank _0"></span> <span class="blank _1"> </span>vários </div><div class="t m0 x1b hd y1cf ff4 fs5 fc0 sc0 ls4 ws15">parâmetros na u<span class="blank _1"> </span>rina. No <span class="blank _1"> </span>contex<span class="blank _0"></span>to <span class="blank _1"> </span>da infecção <span class="blank _1"> </span>urinár<span class="blank _0"></span>ia </div><div class="t m0 x1b hd y1d0 ff4 fs5 fc0 sc0 ls9 ws15">é <span class="blank _3"> </span><span class="ls1f">relevante <span class="blank _3"> </span><span class="ls4">o <span class="blank _1"> </span>t<span class="blank _1"> </span>este<span class="blank _0"></span> <span class="blank _3"> </span>de <span class="blank _1"> </span>tiras <span class="blank _3"> </span><span class="ff2 fc2 ls1f">(Fig. <span class="blank _1"> </span>6<span class="ls4 ws3">-<span class="lsd ws7">2)</span></span></span> <span class="blank _1"> </span>que <span class="blank _3"> </span>permite <span class="blank _1"> </span>de-</span></span></div><div class="t m0 x1b hd y1d1 ff4 fs5 fc0 sc0 ls2 ws2">tectar<span class="ls3c ws15"> <span class="ff2 lsc ws23">nit<span class="blank _0"></span>ritos<span class="ff4 ls4 ws15"> (as Enterobacter<span class="ls7 ws19">al<span class="blank _0"></span>e<span class="ls4 ws15">s, mas n<span class="blank _0"></span>ão todas, </span></span></span></span></span></div><div class="t m0 x1b hd y1d2 ff4 fs5 fc0 sc0 ls4 ws15">convertem nitratos em nitritos<span class="ls2">; <span class="blank _1"> </span>é </span>nece<span class="blank _0"></span>ssária incubação </div><div class="t m0 x1b hd y1d3 ff4 fs5 fc0 sc0 ls4 ws15">na <span class="blank _3"> </span>bexiga <span class="blank _3"> </span>dur<span class="blank _0"></span>ante <span class="blank _3"> </span>4 <span class="blank _3"> </span>horas <span class="blank _3"> </span>para <span class="blank _1"> </span>que <span class="blank _3"> </span>esta <span class="blank _3"> </span>reacção <span class="blank _3"> </span>seja </div><div class="t m0 x1b hd y1d4 ff4 fs5 fc0 sc0 ls6 wsd">dete<span class="blank _0"></span>ctáve<span class="blank _0"></span>l<span class="ls4 ws15">) <span class="blank _1"> </span><span class="ls9">e <span class="blank _3"> </span></span><span class="ff2">esterase leucocitária</span> <span class="blank _3"> </span>(<span class="blank _0"></span>detecta <span class="blank _1"> </span>esta <span class="blank _1"> </span>enzi-</span></div><div class="t m0 x1b hd y1d5 ff4 fs5 fc0 sc0 ls4 ws15">ma <span class="blank _1"> </span>em <span class="blank _1"> </span>leucócitos intactos <span class="blank _1"> </span>ou <span class="blank _1"> </span>lisados, <span class="blank _1"> </span>dando <span class="blank _1"> </span>uma <span class="blank _1"> </span>me-</div><div class="t m0 x1b hd y1d6 ff4 fs5 fc0 sc0 ls6 ws15">dida <span class="blank _5"> </span>da pi<span class="blank _0"></span>úria)<span class="blank _0"></span> e<span class="ls4"> me<span class="blank _0"></span>dir o <span class="ff2 ls3e ws33">pH</span> (as Enterobacteral<span class="blank _0"></span>e<span class="ls3f">s </span></span></div><div class="t m0 x1b hd y1d7 ff4 fs5 fc0 sc0 ls4 ws15">produtoras de urease, como <span class="ff8 ws3">Proteus</span> <span class="blank _1"> </span>spp., aumentam<span class="blank _0"></span> o </div><div class="t m0 x1b hd y1d8 ff4 fs5 fc0 sc0 ls6 ws15">pH <span class="blank _3"> </span>da <span class="blank _3"> </span>urina).<span class="ls4"> <span class="blank _6"> </span>O <span class="blank _3"> </span>teste <span class="blank _6"> </span>de <span class="blank _6"> </span>tiras <span class="blank _3"> </span>p<span class="blank _1"> </span>ermite<span class="blank _0"></span> <span class="blank _6"> </span>avaliar <span class="blank _6"> </span>vários </span></div><div class="t m0 x1b hd y1d9 ff4 fs5 fc0 sc0 ls4 ws15">outros <span class="blank _4"> </span>parâme<span class="blank _0"></span>tros <span class="blank _4"> </span>químicos, que <span class="blank _4"> </span>não <span class="blank _4"> </span>são úteis <span class="blank _4"> </span>na </div><div class="t m0 x1b hd y1da ff4 fs5 fc0 sc0 ls4 ws15">pesquisa de I<span class="blank _0"></span>TU. </div><div class="t m0 x1c hd y1db ff4 fs5 fc0 sc0 ls4 ws15">A <span class="blank _1"> </span>análise <span class="blank _1"> </span>sumária <span class="blank _3"> </span>da <span class="blank _1"> </span>urina <span class="blank _1"> </span>inclui <span class="blank _1"> </span>ainda <span class="blank _3"> </span><span class="ls7">a <span class="blank _1"> </span>avalia<span class="blank _0"></span>ção </span></div><div class="t m0 x1b hd y1dc ff4 fs5 fc0 sc0 ls4 ws15">das suas <span class="blank _4"> </span>propried<span class="blank _0"></span>ades <span class="blank _4"> </span>fís<span class="blank _0"></span>icas <span class="blank _4"> </span>e<span class="blank _0"></span> <span class="blank _4"> </span>micro<span class="blank _0"></span>scópicas. Em </div><div class="t m0 x1b hd y1dd ff4 fs5 fc0 sc0 ls4 ws15">geral <span class="blank _1"> </span>p<span class="blank _1"> </span>erante <span class="blank _3"> </span>uma <span class="blank _3"> </span>tir<span class="blank _0"></span>a <span class="blank _3"> </span>de <span class="blank _3"> </span>teste <span class="blank _3"> </span>normal <span class="blank _3"> </span>a <span class="blank _3"> </span>micro<span class="blank _0"></span>scopia </div><div class="t m0 x1b hd y1de ff4 fs5 fc0 sc0 ls4 ws15">não <span class="blank _5"> </span>é <span class="blank _5"> </span>real<span class="blank _0"></span>izada, <span class="blank _5"> </span>a <span class="blank _5"> </span>me<span class="blank _0"></span>nos <span class="blank _5"> </span>que <span class="blank _6"> </span>o q<span class="blank _0"></span>uadro <span class="blank _5"> </span>clínico<span class="blank _0"></span> <span class="blank _5"> </span>seja </div><div class="t m0 x1b hd y1df ff4 fs5 fc0 sc0 ls4 ws15">muito <span class="blank _1"> </span>sugestivo. <span class="blank _1"> </span>Ao <span class="blank _1"> </span>mic<span class="blank _1"> </span>roscó<span class="blank _0"></span>pio <span class="blank _1"> </span>é <span class="blank _3"> </span>observ<span class="blank _0"></span>ado <span class="blank _3"> </span>um <span class="blank _1"> </span>se-</div><div class="t m0 x1b hd y1e0 ff4 fs5 fc0 sc0 ls4 ws15">dimento <span class="blank _3"> </span>urinário <span class="blank _3"> </span>não <span class="blank _6"> </span>corado, <span class="blank _3"> </span>à <span class="blank _6"> </span>procura <span class="blank _3"> </span>d<span class="blank _1"> </span>e <span class="blank _3"> </span>bactérias, </div><div class="t m0 x1b hd y1e1 ff4 fs5 fc0 sc0 ls4 ws15">células, cilindro<span class="blank _0"></span>s, cristais, entre o<span class="blank _0"></span>utros. </div><div class="t m0 x1c h36 y1e2 ff4 fs4 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1b h11 y1e3 ffb fs5 fc2 sc0 ls4 ws15">EXAME DIRECTO<span class="blank _0"></span> </div><div class="t m0 x1b hd y1e4 ff4 fs5 fc0 sc0 ls4 ws15">A <span class="blank _3"> </span>coloração <span class="blank _3"> </span>de <span class="blank _3"> </span>G<span class="blank _0"></span>ram <span class="blank _3"> </span>é <span class="blank _3"> </span>feita <span class="blank _1"> </span>p<span class="blank _1"> </span>or <span class="blank _3"> </span>ro<span class="blank _0"></span>tina <span class="blank _3"> </span>nas <span class="blank _3"> </span>amostras<span class="blank _0"></span> </div><div class="t m0 x1b he y1e5 ffa fs5 fc0 sc0 ls4 ws15">de <span class="blank _5"> </span>urina. <span class="blank _5"> </span>Para <span class="blank _5"> </span>isso <span class="blank _5"> </span>são <span class="blank _5"> </span>usa<span class="blank _0"></span>dos <span class="blank _5"> </span>10 <span class="blank _5"> </span>μL <span class="blank _5"> </span>de <span class="blank _5"> </span>urina <span class="blank _5"> </span>não </div><div class="t m0 x1b hd y1af ff4 fs5 fc0 sc0 ls4 ws15">centrifugada <span class="blank _4"> </span>e b<span class="blank _1"> </span>em <span class="blank _4"> </span>homog<span class="blank _0"></span>eneizada. <span class="blank _4"> </span>O <span class="blank _4"> </span>núme<span class="blank _0"></span>ro <span class="blank _4"> </span>de </div><div class="t m0 x1b hd y1b0 ff4 fs5 fc0 sc0 ls4 ws15">organismos <span class="blank _4"> </span>por <span class="blank _4"> </span>campo, <span class="blank _4"> </span>com <span class="blank _4"> </span>objectiv<span class="blank _0"></span>a <span class="blank _4"> </span>de <span class="blank _4"> </span>imersão </div><div class="t m0 x1b hd y1b1 ff4 fs5 fc0 sc0 ls4 ws15">(100x), é determinado: a <span class="blank _1"> </span>presença de pelo menos u<span class="blank _1"> </span>ma </div><div class="t m0 x1b hd y1b2 ff4 fs5 fc0 sc0 ls6 ws15">bacté<span class="blank _0"></span>ria <span class="blank _3"> </span>por <span class="blank _6"> </span>cam<span class="blank _0"></span>po <span class="blank _6"> </span>cons<span class="blank _0"></span>ide<span class="blank _0"></span>ra<span class="ls4">-se <span class="blank _6"> </span>correlacionada <span class="blank _6"> </span>com</span></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf7" class="pf w0 h0" data-page-no="7"><div class="pc pc7 w0 h0"><img fetchpriority="low" loading="lazy" class="bi x0 yf0 w7 h2c" alt src="https://files.passeidireto.com/e78ed9d7-0969-4804-95c1-3a92effc5fc9/bg7.png" alt="Pré-visualização de imagem de arquivo"><div class="c x1d yc1 w8 h1b"><div class="t m2 x1e h1c yc2 ff2 fs7 fc1 sc0 ls4 ws15">Aula 6<span class="ff4"> </span></div></div><div class="c x0 yc3 w9 h15"><div class="t m0 x1f h19 yc4 ff2 fs8 fc1 sc0 ls4 ws15">Infecção Urinária<span class="ff4"> </span></div></div><div class="t m0 x20 h2 y53 ff1 fs0 fc0 sc0 ls2a ws15"> <span class="ff2 fs8 lsd ws16">169</span><span class="ls4"> <span class="blank _8"> </span> </span></div><div class="t m0 x1 h2 y54 ff1 fs0 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h37 y1e6 ff4 fs5 fc0 sc0 ls4 ws15">uma <span class="blank _a"> </span>concentração <span class="blank _b"> </span>de <span class="blank _b"> </span>bactérias <span class="blank _b"> </span>su<span class="blank _1"> </span>perior<span class="blank _0"></span> <span class="blank _a"> </span>a <span class="blank _b"> </span>1<span class="blank _1"> </span>0<span class="fsb v1">5</span></div><div class="t m0 x2e hd y1e6 ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 hd y1e7 ff4 fs5 fc0 sc0 ls13 wsf">CFU<span class="blank _0"></span>/mL<span class="ls4 ws15"> (unidades formadoras de colónia, <span class="ff8 ls8 ws30">co l o ny <span class="ls4 ws3">-<span class="ls7 ws15"> </span></span></span></span></div><div class="t m0 x1 hd y1e8 ff8 fs5 fc0 sc0 ls4 ws15">-forming units<span class="ff4">). </span></div><div class="t m0 x9 hd y1e9 ff4 fs5 fc0 sc0 ls4 ws15">Além da observação da <span class="blank _4"> </span>ur<span class="blank _0"></span>ina corada, é <span class="blank _4"> </span>també<span class="blank _0"></span>m </div><div class="t m0 x1 hd y1ea ff4 fs5 fc0 sc0 ls4 ws15">feito <span class="blank _3"> </span>um <span class="blank _3"> </span>sedimento <span class="blank _1"> </span>urinário <span class="blank _3"> </span>por <span class="blank _3"> </span>centrifugaç<span class="blank _0"></span>ão, <span class="blank _3"> </span>que <span class="blank _3"> </span>é </div><div class="t m0 x1 hd y1eb ff4 fs5 fc0 sc0 ls4 ws15">observado <span class="blank _3"> </span>sem <span class="blank _3"> </span>cor<span class="blank _0"></span>ar <span class="blank _3"> </span><span class="ff2 fc2 ls1f">(Fig. <span class="blank _3"> </span>6<span class="blank _1"> </span><span class="ls4 ws3">-3)</span></span> <span class="blank _1"> </span>para <span class="blank _3"> </span>pesquisar <span class="blank _3"> </span>a <span class="blank _3"> </span>pre-</div><div class="t m0 x1 hd y1ec ff4 fs5 fc0 sc0 ls4 ws15">sença de <span class="blank _1"> </span>células epiteliais, <span class="blank _1"> </span>leucócitos,<span class="blank _0"></span> <span class="blank _1"> </span>eritró<span class="blank _0"></span>citos, <span class="blank _1"> </span>fun-</div><div class="t m0 x1 hd y1ed ff4 fs5 fc0 sc0 ls4 ws15">gos <span class="blank _1"> </span>e pa<span class="blank _1"> </span>rasitas. Cada <span class="blank _1"> </span>leucócito visto <span class="blank _1"> </span>por <span class="blank _1"> </span>campo <span class="blank _1"> </span>(40x) </div><div class="t m0 x1 hd y1ee ff4 fs5 fc0 sc0 ls4 ws15">corresponde <span class="blank _5"> </span>a cerca <span class="blank _5"> </span>de 5-10 l<span class="blank _0"></span>eucócitos <span class="blank _5"> </span>por mL<span class="blank _0"></span> <span class="blank _5"> </span>de </div><div class="t m0 x1 hd y1ef ff4 fs5 fc0 sc0 ls6 ws15">urina.<span class="blank _0"></span> <span class="blank _3"> </span>Cinco <span class="blank _3"> </span>a <span class="blank _3"> </span><span class="ls4">10 <span class="blank _3"> </span>leucócitos <span class="blank _6"> </span>por <span class="blank _3"> </span>campo <span class="blank _3"> </span>são <span class="blank _6"> </span>o <span class="blank _3"> </span>limite </span></div><div class="t m0 x1 hd y1f0 ff4 fs5 fc0 sc0 ls4 ws15">superior do normal<span class="blank _0"></span>. </div><div class="t m0 x9 hd y1f1 ff4 fs5 fc0 sc0 lsc ws15">Se a<span class="blank _1"> </span> u<span class="blank _1"> </span>rina não <span class="blank _1"> </span>centrifu<span class="blank _1"> </span>gada for <span class="blank _1"> </span>negativa <span class="blank _1"> </span>para <span class="blank _1"> </span>bacté<span class="blank _1"> </span><span class="ls4">-</span></div><div class="t m0 x1 hd y1f2 ff4 fs5 fc0 sc0 ls4 ws15">rias <span class="blank _1"> </span>deve-se <span class="blank _1"> </span>corar <span class="blank _1"> </span>o <span class="blank _1"> </span>s<span class="blank _1"> </span>edimento. <span class="blank _1"> </span>Se <span class="blank _1"> </span>desta <span class="blank _1"> </span>forma <span class="blank _1"> </span>forem </div><div class="t m0 x1b h37 y8b ff4 fs5 fc0 sc0 ls4 ws15">observadas <span class="blank _6"> </span>bactérias <span class="blank _3"> </span>a <span class="blank _5"> </span>concentraç<span class="blank _0"></span>ão <span class="blank _3"> </span>é <span class="blank _5"> </span>infe<span class="blank _0"></span>rior <span class="blank _6"> </span>a <span class="blank _5"> </span>10<span class="fsb ws34 v1">5</span> </div><div class="t m0 x1b hd y8c ff4 fs5 fc0 sc0 ls4 ws15">CFU/mL<span class="blank _0"></span>. <span class="blank _1"> </span>Este ach<span class="blank _1"> </span>ado não <span class="blank _1"> </span>si<span class="ls11">gnifi<span class="blank _1"> </span>ca <span class="blank _1"> </span>que <span class="blank _1"> </span>não <span class="blank _1"> </span>há<span class="blank _1"> </span> in<span class="blank _1"> </span>fec</span>- </div><div class="t m0 x1b hd y8d ff4 fs5 fc0 sc0 ls4 ws15">ção. <span class="blank _1"> </span>Por <span class="blank _1"> </span>exempl<span class="blank _0"></span>o, <span class="blank _1"> </span>no <span class="blank _1"> </span>caso <span class="blank _1"> </span>de <span class="blank _1"> </span>obstrução <span class="blank _1"> </span>do <span class="blank _1"> </span>tracto <span class="blank _1"> </span>uri-</div><div class="t m0 x1b hd y8e ff4 fs5 fc0 sc0 ls6 ws15">nário <span class="blank _6"> </span>a <span class="blank _6"> </span>jusante <span class="blank _6"> </span>da <span class="blank _6"> </span>infecção<span class="blank _0"></span>, <span class="blank _5"> </span>a <span class="blank _6"> </span>conce<span class="blank _0"></span>ntra<span class="blank _0"></span>ção <span class="blank _6"> </span>de <span class="blank _5"> </span>b<span class="blank _0"></span>ac<span class="blank _1"> </span><span class="ls4">-</span></div><div class="t m0 x1b h37 y8f ff4 fs5 fc0 sc0 ls4 ws15">térias <span class="blank _5"> </span>pode <span class="blank _5"> </span>estar <span class="blank _5"> </span>dimin<span class="blank _0"></span>uída <span class="blank _5"> </span>abaixo <span class="blank _5"> </span>de <span class="blank _5"> </span>10<span class="fsb ws34 v1">5</span><span class="ls19"> <span class="ls13">CFU/mL<span class="blank _0"></span> </span></span></div><div class="t m0 x1b hd y90 ff4 fs5 fc0 sc0 ls4 ws15">mesmo num doe<span class="blank _0"></span>nte com sintom<span class="blank _0"></span>as de ITU. </div><div class="t m0 x1c hd y91 ff4 fs5 fc0 sc0 ls4 ws15">Na <span class="blank _1"> </span>p<span class="blank _1"> </span>rese<span class="blank _0"></span>nça <span class="blank _1"> </span>de <span class="blank _3"> </span>leve<span class="blank _0"></span>duras <span class="blank _3"> </span>a <span class="blank _1"> </span>coloração <span class="blank _1"> </span>de <span class="blank _1"> </span>Gram <span class="blank _3"> </span>ha<span class="blank _1"> </span>-</div><div class="t m0 x1b hd y92 ff4 fs5 fc0 sc0 ls4 ws15">bitualmente <span class="blank _3"> </span>permite<span class="blank _0"></span> <span class="blank _3"> </span>observar <span class="blank _3"> </span>tais <span class="blank _3"> </span>células, <span class="blank _3"> </span>mas <span class="blank _3"> </span>isso <span class="blank _3"> </span>é </div><div class="t m0 x1b hd y93 ff4 fs5 fc0 sc0 ls4 ws15">mais <span class="blank _1"> </span>difícil <span class="blank _1"> </span>na <span class="blank _1"> </span>presença <span class="blank _1"> </span>de <span class="blank _1"> </span>outros <span class="blank _1"> </span>fungos, <span class="blank _1"> </span>que <span class="blank _1"> </span>podem </div><div class="t m0 x1b hd y94 ff4 fs5 fc0 sc0 ls4 ws15">exigir <span class="blank _1"> </span>colorações <span class="blank _1"> </span>específicas<span class="blank _0"></span>. <span class="blank _1"> </span>Na <span class="blank _3"> </span>s<span class="blank _0"></span>uspeita <span class="blank _1"> </span>de <span class="blank _1"> </span>tubercu- </div><div class="t m0 x1b hd y95 ff4 fs5 fc0 sc0 ls4 ws15">lose <span class="blank _3"> </span>renal <span class="blank _1"> </span>pode-se <span class="blank _3"> </span>usar <span class="blank _3"> </span>a <span class="blank _3"> </span>coloração <span class="blank _1"> </span>de <span class="blank _3"> </span>Ziehl-Neelsen </div><div class="t m0 x1b hd y96 ff4 fs5 fc0 sc0 ls4 ws15">para detectar as<span class="blank _0"></span> micobactérias. </div><div class="t m0 x1c hd y97 ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1b h11 y1f3 ffb fs5 fc2 sc0 ls4 ws15">EXAME CULTUR<span class="blank _0"></span>AL </div><div class="t m0 x1b hd y99 ff4 fs5 fc0 sc0 ls4 ws15">Para <span class="blank _3"> </span>a <span class="blank _6"> </span>inoculação <span class="blank _3"> </span>nos <span class="blank _3"> </span>meios <span class="blank _3"> </span>de <span class="blank _6"> </span>cultura <span class="blank _3"> </span>deve-se <span class="blank _3"> </span>usar </div><div class="t m0 x1b hd y9a ff4 fs5 fc0 sc0 ls4 ws15">uma amostra de urina homogeneizada. Nesta, uma <span class="ls29 ws24">an</span>-</div><div class="t m0 x1b he y9b ffa fs5 fc0 sc0 ls4 ws15">sa <span class="blank _1"> </span>calibrada <span class="blank _1"> </span>de <span class="blank _1"> </span>1<span class="blank _1"> </span> <span class="blank _1"> </span>μL <span class="blank _1"> </span>é <span class="blank _1"> </span>in<span class="blank _1"> </span>serida <span class="blank _1"> </span>verticalme<span class="blank _0"></span>nte. <span class="blank _1"> </span>A <span class="blank _1"> </span>an<span class="blank _1"> </span>sa </div><div class="t m0 x1b hd y9c ff4 fs5 fc0 sc0 ls4 ws15">é <span class="blank _4"> </span>então <span class="blank _4"> </span>semeada <span class="blank _4"> </span>nos <span class="blank _4"> </span>meios <span class="blank _4"> </span>apropriados. <span class="blank _4"> </span>Também </div><div class="t m0 x1b he yd7 ffa fs5 fc0 sc0 ls4 ws15">existem ansas de 10 μL<span class="blank _0"></span>, que podem ser utilizadas nes<span class="blank _1"> </span><span class="ff4">-</span></div><div class="t m0 x1b hd y9e ff4 fs5 fc0 sc0 ls4 ws15">te cont<span class="blank _1"> </span>exto<span class="blank _0"></span> <span class="blank _1"> </span>e que, <span class="blank _1"> </span>por t<span class="blank _1"> </span>ere<span class="blank _0"></span>m u<span class="blank _1"> </span>m inóculo maior, <span class="blank _1"> </span>forne-</div><div class="t m0 x1b hd y9f ff4 fs5 fc0 sc0 ls4 ws15">cem uma quantifi<span class="blank _0"></span>cação mais pre<span class="blank _0"></span>cisa.</div><div class="c x0 y112 w16 h2f"><div class="t m0 x2f h30 y1f4 ff4 fsb fc0 sc0 ls4">2</div></div><div class="t m0 x30 hd y9f ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1c hd ya0 ff4 fs5 fc0 sc0 ls4 ws15">Os meios usados por ro<span class="blank _0"></span>tina são a gel<span class="blank _0"></span>ose de sangue e </div><div class="t m0 x1b hd ya1 ff4 fs5 fc0 sc0 ls4 ws15">o me<span class="blank _0"></span>io de<span class="blank _0"></span> MacCon<span class="blank _0"></span>key. A<span class="blank _0"></span>s <span class="blank _5"> </span>placas são <span class="blank _5"> </span>incubadas a<span class="blank _0"></span> </div><div class="t m0 x1b hd ya2 ff4 fs5 fc0 sc0 ls4 ws15">35ºC <span class="blank _1"> </span>em aerobiose du<span class="blank _1"> </span>r<span class="blank _0"></span>ante 1<span class="blank _1"> </span>8-24 horas. <span class="blank _1"> </span>O número de </div><div class="t m0 x1b hd ya3 ff4 fs5 fc0 sc0 ls4 ws15">colónias é contado p<span class="blank _0"></span>ara obter um valo<span class="blank _0"></span>r aproximado da </div><div class="t m0 x1b hd ya4 ff4 fs5 fc0 sc0 ls4 ws15">concentração <span class="blank _1"> </span>de <span class="blank _1"> </span>bactérias <span class="blank _1"> </span>n<span class="blank _1"> </span>a <span class="blank _1"> </span>urina. <span class="blank _1"> </span>Assim, <span class="blank _1"> </span>se <span class="blank _3"> </span>crescer </div><div class="t m0 x1b h37 ya5 ff4 fs5 fc0 sc0 ls6 ws15">1 coló<span class="blank _0"></span>nia a con<span class="blank _0"></span>centra<span class="blank _0"></span>ção é de<span class="blank _0"></span> 10<span class="fsb ls4 v1">3</span></div><div class="t m0 x31 hd ya5 ff4 fs5 fc0 sc0 ls4 ws15"> CFU/mL, se cresce-</div><div class="t m0 x1b h37 ya6 ff4 fs5 fc0 sc0 ls4 ws15">rem <span class="blank _3"> </span>10 <span class="blank _3"> </span>colónias<span class="blank _0"></span> <span class="blank _3"> </span>a <span class="blank _3"> </span>concentração<span class="blank _0"></span> <span class="blank _3"> </span>é <span class="blank _3"> </span>de <span class="blank _3"> </span>10<span class="fsb ws34 v1">4</span> <span class="blank _3"> </span>CFU/mL<span class="blank _0"></span>, <span class="blank _3"> </span>e </div><div class="t m0 x1b h37 ya7 ff4 fs5 fc0 sc0 ls4 ws15">se <span class="blank _5"> </span>crescere<span class="blank _0"></span>m <span class="blank _5"> </span>100 col<span class="blank _0"></span>ónias <span class="blank _5"> </span>a <span class="blank _5"> </span>concen<span class="blank _0"></span>tração <span class="blank _5"> </span>é <span class="blank _5"> </span>de <span class="blank _5"> </span>10<span class="fsb ws34 v1">5</span> </div><div class="t m0 x1b he ya8 ff4 fs5 fc0 sc0 ls13 wsf">CFU<span class="blank _0"></span>/mL.<span class="ls4 ws15"> <span class="blank _1"> </span>Se <span class="blank _1"> </span>foi <span class="blank _1"> </span>usada <span class="blank _1"> </span>uma <span class="blank _1"> </span>ansa <span class="blank _1"> </span>de <span class="blank _1"> </span>10 <span class="blank _1"> </span><span class="ffa">μL <span class="blank _1"> </span>estes <span class="blank _1"> </span>cres</span>-</span></div><div class="t m0 x1b hd ya9 ff4 fs5 fc0 sc0 ls4 ws15">cimentos corre<span class="blank _0"></span>spondem a inóculo<span class="blank _0"></span>s 10 veze<span class="blank _0"></span>s menores. </div><div class="t m0 x1c hd yaa ff4 fs5 fc0 sc0 ls4 ws15">Quando <span class="blank _3"> </span>a <span class="blank _1"> </span>cultura <span class="blank _3"> </span>e/ou <span class="blank _3"> </span>o <span class="blank _1"> </span>exame <span class="blank _3"> </span>directo <span class="blank _3"> </span>lev<span class="blank _0"></span>antam <span class="blank _3"> </span>a </div><div class="t m0 x1b hd yab ff4 fs5 fc0 sc0 ls4 ws15">suspeita <span class="blank _1"> </span>d<span class="blank _1"> </span>e <span class="blank _1"> </span>infecção <span class="blank _3"> </span>fúng<span class="blank _0"></span>ica, <span class="blank _3"> </span>ou <span class="blank _1"> </span>quando <span class="blank _3"> </span>o <span class="blank _1"> </span>clínico <span class="blank _3"> </span>in-</div><div class="t m0 x1b hd yac ff4 fs5 fc0 sc0 ls6 wsd">dica<span class="ls4 ws15"> essa suspe<span class="blank _0"></span>ita ao Laboratório, uma terce<span class="blank _0"></span>ira cultura </span></div><div class="t m0 x1b hd yad ff4 fs5 fc0 sc0 ls4 ws15">é <span class="blank _3"> </span>feita <span class="blank _3"> </span>e<span class="blank _0"></span>m <span class="blank _3"> </span>meio <span class="blank _1"> </span>de<span class="blank _1"> </span> <span class="blank _1"> </span>Sab<span class="blank _1"> </span>ouraud. <span class="blank _3"> </span>Na <span class="blank _1"> </span>su<span class="blank _1"> </span>speita <span class="blank _1"> </span>de <span class="blank _3"> </span>tuber-</div><div class="t m0 x1b hd yae ff4 fs5 fc0 sc0 ls4 ws15">culose renal a<span class="blank _1"> </span> urina deve <span class="blank _1"> </span>ser descontaminada e <span class="blank _1"> </span>inocu-</div><div class="t m0 x1b hd yaf ff4 fs5 fc0 sc0 ls4 ws15">lada <span class="blank _1"> </span>em meio de <span class="blank _1"> </span>Löw<span class="blank _0"></span>enstein-Jensen ou <span class="blank _1"> </span>outro apropri-</div><div class="t m0 x1b hd yb0 ff4 fs5 fc0 sc0 ls7 ws19">ado.<span class="ls4 ws15"> </span></div><div class="t m0 x1c hd yb1 ff4 fs5 fc0 sc0 ls4 ws15">A <span class="blank _1"> </span>cultura <span class="blank _1"> </span>deve <span class="blank _1"> </span>ser <span class="blank _1"> </span>pura <span class="blank _3"> </span>par<span class="blank _0"></span>a <span class="blank _1"> </span>ser <span class="blank _1"> </span>aceite. <span class="blank _1"> </span>No <span class="blank _3"> </span>caso <span class="blank _1"> </span>de </div><div class="t m0 x1b hd yb2 ff4 fs5 fc0 sc0 ls4 ws15">urina <span class="blank _3"> </span>colhida <span class="blank _3"> </span>pela <span class="blank _3"> </span>técnica <span class="blank _3"> </span>do <span class="blank _3"> </span>jacto <span class="blank _3"> </span>médio, <span class="blank _3"> </span>se <span class="blank _3"> </span>cre<span class="blank _0"></span>sce<span class="blank _1"> </span>-</div><div class="t m0 x1b hd yb3 ff4 fs5 fc0 sc0 ls4 ws15">rem duas o<span class="blank _0"></span>u mais e<span class="blank _0"></span>stirpes bacter<span class="blank _0"></span>ianas consider<span class="blank _0"></span>a<span class="blank _1"> </span>-se </div><div class="t m0 x1b hd yb4 ff4 fs5 fc0 sc0 ls4 ws15">que <span class="blank _1"> </span>h<span class="blank _1"> </span>ouve <span class="blank _1"> </span>má <span class="blank _3"> </span>técnica <span class="blank _1"> </span>de <span class="blank _3"> </span>colheita <span class="blank _3"> </span>ou<span class="blank _0"></span> <span class="blank _3"> </span>atraso <span class="blank _1"> </span>no <span class="blank _3"> </span>trans<span class="blank _1"> </span>-</div><div class="t m0 x1b hd yb5 ff4 fs5 fc0 sc0 ls4 ws15">porte <span class="blank _3"> </span>e<span class="blank _0"></span>/ou <span class="blank _3"> </span>no <span class="blank _3"> </span>processame<span class="blank _0"></span>nto <span class="blank _3"> </span>laborato<span class="blank _0"></span>rial <span class="blank _3"> </span>da <span class="blank _3"> </span>amostra. </div><div class="t m0 x1b hd yb6 ff4 fs5 fc0 sc0 ls4 ws15">Nesses <span class="blank _1"> </span>c<span class="blank _1"> </span>asos, <span class="blank _3"> </span>a <span class="blank _3"> </span>amostra <span class="blank _3"> </span>é <span class="blank _3"> </span>reje<span class="blank _0"></span>itada <span class="blank _3"> </span>e <span class="blank _3"> </span>s<span class="ls11 ws1f">oli c i t a </span>-se <span class="blank _3"> </span>uma </div><div class="t m0 x1b hd y80 ff4 fs5 fc0 sc0 ls6 ws15">nova <span class="blank _0"></span>colhe<span class="blank _0"></span>ita.<span class="blank _0"></span><span class="ls4"> </span></div><div class="t m0 x1c hd yb7 ff4 fs5 fc0 sc0 ls4 ws15">A urina colhida por saco colector<span class="blank _0"></span> em crianças resul-</div><div class="t m0 x1b hd yb8 ff4 fs5 fc0 sc0 ls4 ws15">ta <span class="blank _5"> </span>freq<span class="blank _0"></span>uentemente <span class="blank _6"> </span>na <span class="blank _5"> </span>contam<span class="blank _0"></span>inação <span class="blank _6"> </span>da <span class="blank _5"> </span>amostra <span class="blank _6"> </span>pela </div><div class="t m0 x1b hd yb9 ff4 fs5 fc0 sc0 ls4 ws15">flora do <span class="blank _1"> </span>períneo, dando <span class="blank _1"> </span>resul<span class="blank _0"></span>tados falsos p<span class="blank _1"> </span>ositivo<span class="blank _0"></span>s. <span class="blank _1"> </span>Se </div><div class="t m0 x1b hd yd8 ff4 fs5 fc0 sc0 ls4 ws15">necessário, o <span class="blank _1"> </span>resultado pode ser <span class="blank _1"> </span>confirmado repetindo </div><div class="t m0 x1b hd yba ff4 fs5 fc0 sc0 ls7 ws15">a colheita por<span class="ls4"> outro método, como uma punção supra-</span></div><div class="t m0 x1b hd ybb ff4 fs5 fc0 sc0 ls4 ws3">-<span class="ls6 wsd">púbi<span class="blank _0"></span>ca.<span class="ls4 ws15"> </span></span></div><div class="c x0 y112 w16 h2f"><div class="t m0 x1b h2 y121 ff1 fs0 fc0 sc0 ls33 ws15"> </div></div><div class="t m0 x32 h2 y121 ff1 fs0 fc0 sc0 ls4 ws15"> </div><div class="c x0 y112 w16 h2f"><div class="t m0 x1b h31 y122 ff7 fsc fc0 sc0 ls4">2</div></div><div class="t m0 x33 h1f y123 ff7 fsa fc0 sc0 ls4 ws15"> Os resultados da quantificação são aqui explicados para a ansa </div><div class="t m0 x1b h1f y124 fff fsa fc0 sc0 ls4 ws15">calibrada de 1 μL, mas os princípios são os mesm<span class="blank _0"></span>os <span class="ff7">par<span class="blank _1"> </span>a a ansa </span></div><div class="t m0 x1b h1f y125 fff fsa fc0 sc0 ls4 ws15">de 10 μL.<span class="ff7"> </span></div><div class="c x1 y1f5 wa h38"><div class="t m0 x0 h1e y1f6 ff5 fsa fc2 sc0 ls4 ws15">Figura <span class="blank _1"> </span>6-3<span class="blank _1"> </span>.<span class="ff7 fc0 ls40"> </span><span class="fc0">Lâmina <span class="blank _1"> </span>para <span class="blank _1"> </span>análise <span class="blank _1"> </span>d<span class="blank _1"> </span>o <span class="blank _1"> </span>sedimento <span class="blank _1"> </span>urinário<span class="blank _1"> </span><span class="ff7 ls2b">. <span class="blank _1"> </span><span class="ls42">Um<span class="blank _0"></span>a </span></span></span></div><div class="t m0 x0 h1f y1f7 ff7 fsa fc0 sc0 ls4 ws15">amostra <span class="blank _6"> </span>d<span class="blank _1"> </span>e <span class="blank _6"> </span>sed<span class="blank _1"> </span>imento <span class="blank _6"> </span>é colocada <span class="blank _5"> </span>com<span class="blank _0"></span> <span class="blank _6"> </span>pi<span class="blank _1"> </span>peta <span class="blank _5"> </span>em<span class="blank _0"></span> <span class="blank _6"> </span>cad<span class="blank _1"> </span>a <span class="blank _6"> </span>cai<span class="blank _1"> </span>xa </div><div class="t m0 x0 h1f y1f8 ff7 fsa fc0 sc0 ls4 ws15">desta <span class="blank _3"> </span>lâmina, <span class="blank _3"> </span>num <span class="blank _3"> </span>total <span class="blank _3"> </span>de <span class="blank _3"> </span>10 <span class="blank _3"> </span>cai<span class="blank _1"> </span>xas, <span class="blank _3"> </span>um<span class="blank _0"></span>a <span class="blank _3"> </span>para <span class="blank _3"> </span>cada <span class="blank _3"> </span>amostra. </div><div class="t m0 x0 h1f y1f9 ff7 fsa fc0 sc0 ls4 ws15">Os elementos celulares presentes são observados e contados. </div></div><div class="c x1 y1fa wa h39"><div class="t m0 x0 h1e y1fb ff5 fsa fc2 sc0 ls4 ws15">Figura <span class="blank _1"> </span>6-2.<span class="ff7 fc0 ls41"> </span><span class="fc0">An<span class="blank _0"></span>álise <span class="blank _1"> </span>sumária da <span class="blank _1"> </span>urina<span class="ff7">. Entr<span class="blank _1"> </span>e uma a<span class="blank _1"> </span>valiação das </span></span></div><div class="t m0 x0 h1f y1fc ff7 fsa fc0 sc0 ls4 ws15">propriedades físicas e m<span class="blank _0"></span>icroscópicas,<span class="blank _1"> </span> <span class="ls43 ws35">in</span>c<span class="blank _0"></span>lui um <span class="blank _6"> </span>te<span class="blank _1"> </span>ste de tiras </div><div class="t m0 x0 h1f y1fd ff7 fsa fc0 sc0 ls4 ws15">para uma avaliação das pro<span class="blank _1"> </span>priedades químicas. De relevo para a </div><div class="t m0 x0 h1f y1fe ff7 fsa fc0 sc0 ls4 ws15">ITU este <span class="blank _1"> </span>teste inclui a <span class="blank _1"> </span>m<span class="blank _0"></span>edição <span class="blank _1"> </span>de nitritos, esterase leuco<span class="blank _1"> </span>citár<span class="blank _0"></span>ia <span class="blank _1"> </span>e </div><div class="t m0 x0 h1f y1ff ff7 fsa fc0 sc0 ls4 ws15">pH. <span class="blank _c"> </span>Repare q<span class="blank _1"> </span>ue as <span class="blank _c"> </span>cores <span class="blank _c"> </span>de <span class="blank _c"> </span>referência estão <span class="blank _c"> </span>impressas <span class="blank _c"> </span>na </div><div class="t m0 x0 h1f y200 ff7 fsa fc0 sc0 ls4 ws15">caixa, <span class="blank _1"> </span>de <span class="blank _1"> </span>onde <span class="blank _1"> </span>p<span class="blank _1"> </span>odem<span class="blank _0"></span> <span class="blank _1"> </span>facilmente <span class="blank _1"> </span>ser <span class="blank _3"> </span>com<span class="blank _0"></span>parad<span class="blank _1"> </span>as <span class="blank _1"> </span>com <span class="blank _1"> </span>os <span class="blank _1"> </span>resul-</div><div class="t m0 x0 h1f y201 ff7 fsa fc0 sc0 ls4 ws15">tados obtidos na tira. </div></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf8" class="pf w0 h0" data-page-no="8"><div class="pc pc8 w0 h0"><img fetchpriority="low" loading="lazy" class="bi x15 y202 w1 h3a" alt src="https://files.passeidireto.com/e78ed9d7-0969-4804-95c1-3a92effc5fc9/bg8.png" alt="Pré-visualização de imagem de arquivo"><div class="c x16 y4f w5 h13"><div class="t m1 x17 h14 y50 ff2 fs7 fc1 sc0 ls4 ws15">Aula 6 </div></div><div class="c xb y51 w6 h15"><div class="t m0 x18 h16 y52 ff2 fs8 fc1 sc0 ls4 ws15">Infecção Urinária </div></div><div class="t m0 x19 h16 y53 ff2 fs8 fc0 sc0 lsd ws16">170<span class="ls4 ws15"> </span></div><div class="t m0 x1 h2 y54 ff1 fs0 fc0 sc0 ls4 ws15"> </div><div class="t m0 x9 hd y8b ff4 fs5 fc0 sc0 ls4 ws15">No <span class="blank _1"> </span>caso <span class="blank _3"> </span>de <span class="blank _1"> </span>urina <span class="blank _3"> </span>colhida <span class="blank _1"> </span>por <span class="blank _1"> </span>punção <span class="blank _1"> </span>su<span class="blank _1"> </span>pra-<span class="ls11">púbica<span class="blank _1"> </span>, </span></div><div class="t m0 x1 hd y8c ff4 fs5 fc0 sc0 ls4 ws15">excluindo a <span class="blank _1"> </span>contaminação da <span class="blank _1"> </span>amostra pela mi<span class="blank _1"> </span>crobiota </div><div class="t m0 x1 hd y8d ff4 fs5 fc0 sc0 ls4 ws15">da <span class="blank _1"> </span>pele, qualquer <span class="blank _1"> </span>espécie identificada <span class="blank _1"> </span>deve<span class="blank _0"></span> <span class="blank _1"> </span>ser <span class="blank _1"> </span>valor<span class="blank _0"></span>i<span class="blank _1"> </span>-</div><div class="t m0 x1 hd y8e ff4 fs5 fc0 sc0 ls4 ws15">zada, indepe<span class="blank _0"></span>ndentemente da s<span class="blank _0"></span>ua quantificação<span class="blank _0"></span>. </div><div class="t m0 x9 h2e y203 ff4 fsa fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h11 y204 ffb fs5 fc2 sc0 ls4 ws15">INTERPRETAÇÃO<span class="blank _0"></span> DOS RESULTAD<span class="blank _0"></span>OS </div><div class="t m0 x1 hd yf4 ff4 fs5 fc0 sc0 ls4 ws15">Os resul<span class="blank _0"></span>tados são interpretados de <span class="blank _5"> </span>acordo com (1) </div><div class="t m0 x1 hd yf5 ff4 fs5 fc0 sc0 ls7 ws19">con<span class="ls4 ws15">tagem de <span class="blank _1"> </span>coló<span class="blank _0"></span>nias <span class="blank _1"> </span>de um <span class="blank _1"> </span>organ<span class="blank _0"></span>ismo predominante </span></div><div class="t m0 x1 hd yf6 ff4 fs5 fc0 sc0 ls4 ws15">ou de cultura pura, (2) medição da piúria e <span class="blank _1"> </span>(3) prese<span class="blank _0"></span>n<span class="blank _1"> </span>-</div><div class="t m0 x1 hd yf7 ff4 fs5 fc0 sc0 ls4 ws15">ça ou ausência de<span class="blank _0"></span> sintomas de I<span class="blank _0"></span>TU. </div><div class="t m0 x9 hd yf8 ff4 fs5 fc0 sc0 ls4 ws15">Cem mil bactérias por mL de urin<span class="blank _1"> </span>a é frequentemen-</div><div class="t m0 x1 hd yf9 ff4 fs5 fc0 sc0 ls4 ws15">te <span class="blank _3"> </span>definido <span class="blank _3"> </span>como <span class="blank _3"> </span>ponto <span class="blank _3"> </span>de <span class="blank _3"> </span>clivagem <span class="blank _3"> </span>para <span class="blank _3"> </span>a <span class="blank _6"> </span>presença </div><div class="t m0 x1 hd yfa ff4 fs5 fc0 sc0 ls4 ws15">de <span class="blank _5"> </span>I<span class="blank _0"></span>TU. <span class="blank _6"> </span>Este <span class="blank _6"> </span>a<span class="blank _1"> </span>chado <span class="blank _6"> </span>num <span class="blank _6"> </span>doente <span class="blank _5"> </span>si<span class="blank _0"></span>ntomático <span class="blank _6"> </span>geral-</div><div class="t m0 x1 hd yfb ff4 fs5 fc0 sc0 ls4 ws15">mente <span class="blank _6"> </span>significa <span class="blank _3"> </span>cistite <span class="blank _6"> </span>ou <span class="blank _6"> </span>pielonefrite, <span class="blank _3"> </span>independente-</div><div class="t m0 x1 hd yfc ff4 fs5 fc0 sc0 ls4 ws15">mente <span class="blank _1"> </span>da <span class="blank _1"> </span>piúria. <span class="blank _1"> </span>Num <span class="blank _1"> </span>doente <span class="blank _1"> </span>sem <span class="blank _1"> </span>sintomas <span class="blank _3"> </span>po<span class="blank _0"></span>de <span class="blank _1"> </span>sig<span class="blank _1"> </span>-</div><div class="t m0 x1 hd yfd ff4 fs5 fc0 sc0 ls4 ws15">nificar <span class="blank _6"> </span>bacteriúria <span class="blank _6"> </span>assintomática, <span class="blank _5"> </span>ma<span class="blank _0"></span>s <span class="blank _6"> </span>se <span class="blank _5"> </span>não <span class="blank _6"> </span><span class="ls6">houver </span></div><div class="t m0 x1 hd y205 ff4 fs5 fc0 sc0 ls4 ws15">piúria pode <span class="blank _1"> </span>ser contaminação da a<span class="blank _1"> </span>mo<span class="blank _0"></span>stra <span class="blank _1"> </span>ou coloniza-</div><div class="t m0 x1 hd y206 ff4 fs5 fc0 sc0 ls7 ws15">ção trans<span class="blank _0"></span>itóri<span class="blank _0"></span>a.<span class="ls4"> </span></div><div class="t m0 x9 h37 y207 ff4 fs5 fc0 sc0 ls4 ws15">Um resultado <span class="blank _1"> </span>entre<span class="blank _0"></span> <span class="blank _1"> </span>10<span class="fsb v1">2</span></div><div class="t m0 x34 h37 y207 ff4 fs5 fc0 sc0 ls3b ws15"> <span class="ls8">e <span class="blank _1"> </span>10<span class="fsb ls4 ws34 v1">5</span><span class="ls4"> <span class="blank _1"> </span>bactérias por <span class="blank _1"> </span>mL<span class="blank _0"></span> d<span class="blank _1"> </span>eve </span></span></div><div class="t m0 x1 hd y208 ff4 fs5 fc0 sc0 ls4 ws15">ser <span class="blank _5"> </span>interpretado <span class="blank _5"> </span>no <span class="blank _5"> </span>contex<span class="blank _0"></span>to <span class="blank _5"> </span>do <span class="blank _5"> </span>doente. <span class="blank _5"> </span>Pode <span class="blank _5"> </span>haver </div><div class="t m0 x1 hd y209 ff4 fs5 fc0 sc0 ls4 ws15">alguma <span class="blank _1"> </span>condição que <span class="blank _1"> </span>diminua <span class="blank _1"> </span>a <span class="blank _1"> </span>concentração d<span class="blank _1"> </span>e b<span class="blank _1"> </span>ac-</div><div class="t m0 x1 hd y20a ff4 fs5 fc0 sc0 ls2 ws2">térias<span class="ls4 ws15"> <span class="blank _6"> </span>na <span class="blank _5"> </span>urina, <span class="blank _5"> </span>mas <span class="blank _5"> </span>o <span class="blank _6"> </span>mais <span class="blank _5"> </span>provável <span class="blank _5"> </span>é<span class="blank _0"></span> <span class="blank _5"> </span>que, <span class="blank _5"> </span>se <span class="blank _5"> </span>não </span></div><div class="t m0 x1 hd y20b ff4 fs5 fc0 sc0 ls4 ws15">houver <span class="blank _1"> </span>sintomas, <span class="blank _1"> </span>se <span class="blank _1"> </span>trate <span class="blank _1"> </span>de <span class="blank _3"> </span>bacteriúria <span class="blank _1"> </span>assintomátic<span class="blank _0"></span>a </div><div class="t m0 x1 hd y20c ff4 fs5 fc0 sc0 ls4 ws15">ou <span class="blank _1"> </span>contaminação. <span class="blank _1"> </span>Have<span class="blank _0"></span>ndo <span class="blank _1"> </span>disúria, <span class="blank _1"> </span>é <span class="blank _1"> </span>importante p<span class="blank _1"> </span>en-</div><div class="t m0 x1 hd y20d ff4 fs5 fc0 sc0 ls4 ws15">sar em uretrite<span class="blank _0"></span> como diagnóstico d<span class="blank _0"></span>iferencial. </div><div class="t m0 x9 h37 y20e ff4 fs5 fc0 sc0 ls4 ws15">Menos <span class="blank _3"> </span>de <span class="blank _3"> </span>10<span class="fsb ws34 v1">2</span> <span class="blank _3"> </span>bactérias <span class="blank _3"> </span>por <span class="blank _3"> </span>mL <span class="blank _3"> </span>não <span class="blank _3"> </span>é <span class="blank _3"> </span>interpretado </div><div class="t m0 x1 hd y20f ff4 fs5 fc0 sc0 ls4 ws15">como <span class="blank _1"> </span>IT<span class="blank _0"></span>U, <span class="blank _1"> </span>mesmo <span class="blank _1"> </span>que <span class="blank _1"> </span>exista piúria, <span class="blank _1"> </span>mas na <span class="blank _1"> </span>presença </div><div class="t m0 x1 hd y210 ff4 fs5 fc0 sc0 ls4 ws15">de disúria pode s<span class="blank _0"></span>ignificar uretri<span class="blank _0"></span>te. </div><div class="t m0 x9 hd y211 ff4 fs5 fc0 sc0 ls15 ws15">A <span class="blank _5"> </span>evi<span class="blank _1"> </span>dên<span class="blank _1"> </span>c<span class="blank _1"> </span>ia<span class="blank _1"> </span> <span class="blank _6"> </span>a<span class="blank _1"> </span>ctu<span class="blank _1"> </span>al<span class="blank _1"> </span> <span class="blank _5"> </span><span class="ls4">suge<span class="blank _0"></span>re <span class="blank _6"> </span>que <span class="blank _6"> </span><span class="lsd">10</span></span></div><div class="t m0 x35 h30 y212 ff4 fsb fc0 sc0 ls4 ws34">2<span class="fs5 ls44 ws15 v2"> <span class="ls13 wsf">CFU<span class="blank _0"></span>/<span class="ls2e ws15">mL<span class="blank _0"></span> <span class="blank _6"> </span><span class="ls8">é <span class="blank _5"> </span>um<span class="ls4"> </span></span></span></span></span></div><div class="t m0 x1 hd y213 ff4 fs5 fc0 sc0 ls4 ws15">ponto <span class="blank _6"> </span>de <span class="blank _6"> </span>clivagem <span class="blank _6"> </span>mais <span class="blank _6"> </span>sensível<span class="blank _0"></span> <span class="blank _6"> </span>(95%) <span class="blank _6"> </span>e <span class="blank _6"> </span>específico </div><div class="t m0 x1 h37 y214 ff4 fs5 fc0 sc0 ls4 ws15">(85%) que <span class="blank _5"> </span>10<span class="fsb ws34 v1">5</span> CFU/mL<span class="blank _0"></span> <span class="ls6">para <span class="blank _5"> </span>a <span class="blank _5"> </span>detecç</span>ão <span class="blank _5"> </span>de cistite </div><div class="t m0 x1 hd y215 ff4 fs5 fc0 sc0 ls7 ws15">aguda <span class="blank _3"> </span>na <span class="blank _6"> </span>mulhe<span class="blank _0"></span>r<span class="ls4">. <span class="blank _6"> </span>Em <span class="blank _6"> </span>homens, <span class="blank _3"> </span>o <span class="blank _6"> </span>nível <span class="blank _3"> </span>míni<span class="blank _1"> </span>mo <span class="blank _3"> </span>indi-</span></div><div class="t m0 x1 h37 y216 ff4 fs5 fc0 sc0 ls4 ws15">cando infecção p<span class="blank _0"></span>arece ser 10<span class="fsb v1">3</span></div><div class="t m0 x36 hd y216 ff4 fs5 fc0 sc0 ls4 ws15"> CFU/mL<span class="blank _0"></span>. </div><div class="t m0 x1 h2e y217 ff4 fsa fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h11 y218 ffb fs5 fc2 sc0 ls4 ws15">HEMOCULTU<span class="blank _0"></span>RAS </div><div class="t m0 x1 hd y170 ff4 fs5 fc0 sc0 lse ws15">Vint<span class="blank _1"> </span>e <span class="blank _6"> </span>a<span class="blank _1"> </span> <span class="blank _5"> </span><span class="ls4">30% <span class="blank _5"> </span>dos <span class="blank _5"> </span>caso<span class="blank _0"></span>s <span class="blank _5"> </span>de <span class="blank _5"> </span>pie<span class="blank _0"></span>lonefrite <span class="blank _5"> </span>cursam <span class="blank _6"> </span>com </span></div><div class="t m0 x1 hd y171 ff4 fs5 fc0 sc0 ls4 ws15">bacteriémia. <span class="blank _1"> </span>Apesar <span class="blank _1"> </span>disso, como <span class="blank _1"> </span>a<span class="blank _1"> </span>s <span class="blank _1"> </span>he<span class="blank _0"></span>moculturas <span class="blank _1"> </span>não </div><div class="t m0 x1 hd y172 ff4 fs5 fc0 sc0 ls4 ws15">acrescentam <span class="blank _1"> </span>muito <span class="blank _3"> </span>ao <span class="blank _3"> </span>restante <span class="blank _1"> </span>exame <span class="blank _3"> </span>microbiológ<span class="blank _0"></span>ico </div><div class="t m0 x1 hd y173 ff4 fs5 fc0 sc0 ls4 ws15">(a <span class="blank _6"> </span>bacteriémia <span class="blank _3"> </span>não <span class="blank _6"> </span>é <span class="blank _6"> </span>sinal <span class="blank _6"> </span>de <span class="blank _6"> </span>mau <span class="blank _6"> </span>prognóstico), <span class="blank _3"> </span>não </div><div class="t m0 x1 hd y174 ff4 fs5 fc0 sc0 ls4 ws15">estão <span class="blank _3"> </span>ind<span class="blank _0"></span>icadas <span class="blank _1"> </span>p<span class="blank _1"> </span>or <span class="blank _1"> </span>rotina. <span class="blank _3"> </span>Podem <span class="blank _1"> </span>ser <span class="blank _3"> </span>úteis<span class="blank _0"></span> <span class="blank _3"> </span>em <span class="blank _1"> </span>doen<span class="blank _1"> </span>-</div><div class="t m0 x1 hd y175 ff4 fs5 fc0 sc0 ls4 ws15">tes com su<span class="blank _0"></span>speita de<span class="blank _0"></span> pielo<span class="blank _0"></span>nefrite. Em mulhe<span class="blank _0"></span>res não<span class="blank _0"></span> </div><div class="t m0 x1 hd y176 ff4 fs5 fc0 sc0 ls4 ws15">grávidas <span class="blank _3"> </span>previame<span class="blank _0"></span>nte <span class="blank _3"> </span>saudáve<span class="blank _0"></span>is <span class="blank _3"> </span>com <span class="blank _3"> </span>suspeita <span class="blank _1"> </span>de <span class="blank _3"> </span>pi<span class="blank _1"> </span>e-</div><div class="t m0 x1 hd y219 ff4 fs5 fc0 sc0 ls4 ws15">lonefrite<span class="blank _0"></span> este teste pode ser<span class="blank _0"></span> dispensado. </div><div class="t m0 x9 h3b y21a ff4 fs0 fc0 sc0 ls4 ws15"> </div><div class="t m0 x2b h14 y21b ff2 fs7 fc1 sc0 ls37 ws15">Men<span class="blank _0"></span>s<span class="blank _0"></span>ag<span class="blank _0"></span>en<span class="blank _0"></span>s<span class="blank _0"></span> a<span class="blank _0"></span> R<span class="blank _0"></span>et<span class="blank _0"></span>er<span class="ls4"> </span></div><div class="t m0 x1 h17 y21c ff2 fs6 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h10 y21d ff2 fs5 fc0 sc0 ls4 ws15">Diagnóstico et<span class="blank _0"></span>iológico de infe<span class="blank _0"></span>cção urinária </div><div class="t m0 x1 he y21e ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">Na maioria dos c<span class="blank _0"></span>asos a urocultur<span class="blank _0"></span>a não é nece<span class="blank _0"></span>ssária, </span></span></div><div class="t m0 x9 hd y21f ff4 fs5 fc0 sc0 ls4 ws15">mas esta deve<span class="blank _0"></span> ser pedida em casos <span class="blank _0"></span>de I<span class="blank _0"></span>TU </div><div class="t m0 x9 hd y1ad ff4 fs5 fc0 sc0 ls4 ws15">complicada, a menos <span class="blank _0"></span>que o doente e<span class="blank _0"></span>steja algalia<span class="blank _0"></span>do </div><div class="t m0 x9 hd y1ae ff4 fs5 fc0 sc0 ls4 ws15">há muito tempo.<span class="blank _0"></span> </div><div class="t m0 x1 he y1af ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">A tira de teste<span class="blank _0"></span> da Urina II<span class="blank _0"></span> permite aumentar <span class="blank _0"></span>a </span></span></div><div class="t m0 x9 hd y1b0 ff4 fs5 fc0 sc0 ls4 ws15">suspeita de I<span class="blank _0"></span>TU ao detectar le<span class="blank _0"></span>ucócitos e nitritos e<span class="blank _0"></span> </div><div class="t m0 x9 hd y1b1 ff4 fs5 fc0 sc0 ls4 ws15">medir o pH. Os le<span class="blank _0"></span>ucócitos signific<span class="blank _0"></span>am inflamação,<span class="blank _0"></span> </div><div class="t m0 x9 hd y1b2 ff4 fs5 fc0 sc0 ls4 ws15">os nitritos signific<span class="blank _0"></span>am a prese<span class="blank _0"></span>nça de bactérias, um<span class="blank _0"></span> </div><div class="t m0 x1c hd y8b ff4 fs5 fc0 sc0 ls4 ws15">pH elev<span class="blank _0"></span>ado aponta para bactérias<span class="blank _0"></span> produtoras <span class="blank _0"></span>de </div><div class="t m0 x1c hd y8c ff4 fs5 fc0 sc0 ls4 ws15">urease com<span class="ls10">o </span><span class="ff8 ws3">Proteus</span>. </div><div class="t m0 x1b he y128 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">O exame dire<span class="blank _0"></span>cto é feito com col<span class="blank _0"></span>oração de Gr<span class="blank _0"></span>am. A </span></span></div><div class="t m0 x1c hd y129 ff4 fs5 fc0 sc0 ls4 ws15">presença de um<span class="blank _0"></span>a bactéria por c<span class="blank _0"></span>ampo (100x) é mu<span class="blank _0"></span>ito </div><div class="t m0 x1c hd y12a ff4 fs5 fc0 sc0 ls4 ws15">sugestiva de infe<span class="blank _0"></span>cção. Fungos e mico<span class="blank _0"></span>bactérias </div><div class="t m0 x1c hd y12b ff4 fs5 fc0 sc0 ls4 ws15">podem requere<span class="blank _0"></span>r coloraçõe<span class="blank _0"></span>s específicas. </div><div class="t m0 x1b he y220 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">É observado o se<span class="blank _0"></span>dimento urinário <span class="blank _0"></span>não corado par<span class="blank _0"></span>a </span></span></div><div class="t m0 x1c hd y12d ff4 fs5 fc0 sc0 ls4 ws15">pesquisar a prese<span class="blank _0"></span>nça de eritrócitos, l<span class="blank _0"></span>eucócitos, </div><div class="t m0 x1c hd y12e ff4 fs5 fc0 sc0 ls4 ws15">células epiteliais, f<span class="blank _0"></span>ungos e paras<span class="blank _0"></span>itas. 5-<span class="lsd">10 </span></div><div class="t m0 x1c hd y12f ff4 fs5 fc0 sc0 ls4 ws15">leucócitos por cam<span class="blank _0"></span>po (40x) são o li<span class="blank _0"></span>mite super<span class="blank _0"></span>ior do </div><div class="t m0 x1c hd y130 ff4 fs5 fc0 sc0 ls4 ws15">normal. </div><div class="t m0 x1b he y221 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">O exame cultural é<span class="blank _0"></span> feito com c<span class="blank _0"></span>ulturas quantitativas<span class="blank _0"></span> </span></span></div><div class="t m0 x1c hd y132 ff4 fs5 fc0 sc0 ls4 ws15">em gelose<span class="blank _0"></span> de sangue e meio de M<span class="blank _0"></span>acConkey<span class="blank _0"></span>. </div><div class="t m0 x1c hd y133 ff4 fs5 fc0 sc0 ls4 ws15">Fungos e micoba<span class="blank _0"></span>ctérias requerem me<span class="blank _0"></span>ios </div><div class="t m0 x1c hd y134 ff4 fs5 fc0 sc0 ls4 ws15">específicos. Em ge<span class="blank _0"></span>ral é usada um<span class="blank _0"></span>a ansa calibrada </div><div class="t m0 x1c he y135 ffa fs5 fc0 sc0 ls4 ws15">de 1 μL<span class="blank _0"></span>, e assim a contagem de <span class="blank _0"></span>colónias permite </div><div class="t m0 x1c hd y136 ff4 fs5 fc0 sc0 ls4 ws15">conhecer o númer<span class="blank _0"></span>o de bactérias vi<span class="blank _0"></span>áveis nessa </div><div class="t m0 x1c hd y137 ff4 fs5 fc0 sc0 ls4 ws15">quantidade de <span class="blank _0"></span>urina e determin<span class="blank _0"></span>ar a concentraç<span class="blank _0"></span>ão de </div><div class="t m0 x1c hd y138 ff4 fs5 fc0 sc0 ls4 ws15">bactérias. </div><div class="t m0 x1b he y222 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">A cultura dev<span class="blank _0"></span>e ser pura para se<span class="blank _0"></span>r ac<span class="blank _1"> </span><span class="ls8">eite. O<span class="blank _1"> </span> </span></span></span></div><div class="t m0 x1c hd y223 ff4 fs5 fc0 sc0 ls4 ws15">crescimento de ma<span class="blank _0"></span>is do que uma mor<span class="blank _0"></span>folog<span class="blank _0"></span>ia de </div><div class="t m0 x1c hd y1fa ff4 fs5 fc0 sc0 ls4 ws15">colónias exige<span class="blank _0"></span> nova colheita de uri<span class="blank _0"></span>na. </div><div class="t m0 x1b he y224 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls15">A c<span class="blank _1"> </span>ul<span class="blank _1"> </span>tu<span class="blank _1"> </span>ra<span class="blank _1"> </span> ob<span class="blank _1"> </span>ti<span class="blank _1"> </span>da <span class="blank _1"> </span>por<span class="blank _1"> </span> p<span class="blank _1"> </span>unç<span class="blank _1"> </span>ão<span class="blank _1"> </span> su<span class="blank _1"> </span>pr<span class="blank _1"> </span>a<span class="blank _1"> </span><span class="ls4 ws3">-</span><span class="ls11">púbica é </span></span></span></div><div class="t m0 x1c hd y225 ff4 fs5 fc0 sc0 ls4 ws15">geralmente p<span class="blank _0"></span>ura, pelo que, a menos <span class="blank _0"></span>que se trate <span class="blank _0"></span>de </div><div class="t m0 x1c hd y226 ff4 fs5 fc0 sc0 ls4 ws15">contaminação <span class="blank _0"></span>pela flora da pel<span class="blank _0"></span>e, o organismo </div><div class="t m0 x1c hd y227 ff4 fs5 fc0 sc0 ls4 ws15">isolado deve se<span class="blank _0"></span>r considerado como o <span class="blank _0"></span>agente </div><div class="t m0 x1c hd y228 ff4 fs5 fc0 sc0 ls8 ws1b">eti ológi c o .<span class="ls4 ws15"> </span></div><div class="t m0 x1b h37 y212 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">Classicamente<span class="blank _0"></span> o valor de 10<span class="fsb v1">5</span></span></span></div><div class="t m0 x37 hd y212 ff4 fs5 fc0 sc0 ls4 ws15"> bactérias/mL<span class="blank _0"></span> de urina </div><div class="t m0 x1c hd y229 ff4 fs5 fc0 sc0 ls4 ws15">tem sido usado co<span class="blank _0"></span>mo ponto de co<span class="blank _0"></span>rte para </div><div class="t m0 x1c hd y22a ff4 fs5 fc0 sc0 ls4 ws15">diagnosticar I<span class="blank _0"></span>TU. Um valor<span class="blank _0"></span> acima deste é muito </div><div class="t m0 x1c hd y22b ff4 fs5 fc0 sc0 ls4 ws15">sugestivo de I<span class="blank _0"></span>TU, mas valor<span class="blank _0"></span>es abaixo também </div><div class="t m0 x1c hd y22c ff4 fs5 fc0 sc0 ls4 ws15">podem significar I<span class="blank _0"></span>TU. É impor<span class="blank _0"></span>tante ter em co<span class="ls6">nta o<span class="blank _0"></span> </span></div><div class="t m0 x1c h37 y22d ff4 fs5 fc0 sc0 ls4 ws15">contexto do doe<span class="blank _0"></span>nte. Valore<span class="blank _0"></span>s inferiores a 10<span class="fsb ws34 v1">2</span> </div><div class="t m0 x1c hd y22e ff4 fs5 fc0 sc0 ls4 ws15">bactérias/mL<span class="blank _0"></span> praticamente e<span class="blank _0"></span>xcluem o diagnóst<span class="blank _0"></span>ico. </div><div class="t m0 x1b he y22f ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">A colhe<span class="blank _0"></span>ita de hemoculturas pode<span class="blank _0"></span> ser importante e<span class="blank _0"></span>m </span></span></div><div class="t m0 x1c hd y230 ff4 fs5 fc0 sc0 ls4 ws15">doentes com sus<span class="blank _0"></span>peita de pielo<span class="blank _0"></span>nefrite, mas </div><div class="t m0 x1c hd y231 ff4 fs5 fc0 sc0 ls4 ws15">acrescentam po<span class="blank _0"></span>uco ao exame<span class="blank _0"></span> microbiológico. </div><div class="t m0 x1b h7 y232 ff4 fs1 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1b h14 y233 ff2 fs7 fc2 sc0 ls45 ws15">Ordem En<span class="blank _0"></span>terobacter<span class="ls46 ws36">ales</span><span class="ls4"> </span></div><div class="t m0 x1b h17 y119 ff2 fs6 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1b hd y234 ff4 fs5 fc0 sc0 ls4 ws15">As <span class="blank _7"> </span>Enterobacter<span class="ls7 ws19">ale</span>s <span class="blank _7"> </span>(antiga <span class="blank _7"> </span>denominação: <span class="blank _7"> </span>Família </div><div class="t m0 x1b hd y235 ff4 fs5 fc0 sc0 ls4 ws15">Enterobacteriace<span class="blank _0"></span>ae) <span class="blank _1"> </span>são uma <span class="blank _1"> </span><span class="ls11 wsa">ordem</span> <span class="blank _1"> </span>larga e <span class="blank _1"> </span>diversa de </div><div class="t m0 x1b hd y236 ff4 fs5 fc0 sc0 ls4 ws15">bacilos <span class="blank _6"> </span>Gram-<span class="ls6">neg<span class="blank _0"></span>ativo<span class="blank _0"></span>, <span class="blank _6"> </span><span class="ls7 ws19">cu<span class="blank _1"> </span>j</span><span class="ls4">os <span class="blank _6"> </span>membros <span class="blank _6"> </span>tanto <span class="blank _5"> </span></span>po<span class="blank _0"></span>dem<span class="blank _0"></span> </span></div><div class="t m0 x1b hd y21b ff4 fs5 fc0 sc0 ls11 ws1f">viver<span class="ls4 ws15"> <span class="blank _1"> </span>livremente como podem constituir <span class="blank _1"> </span><span class="ls11">parte <span class="blank _1"> </span>da <span class="blank _1"> </span>flora </span></span></div><div class="t m0 x1b hd y237 ff4 fs5 fc0 sc0 ls4 ws15">indígena <span class="blank _3"> </span>de <span class="blank _3"> </span>humanos <span class="blank _3"> </span>e <span class="blank _3"> </span>animais. <span class="blank _3"> </span>As <span class="blank _3"> </span>Enterobacter<span class="ls7 ws19">ale</span><span class="ls3f">s </span></div><div class="t m0 x1b hd y238 ff4 fs5 fc0 sc0 ls4 ws15">crescem <span class="blank _6"> </span>rapidamente <span class="blank _5"> </span>e<span class="blank _0"></span>m <span class="blank _5"> </span>co<span class="blank _0"></span>ndições <span class="blank _6"> </span>de <span class="blank _5"> </span>aerobiose <span class="blank _6"> </span>ou </div><div class="t m0 x1b hd y21e ff4 fs5 fc0 sc0 ls4 ws15">anaerobiose. <span class="blank _6"> </span>Todas <span class="blank _6"> </span>as <span class="blank _6"> </span>Enterob<span class="ls7 ws19">acteral<span class="blank _0"></span>e<span class="ls4 ws15">s <span class="blank _6"> </span>fermentam <span class="blank _6"> </span>a </span></span></div><div class="t m0 x1b hd y21f ff4 fs5 fc0 sc0 ls4 ws15">glicose <span class="blank _3"> </span>e <span class="blank _3"> </span>são <span class="blank _3"> </span>oxidase <span class="blank _3"> </span>negativas <span class="blank _3"> </span>(apenas <span class="blank _3"> </span><span class="ff8 lsf ws2f">Ple si o mon a s</span> </div><div class="t m0 x1b hd y1ad ff4 fs5 fc0 sc0 ls4 ws15">é <span class="blank _3"> </span>oxidase-positiva), <span class="blank _3"> </span>e <span class="blank _1"> </span>quase <span class="blank _3"> </span>todas <span class="blank _3"> </span>reduzem <span class="blank _3"> </span>nitratos <span class="blank _3"> </span>a<span class="blank _0"></span> </div><div class="t m0 x1b hd y1ae ff4 fs5 fc0 sc0 ls4 ws15">nitritos. <span class="blank _6"> </span>Dentro <span class="blank _3"> </span>desta<span class="blank _1"> </span> <span class="blank _3"> </span><span class="ls1f">famíli<span class="blank _1"> </span>a <span class="blank _6"> </span>ex</span>istem <span class="blank _3"> </span>vários <span class="blank _6"> </span>géneros </div><div class="t m0 x1b hd y156 ff4 fs5 fc0 sc0 ls4 ws15">medicamente <span class="blank _d"> </span>importantes, <span class="blank _d"> </span>entre <span class="blank _d"> </span>eles <span class="blank _e"> </span><span class="ff8 ws37">Escherichia</span><span class="ls9">, </span></div><div class="t m0 x1b hd y157 ff8 fs5 fc0 sc0 ls6 wsd">Salmo<span class="blank _0"></span>nell<span class="blank _0"></span>a<span class="ff4 ls9 ws15">, <span class="blank _4"> </span></span><span class="ls11 wsb">Sh<span class="blank _1"> </span>igella <span class="ff4 ls9 ws15">, <span class="blank _7"> </span></span><span class="ls4 ws3">Pr<span class="blank _0"></span>oteus<span class="ff4 ls21 ws15">, <span class="blank _4"> </span></span><span class="ws38">Klebsiella<span class="ff4 ls21 ws15">, <span class="blank _4"> </span></span><span class="ws39">Y<span class="blank _0"></span>ersinia<span class="ff4 ls9 ws15">, </span></span></span></span></span></div><div class="t m0 x1b hd y158 ff8 fs5 fc0 sc0 ls4 ws3">Serratia<span class="ff4 ls21 ws15">, <span class="blank _f"> </span></span>Enterobacter<span class="ff4 ls21 ws15">, <span class="blank _f"> </span></span><span class="ls28 ws3a">Citrob ac ter <span class="ff4 ls21 ws15">, <span class="blank _f"> </span></span></span><span class="ws1e">Mo rganella<span class="ff4 ls21 ws15">, </span></span></div><div class="t m0 x1b hd y159 ff4 fs5 fc0 sc0 ls4 ws15">entre outros. </div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf9" class="pf w0 h0" data-page-no="9"><div class="pc pc9 w0 h0"><img fetchpriority="low" loading="lazy" class="bi x0 y15a w7 h34" alt src="https://files.passeidireto.com/e78ed9d7-0969-4804-95c1-3a92effc5fc9/bg9.png" alt="Pré-visualização de imagem de arquivo"><div class="c x1d yc1 w8 h1b"><div class="t m2 x1e h1c yc2 ff2 fs7 fc1 sc0 ls4 ws15">Aula 6<span class="ff4"> </span></div></div><div class="c x0 yc3 w9 h15"><div class="t m0 x1f h19 yc4 ff2 fs8 fc1 sc0 ls4 ws15">Infecção Urinária<span class="ff4"> </span></div></div><div class="t m0 x20 h2 y53 ff1 fs0 fc0 sc0 ls2a ws15"> <span class="ff2 fs8 lsd ws16">171</span><span class="ls4"> <span class="blank _8"> </span> </span></div><div class="t m0 x1 h2 y54 ff1 fs0 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h11 y239 ffb fs5 fc2 sc0 ls4 ws15">MORFOLOGIA </div><div class="t m0 x1 hd y8c ff4 fs5 fc0 sc0 ls4 ws15">As <span class="blank _3"> </span>Enterobacter<span class="ls7 ws19">ale<span class="blank _0"></span><span class="ls4 ws15">s <span class="blank _3"> </span>estão <span class="blank _3"> </span>entre <span class="blank _3"> </span>as <span class="blank _3"> </span>maiores <span class="blank _1"> </span>b<span class="blank _1"> </span>actér<span class="blank _0"></span>ias, </span></span></div><div class="t m0 x1 hd y8d ff4 fs5 fc0 sc0 ls4 ws15">medindo <span class="blank _3"> </span>entre <span class="blank _3"> </span>2<span class="blank _1"> </span> <span class="blank _3"> </span>a <span class="blank _3"> </span>4<span class="blank _1"> </span> <span class="blank _6"> </span><span class="ffd fs4 ws3b"></span>m <span class="blank _3"> </span>de <span class="blank _6"> </span>comprime<span class="blank _0"></span>nto <span class="blank _6"> </span>com <span class="blank _6"> </span>lados </div><div class="t m0 x1 hd y8e ff4 fs5 fc0 sc0 ls4 ws15">paralelos <span class="blank _9"> </span>e <span class="blank _9"> </span>terminações <span class="blank _9"> </span>arredondadas. <span class="blank _9"> </span>As <span class="blank _9"> </span>formas </div><div class="t m0 x1 hd y8f ff4 fs5 fc0 sc0 ls4 ws15">variam <span class="blank _3"> </span>desde <span class="blank _3"> </span>gr<span class="blank _0"></span>andes <span class="blank _3"> </span>cocobacilos <span class="blank _3"> </span>a <span class="blank _1"> </span>b<span class="blank _1"> </span>acilo<span class="blank _0"></span>s <span class="blank _3"> </span>longos <span class="blank _3"> </span>e </div><div class="t m0 x1 hd y90 ff4 fs5 fc0 sc0 ls4 ws15">filamentosos. <span class="blank _7"> </span>O<span class="blank _0"></span>s <span class="blank _7"> </span>orga<span class="blank _0"></span>nismos <span class="blank _7"> </span>não <span class="blank _4"> </span>formam <span class="blank _7"> </span>esporos </div><div class="t m0 x1 hd y91 ff4 fs5 fc0 sc0 ls4 ws15">nem são resistente<span class="blank _0"></span>s ao áci<span class="ls6 wsd">do.<span class="blank _0"></span><span class="ls4 ws15"> </span></span></div><div class="t m0 x9 hd y92 ff4 fs5 fc0 sc0 ls4 ws15">As Enterobacter<span class="ls7 ws19">al<span class="blank _0"></span>e<span class="ls4 ws15">s crescem rapidame<span class="blank _0"></span>nte em meios </span></span></div><div class="t m0 x1 hd y93 ff4 fs5 fc0 sc0 ls4 ws15">simples, <span class="blank _1"> </span>produzindo <span class="blank _1"> </span>colónias <span class="blank _1"> </span>de <span class="blank _1"> </span>2-5<span class="blank _1"> </span> <span class="blank _1"> </span>mm <span class="blank _1"> </span>em <span class="blank _1"> </span>gelose <span class="blank _1"> </span>e </div><div class="t m0 x1 hd y94 ff4 fs5 fc0 sc0 ls4 ws15">turbidez <span class="blank _3"> </span>difusa <span class="blank _3"> </span>em <span class="blank _3"> </span>meios <span class="blank _3"> </span>líquidos <span class="blank _3"> </span>às <span class="blank _3"> </span>12<span class="blank _1"> </span>-18 <span class="blank _3"> </span>horas <span class="blank _3"> </span>de </div><div class="t m0 x1 hd y95 ff4 fs5 fc0 sc0 ls2 ws15">incuba<span class="blank _0"></span>ção. <span class="ls4"> </span></div><div class="t m0 x1 hd y96 ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h11 y23a ffb fs5 fc2 sc0 ls4 ws15">ESTRUTURA </div><div class="t m0 x1 hd y98 ff4 fs5 fc0 sc0 ls4 ws15">A <span class="blank _3"> </span>parede <span class="blank _1"> </span>c<span class="blank _1"> </span>elular, <span class="blank _3"> </span>a <span class="blank _3"> </span>membra<span class="blank _0"></span>na <span class="blank _3"> </span>celular <span class="blank _3"> </span>e <span class="blank _3"> </span>as <span class="blank _3"> </span>estruturas </div><div class="t m0 x1 hd y99 ff4 fs5 fc0 sc0 ls4 ws15">internas <span class="blank _1"> </span>são <span class="blank _1"> </span>morfologicamente <span class="blank _1"> </span>seme<span class="blank _0"></span>lhantes <span class="blank _1"> </span>dentro <span class="blank _1"> </span>da </div><div class="t m0 x1 hd y9a ff4 fs5 fc0 sc0 ls4 ws15">família, <span class="blank _3"> </span>e <span class="blank _3"> </span>seguem <span class="blank _3"> </span>o <span class="blank _3"> </span>plano <span class="blank _6"> </span>geral <span class="blank _3"> </span>das <span class="blank _6"> </span>bactérias <span class="blank _3"> </span>Gram-<span class="ls21"> </span></div><div class="t m0 x1 hd y9b ff4 fs5 fc0 sc0 ls4 ws3">-<span class="ls6 wsd">neg<span class="blank _0"></span>ativo<span class="ls4 ws15">. <span class="blank _4"> </span>Os <span class="blank _4"> </span>compo<span class="blank _0"></span>nentes <span class="blank _4"> </span>da <span class="blank _4"> </span>pare<span class="blank _0"></span>de <span class="blank _4"> </span>e <span class="blank _4"> </span>superfície </span></span></div><div class="t m0 x1 hd y9c ff4 fs5 fc0 sc0 ls4 ws15">celulare<span class="blank _0"></span>s, q<span class="blank _1"> </span>ue são antigénicos, formam a base dos </div><div class="t m0 x1 hd yd7 ff4 fs5 fc0 sc0 ls4 ws15">sistemas que d<span class="blank _1"> </span>ividem as espécies em serotipos. <span class="blank _4"> </span>O </div><div class="t m0 x1 hd y9e ff4 fs5 fc0 sc0 ls4 ws15">lipopolissacárido <span class="blank _3"> </span>da <span class="blank _3"> </span>membrana <span class="blank _3"> </span>externa <span class="blank _6"> </span>(LPS) <span class="blank _3"> </span>é <span class="blank _3"> </span>c<span class="blank _1"> </span>ha-</div><div class="t m0 x1 hd y9f ff4 fs5 fc0 sc0 ls4 ws15">mado <span class="blank _3"> </span>o <span class="blank _3"> </span><span class="ff2 ls6">an<span class="blank _0"></span>tigén<span class="blank _0"></span>io <span class="blank _1"> </span>O<span class="ff4 ls4">. <span class="blank _3"> </span>Os <span class="blank _3"> </span>polissacári<span class="blank _0"></span>dos <span class="blank _1"> </span>d<span class="blank _1"> </span>a <span class="blank _3"> </span>super<span class="blank _0"></span>fície </span></span></div><div class="t m0 x1 hd ya0 ff4 fs5 fc0 sc0 ls4 ws15">celular <span class="blank _6"> </span>podem <span class="blank _6"> </span>formar <span class="blank _5"> </span>u<span class="blank _0"></span>ma <span class="blank _6"> </span>cápsula <span class="blank _6"> </span>bem <span class="blank _5"> </span>def<span class="blank _0"></span>inida <span class="blank _6"> </span>ou </div><div class="t m0 x1 hd ya1 ff4 fs5 fc0 sc0 ls4 ws15">uma <span class="blank _1"> </span>camada <span class="blank _1"> </span>amorf<span class="blank _0"></span>a <span class="blank _1"> </span>de <span class="blank _1"> </span>biofilme, <span class="blank _1"> </span>e são <span class="blank _1"> </span>ch<span class="blank _1"> </span>amados <span class="blank _1"> </span><span class="ff2 lsd ws7">an<span class="ls4">-</span></span></div><div class="t m0 x1 hd ya2 ff2 fs5 fc0 sc0 ls1f ws15">tigénio <span class="blank _3"> </span>K<span class="ff4 ls4">. <span class="blank _3"> </span>As <span class="blank _1"> </span>estirpes <span class="blank _3"> </span>móveis <span class="blank _1"> </span>t<span class="blank _1"> </span>êm <span class="blank _1"> </span>flagelos <span class="blank _1"> </span>perítricos </span></div><div class="t m0 x1 hd ya3 ff4 fs5 fc0 sc0 ls4 ws15">proteicos, <span class="blank _3"> </span>que <span class="blank _6"> </span>se <span class="blank _6"> </span>estendem <span class="blank _3"> </span>bem <span class="blank _6"> </span>para <span class="blank _6"> </span>fora <span class="blank _3"> </span>d<span class="blank _1"> </span>a <span class="blank _3"> </span>pa<span class="blank _1"> </span>rede<span class="blank _0"></span> </div><div class="t m0 x1 hd ya4 ff4 fs5 fc0 sc0 ls4 ws15">celular <span class="blank _5"> </span>e<span class="blank _0"></span> <span class="blank _5"> </span>que <span class="blank _5"> </span>são <span class="blank _5"> </span>chamados <span class="blank _6"> </span>o <span class="ff2 ls6">ant<span class="blank _0"></span>igén<span class="blank _0"></span>io <span class="blank _5"> </span>H<span class="ff4 ls4">. <span class="blank _6"> </span>Muitas </span></span></div><div class="t m0 x1 hd ya5 ff4 fs5 fc0 sc0 ls4 ws15">Enterobacterale<span class="blank _0"></span>s <span class="blank _4"> </span>têm <span class="blank _4"> </span>també<span class="blank _0"></span>m <span class="blank _4"> </span>fímbrias <span class="blank _4"> </span>superf<span class="blank _0"></span>ici<span class="ls8 ws1b">ai s</span><span class="ls9">, </span></div><div class="t m0 x1 hd ya6 ff4 fs5 fc0 sc0 ls4 ws15">que são proteínas antigé<span class="blank _0"></span>nicas, mas que<span class="blank _0"></span> não são usados </div><div class="t m0 x1 hd ya7 ff4 fs5 fc0 sc0 ls4 ws15">em nenhum esquema <span class="blank _0"></span>de tipagem. </div><div class="t m0 x1 hd ya8 ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h11 y23b ffb fs5 fc2 sc0 ls4 ws15">CLASSIFICAÇÃO<span class="blank _0"></span> </div><div class="t m0 x1 hd yaa ff4 fs5 fc0 sc0 ls4 ws15">A <span class="blank _5"> </span>designação <span class="blank _5"> </span>do <span class="blank _5"> </span>género<span class="blank _0"></span> <span class="blank _5"> </span>e <span class="blank _5"> </span>da espéc<span class="blank _0"></span>ie <span class="blank _5"> </span>baseia-se <span class="blank _5"> </span>em </div><div class="t m0 x1 hd yab ff4 fs5 fc0 sc0 ls4 ws15">características fenotípi<span class="blank _0"></span>cas, como padrõe<span class="blank _0"></span>s de <span class="blank _1"> </span>fer<span class="blank _0"></span>menta<span class="blank _1"> </span>-</div><div class="t m0 x1 hd yac ff4 fs5 fc0 sc0 ls4 ws15">ção <span class="blank _1"> </span>de <span class="blank _3"> </span>gl<span class="blank _0"></span>ícidos <span class="blank _3"> </span>e<span class="blank _0"></span> <span class="blank _3"> </span>cata<span class="blank _0"></span>bolismo <span class="blank _1"> </span>proteico. <span class="blank _1"> </span>Os <span class="blank _3"> </span>a<span class="blank _0"></span>ntigénios </div><div class="t m0 x1 hd yad ff4 fs5 fc0 sc0 ls4 ws15">O, K e H são usados para dividir algumas espécies e<span class="blank _0"></span>m </div><div class="t m0 x1 hd yae ff4 fs5 fc0 sc0 ls4 ws15">vários serotipos. Esses tipos <span class="blank _1"> </span>são<span class="blank _0"></span> expressos com a <span class="blank _1"> </span>le<span class="blank _0"></span>tra </div><div class="t m0 x1 hd yaf ff4 fs5 fc0 sc0 ls4 ws15">e <span class="blank _1"> </span>o <span class="blank _3"> </span>número <span class="blank _1"> </span>do <span class="blank _3"> </span>a<span class="blank _0"></span>ntigénio <span class="blank _1"> </span>específico, <span class="blank _1"> </span>como <span class="blank _1"> </span>em <span class="blank _3"> </span><span class="ff8 ws3">Esche-</span></div><div class="t m0 x1 hd yb0 ff8 fs5 fc0 sc0 ls4 ws15">richia coli<span class="ff4"> O1<span class="blank _0"></span>57:H7. Estas desig<span class="blank _0"></span>nações <span class="blank _5"> </span>anti<span class="blank _1"> </span>gé<span class="blank _0"></span>nicas </span></div><div class="t m0 x1 hd yb1 ff4 fs5 fc0 sc0 ls4 ws15">estão <span class="blank _3"> </span>estabelecidas <span class="blank _3"> </span>apenas <span class="blank _3"> </span>para <span class="blank _3"> </span>as <span class="blank _3"> </span>espé<span class="blank _0"></span>cies <span class="blank _3"> </span>mais <span class="blank _3"> </span>im<span class="blank _1"> </span>-</div><div class="t m0 x1 hd yb2 ff4 fs5 fc0 sc0 ls6 wsd">porta<span class="blank _0"></span>n<span class="ls2 ws2">tes<span class="ls4 ws15">. </span></span></div><div class="t m0 x1 hd yb3 ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h11 y23c ffb fs5 fc2 sc0 ls4 ws15">TOXINAS </div><div class="t m0 x1 hd yb5 ff4 fs5 fc0 sc0 ls4 ws15">Além <span class="blank _9"> </span>d<span class="blank _1"> </span>a <span class="blank _d"> </span><span class="ff2">endotoxina <span class="blank _d"> </span>(LPS)</span> <span class="blank _d"> </span>c<span class="blank _1"> </span>om<span class="blank _0"></span>um <span class="blank _d"> </span>a <span class="blank _e"> </span>todas <span class="blank _9"> </span>as </div><div class="t m0 x1 hd yb6 ff4 fs5 fc0 sc0 ls4 ws15">bactérias Gram-negativas, algumas Enterobacter<span class="ls7 ws19">ale</span><span class="ls3f">s </span></div><div class="t m0 x1 hd y80 ff4 fs5 fc0 sc0 ls4 ws15">também <span class="blank _1"> </span>produzem <span class="blank _1"> </span><span class="ff2">exotoxinas <span class="blank _1"> </span>proteicas</span><span class="ls7">, <span class="blank _1"> </span>que <span class="blank _1"> </span>actuam </span></div><div class="t m0 x1 hd yb7 ff4 fs5 fc0 sc0 ls4 ws15">na maioria <span class="blank _5"> </span>das células ao dan<span class="blank _0"></span>ificar as membran<span class="blank _0"></span>as, </div><div class="t m0 x1 hd yb8 ff4 fs5 fc0 sc0 ls4 ws15">inibir a<span class="blank _1"> </span> síntese p<span class="blank _1"> </span>roteica ou <span class="blank _1"> </span>alterar vias <span class="blank _1"> </span>metabólicas. O </div><div class="t m0 x1 hd yb9 ff4 fs5 fc0 sc0 ls4 ws15">resultado <span class="blank _1"> </span>final <span class="blank _1"> </span>destas <span class="blank _1"> </span>acções <span class="blank _1"> </span>p<span class="blank _1"> </span>ode <span class="blank _1"> </span>ser <span class="blank _1"> </span>a <span class="blank _3"> </span>morte <span class="blank _1"> </span>celular </div><div class="t m0 x1 hd yd8 ff4 fs5 fc0 sc0 ls4 ws3">(<span class="ff2 ls7 ws3c">citotox<span class="blank _0"></span>ina<span class="ff4 ls4 ws15">) <span class="blank _3"> </span>ou <span class="blank _3"> </span>uma <span class="blank _1"> </span>alteração <span class="blank _3"> </span>fisiol<span class="blank _0"></span>ógica, <span class="blank _3"> </span>cujo <span class="blank _3"> </span>efe<span class="blank _0"></span>ito </span></span></div><div class="t m0 x1 hd yba ff4 fs5 fc0 sc0 ls4 ws15">depende da célula atingida. Por exemplo, as <span class="ff2 ls7 ws3d">enteroto<span class="ls4">-</span></span></div><div class="t m0 x1 hd ybb ff2 fs5 fc0 sc0 ls11 ws3e">xinas <span class="ff4 ls4 ws15"> <span class="blank _3"> </span>actuam <span class="blank _1"> </span>sobre <span class="blank _1"> </span>os <span class="blank _1"> </span>enterócitos <span class="blank _1"> </span>de <span class="blank _1"> </span>modo <span class="blank _1"> </span>a <span class="blank _3"> </span>aumen-</span></div><div class="t m0 x1 hd ybc ff4 fs5 fc0 sc0 ls2 ws2">tar<span class="ls4 ws15"> a <span class="blank _5"> </span>secreção de ág<span class="blank _0"></span>ua e<span class="blank _0"></span> ele<span class="blank _0"></span>ctrólitos para o <span class="blank _5"> </span>lúmen </span></div><div class="t m0 x1 hd ybd ff4 fs5 fc0 sc0 ls4 ws15">intestinal, causa<span class="blank _0"></span>ndo assim diarr<span class="blank _0"></span>eia. </div><div class="t m0 x9 hd ybe ff4 fs5 fc0 sc0 ls4 ws15">Muitos <span class="blank _6"> </span>dos <span class="blank _5"> </span>fac<span class="blank _0"></span>tores <span class="blank _6"> </span>de <span class="blank _5"> </span>v<span class="blank _0"></span>irulência <span class="blank _5"> </span>s<span class="blank _0"></span>ão <span class="blank _6"> </span>distribuídos </div><div class="t m0 x1 hd ybf ff4 fs5 fc0 sc0 ls4 ws15">de <span class="blank _6"> </span>uma <span class="blank _6"> </span>forma <span class="blank _6"> </span>complexa <span class="blank _6"> </span>e <span class="blank _6"> </span>sequencial <span class="blank _6"> </span>em <span class="blank _6"> </span>resposta <span class="blank _6"> </span>a </div><div class="t m0 x1b hd y8b ff4 fs5 fc0 sc0 ls4 ws15">pistas <span class="blank _4"> </span>am<span class="blank _0"></span>bientais. <span class="blank _4"> </span>Es<span class="blank _0"></span>ta <span class="blank _4"> </span><span class="ff2 ls8">regula<span class="blank _1"> </span>ção<span class="blank _1"> </span> d<span class="blank _1"> </span>a <span class="blank _4"> </span>viru<span class="blank _1"> </span>lência<span class="blank _1"> </span></span><span class="ls47"> <span class="ls9">é </span></span></div><div class="t m0 x1b hd y8c ff4 fs5 fc0 sc0 ls4 ws15">importante <span class="blank _7"> </span>para <span class="blank _7"> </span>produzir <span class="blank _7"> </span>cada <span class="blank _7"> </span>factor <span class="blank _7"> </span>exactamente </div><div class="t m0 x1b hd y8d ff4 fs5 fc0 sc0 ls4 ws15">quando ele<span class="blank _0"></span> é necessário. </div><div class="t m0 x1b hd y8e ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1b h11 y23d ffb fs5 fc2 sc0 ls4 ws15">EPIDEMIOLOGIA </div><div class="t m0 x1b hd y90 ff4 fs5 fc0 sc0 ls4 ws15">A <span class="blank _4"> </span>maioria <span class="blank _4"> </span>das <span class="blank _7"> </span>Enter<span class="blank _0"></span>obacter<span class="ls7 ws19">ale</span>s <span class="blank _4"> </span>coloniza <span class="blank _4"> </span>primaria-</div><div class="t m0 x1b hd y91 ff4 fs5 fc0 sc0 ls4 ws15">mente <span class="blank _3"> </span>o <span class="blank _1"> </span>tracto <span class="blank _3"> </span>gastrointestinal <span class="blank _1"> </span>i<span class="blank _1"> </span>nferio<span class="blank _0"></span>r <span class="blank _3"> </span>de <span class="blank _1"> </span>h<span class="blank _1"> </span>umanos <span class="blank _3"> </span>e </div><div class="t m0 x1b hd y92 ff4 fs5 fc0 sc0 ls4 ws15">animais. Muitas espéc<span class="blank _0"></span>ies sobrev<span class="blank _0"></span>ivem na natureza e vi-</div><div class="t m0 x1b hd y93 ff4 fs5 fc0 sc0 ls4 ws15">vem livremente <span class="blank _1"> </span>em <span class="blank _1"> </span>qualquer <span class="blank _1"> </span>lugar <span class="blank _1"> </span>onde <span class="blank _1"> </span>exista <span class="blank _1"> </span>água e </div><div class="t m0 x1b hd y94 ff4 fs5 fc0 sc0 ls4 ws15">fontes mínimas de energia. Nos humanos, são os prin<span class="blank _1"> </span>-</div><div class="t m0 x1b hd y95 ff4 fs5 fc0 sc0 ls4 ws15">cipais componentes facultat<span class="blank _0"></span>ivos da flora bacteriana </div><div class="t m0 x1b hd y96 ff4 fs5 fc0 sc0 ls4 ws15">intestinal, e também se<span class="blank _0"></span> encontram no tracto<span class="blank _0"></span> genital fe-</div><div class="t m0 x1b hd y97 ff4 fs5 fc0 sc0 ls4 ws15">minino <span class="blank _1"> </span>e <span class="blank _3"> </span>como<span class="blank _0"></span> <span class="blank _3"> </span>col<span class="blank _0"></span>onizadores <span class="blank _1"> </span>transitórios <span class="blank _1"> </span>da <span class="blank _1"> </span>p<span class="blank _1"> </span>el<span class="blank _0"></span>e. <span class="blank _3"> </span>A<span class="blank _0"></span>s </div><div class="t m0 x1b hd y98 ff4 fs5 fc0 sc0 ls4 ws15">Enterobacterale<span class="blank _0"></span>s são escassas no tract<span class="blank _1"> </span>o respira<span class="blank _0"></span>tório </div><div class="t m0 x1b hd y99 ff4 fs5 fc0 sc0 ls4 ws15">dos <span class="blank _5"> </span>indiv<span class="blank _0"></span>íduos <span class="blank _5"> </span>sau<span class="blank _0"></span>dáveis, <span class="blank _5"> </span>m<span class="blank _0"></span>as <span class="blank _5"> </span>os <span class="blank _6"> </span>seus <span class="blank _5"> </span>números <span class="blank _6"> </span>po<span class="blank _1"> </span>-</div><div class="t m0 x1b hd y9a ff4 fs5 fc0 sc0 ls4 ws15">dem <span class="blank _3"> </span>au<span class="blank _1"> </span>mentar <span class="blank _3"> </span>em <span class="blank _3"> </span>d<span class="blank _1"> </span>oe<span class="blank _0"></span>ntes <span class="blank _6"> </span>hospitalizados <span class="blank _3"> </span>com <span class="blank _6"> </span>doen-</div><div class="t m0 x1b hd y9b ff4 fs5 fc0 sc0 ls4 ws15">ças <span class="blank _6"> </span>crónicas <span class="blank _3"> </span>d<span class="blank _1"> </span>ebilita<span class="blank _0"></span>ntes. <span class="blank _6"> </span>A <span class="blank _6"> </span>espécie <span class="blank _6"> </span>mais <span class="blank _6"> </span>comum <span class="blank _6"> </span>na </div><div class="t m0 x1b hd y9c ff4 fs5 fc0 sc0 ls1f ws15">flora <span class="blank _3"> </span>indígena <span class="blank _3"> </span>é <span class="blank _3"> </span><span class="ff8 ls4">Esc<span class="blank _0"></span>herichia <span class="blank _1"> </span>coli<span class="ff4">, <span class="blank _3"> </span>se<span class="blank _0"></span>guida <span class="blank _1"> </span>pelas <span class="blank _3"> </span>espé-</span></span></div><div class="t m0 x1b hd yd7 ff4 fs5 fc0 sc0 ls4 ws15">cies <span class="blank _3"> </span>d<span class="blank _1"> </span>e <span class="blank _3"> </span><span class="ff8 ls13 ws3f">Klebsie<span class="blank _0"></span>lla<span class="ff4 ls9 ws15">, <span class="blank _6"> </span></span><span class="ls4 ws3">Proteus<span class="ff4 ls17 ws15"> <span class="ls9">e <span class="blank _3"> </span></span></span>Enterobacter<span class="ff4 ws15">. <span class="blank _6"> </span>As <span class="blank _3"> </span>espé-</span></span></span></div><div class="t m0 x1b hd y9e ff4 fs5 fc0 sc0 ls4 ws15">cies <span class="blank _5"> </span>de <span class="blank _5"> </span><span class="ff8 ls6">Sa<span class="blank _0"></span>lmone<span class="blank _0"></span>lla <span class="blank _5"> </span><span class="ff4 ls9">e <span class="blank _5"> </span></span><span class="ls11 ws1f">Shigella </span><span class="ff4 ls48"> <span class="ls6">não <span class="blank _5"> </span>são<span class="blank _0"></span> <span class="blank _5"> </span>cons<span class="blank _0"></span>ider<span class="blank _0"></span>adas<span class="blank _0"></span> </span></span></span></div><div class="t m0 x1b hd y9f ff4 fs5 fc0 sc0 ls4 ws15">membros normais <span class="blank _4"> </span>da flora comensal <span class="blank _4"> </span>humana, mas </div><div class="t m0 x1b hd ya0 ff4 fs5 fc0 sc0 ls4 ws15">estados de portado<span class="blank _0"></span>r podem ex<span class="blank _0"></span>istir. </div><div class="t m0 x1b hd ya1 ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1b h11 y23e ffb fs5 fc2 sc0 lse ws15">DOENÇAS<span class="blank _1"> </span> ASSOCIADAS<span class="ls4"> </span></div><div class="t m0 x1b hd ya3 ff4 fs5 fc0 sc0 ls4 ws15">As En<span class="blank _1"> </span>terobacteral<span class="blank _0"></span>es <span class="blank _4"> </span>são <span class="blank _4"> </span>o <span class="blank _4"> </span>grupo de <span class="blank _4"> </span>bactérias <span class="blank _4"> </span>que </div><div class="t m0 x1b hd ya4 ff4 fs5 fc0 sc0 ls4 ws15">produz a <span class="blank _1"> </span>maior variedade de in<span class="blank _1"> </span>fe<span class="blank _0"></span>cções, incluindo d<span class="blank _1"> </span>o<span class="blank _0"></span>is </div><div class="t m0 x1b hd ya5 ff4 fs5 fc0 sc0 ls4 ws15">dos <span class="blank _6"> </span>estados <span class="blank _6"> </span>infecciosos <span class="blank _6"> </span>mais <span class="blank _6"> </span>comuns, <span class="blank _6"> </span>a <span class="blank _5"> </span><span class="ls2">infec<span class="blank _0"></span>ção <span class="blank _3"> </span>do </span></div><div class="t m0 x1b hd ya6 ff4 fs5 fc0 sc0 ls2 ws15">tracto<span class="blank _0"></span> <span class="blank _1"> </span>urinár<span class="blank _0"></span>io e <span class="blank _1"> </span>a <span class="blank _1"> </span>diar<span class="blank _0"></span>reia aguda<span class="ls21">. <span class="blank _1"> </span><span class="ls4">Tê<span class="blank _0"></span>m <span class="blank _1"> </span>tendência para </span></span></div><div class="t m0 x1b hd ya7 ff4 fs5 fc0 sc0 ls4 ws15">tirar partido da <span class="blank _1"> </span>sua presença comum no ambiente e n<span class="blank _1"> </span>a </div><div class="t m0 x1b hd ya8 ff4 fs5 fc0 sc0 ls4 ws15">flora <span class="blank _1"> </span>normal <span class="blank _1"> </span>para <span class="blank _1"> </span>causar d<span class="blank _1"> </span>oença quando <span class="blank _1"> </span>têm <span class="blank _1"> </span>acesso <span class="blank _1"> </span>a </div><div class="t m0 x1b hd ya9 ff4 fs5 fc0 sc0 ls4 ws15">locais <span class="blank _3"> </span>normalme<span class="blank _0"></span>nte <span class="blank _3"> </span>e<span class="blank _0"></span>stéreis, <span class="blank _3"> </span>produzi<span class="blank _0"></span>ndo <span class="blank _3"> </span>assim <span class="blank _3"> </span><span class="ff2 ls2 ws2">in<span class="blank _0"></span>fec<span class="ls4">-</span></span></div><div class="t m0 x1b hd yaa ff2 fs5 fc0 sc0 ls4 ws15">ções <span class="blank _3"> </span>o<span class="blank _1"> </span>portun<span class="blank _0"></span>istas<span class="ff4">. <span class="blank _6"> </span>A <span class="blank _3"> </span>infecção <span class="blank _6"> </span>oportunista <span class="blank _3"> </span>típica <span class="blank _6"> </span>é <span class="blank _3"> </span>a </span></div><div class="t m0 x1b hd yab ff2 fs5 fc0 sc0 ls2 ws15">infecç<span class="blank _0"></span>ão <span class="blank _1"> </span>do <span class="blank _1"> </span>tract<span class="blank _0"></span>o <span class="blank _1"> </span>urinár<span class="blank _0"></span>io<span class="ff4 ls4">, <span class="blank _3"> </span>em <span class="blank _1"> </span>que <span class="blank _1"> </span>as <span class="blank _1"> </span>Enterobacte-</span></div><div class="t m0 x1b hd yac ff4 fs5 fc0 sc0 ls1f ws40">rale<span class="ls4 ws15">s <span class="blank _5"> </span>acedem <span class="blank _5"> </span>à <span class="blank _5"> </span>bex<span class="blank _0"></span>iga <span class="blank _5"> </span>através <span class="blank _5"> </span>de <span class="blank _5"> </span>traumas <span class="blank _5"> </span>me<span class="blank _0"></span>nores, </span></div><div class="t m0 x1b hd yad ff4 fs5 fc0 sc0 ls4 ws15">manuseamento de material médico, ou mesmo por </div><div class="t m0 x1b hd yae ff4 fs5 fc0 sc0 ls4 ws15">migração <span class="blank _3"> </span>desde <span class="blank _3"> </span>o <span class="blank _3"> </span>p<span class="blank _1"> </span>eríneo<span class="blank _0"></span>. <span class="blank _3"> </span>Da <span class="blank _6"> </span>mesma <span class="blank _3"> </span>forma, <span class="blank _3"> </span>trauma </div><div class="t m0 x1b hd yaf ff4 fs5 fc0 sc0 ls4 ws15">nas <span class="blank _5"> </span>m<span class="blank _0"></span>ucosas <span class="blank _6"> </span>ou <span class="blank _5"> </span>na <span class="blank _6"> </span>pele <span class="blank _6"> </span>pode <span class="blank _6"> </span>p<span class="blank _1"> </span>ermitir <span class="blank _6"> </span>o <span class="blank _6"> </span>a<span class="blank _1"> </span>cesso<span class="blank _0"></span> <span class="blank _5"> </span>ao<span class="blank _0"></span>s </div><div class="t m0 x1b hd yb0 ff4 fs5 fc0 sc0 ls4 ws15">tecidos <span class="blank _1"> </span>moles ou <span class="blank _1"> </span>a <span class="blank _3"> </span>aspiraç<span class="blank _0"></span>ão <span class="blank _1"> </span>para <span class="blank _1"> </span>o <span class="blank _1"> </span>pulmão. <span class="blank _1"> </span><span class="ls15">A <span class="blank _1"> </span>b<span class="blank _1"> </span>ac<span class="blank _1"> </span>te</span>-</div><div class="t m0 x1b hd yb1 ff4 fs5 fc0 sc0 ls4 ws15">riémia <span class="blank _3"> </span>também <span class="blank _1"> </span>é <span class="blank _3"> </span>uma <span class="blank _3"> </span>possibilidade, <span class="blank _1"> </span>e <span class="blank _3"> </span>nestes <span class="blank _3"> </span>casos <span class="blank _3"> </span>é </div><div class="t m0 x1b hd yb2 ff4 fs5 fc0 sc0 ls4 ws15">possível <span class="blank _1"> </span>qu<span class="blank _1"> </span>e <span class="blank _1"> </span>se <span class="blank _3"> </span>cause <span class="blank _1"> </span>uma <span class="blank _3"> </span>meningite<span class="blank _0"></span>, <span class="blank _3"> </span>principalme<span class="blank _0"></span>nte </div><div class="t m0 x1b hd yb3 ff4 fs5 fc0 sc0 ls4 ws15">em recé<span class="blank _0"></span>m-nascidos. </div><div class="t m0 x1c hd yb4 ff8 fs5 fc0 sc0 ls6 wsd">Salmo<span class="blank _0"></span>nell<span class="blank _0"></span>a<span class="ff4 ls49 ws15"> <span class="ls25">spp<span class="blank _1"> </span>., <span class="blank _1"> </span></span></span>Shig<span class="blank _0"></span>ella<span class="ff4 ls49 ws15"> <span class="ls25">spp, <span class="blank _1"> </span><span class="ff8 ls4">Yersinia enterocoli<span class="ls4a ws41">ti</span>-</span></span></span></div><div class="t m0 x1b hd yb5 ff8 fs5 fc0 sc0 ls29 ws24">ca<span class="ff4 ls4 ws15"> <span class="blank _1"> </span>e <span class="blank _1"> </span>certas <span class="blank _3"> </span>e<span class="blank _0"></span>stirpes <span class="blank _1"> </span>de <span class="blank _1"> </span><span class="ff8">Escherichia <span class="blank _1"> </span>coli</span> <span class="blank _1"> </span>p<span class="blank _1"> </span>odem <span class="blank _1"> </span>causar<span class="blank _0"></span> </span></div><div class="t m0 x1b hd yb6 ff2 fs5 fc0 sc0 ls4 ws15">infecções <span class="blank _1"> </span>intestinais<span class="ff4">. <span class="blank _1"> </span>Estes <span class="blank _1"> </span>agentes <span class="blank _1"> </span>têm <span class="blank _1"> </span>propriedades </span></div><div class="t m0 x1b hd y80 ff4 fs5 fc0 sc0 ls4 ws15">invasivas <span class="blank _3"> </span>ou <span class="blank _1"> </span>factores <span class="blank _3"> </span>de <span class="blank _1"> </span>virulência, <span class="blank _3"> </span>como <span class="blank _1"> </span>ci<span class="blank _1"> </span>totoxinas </div><div class="t m0 x1b hd yb7 ff4 fs5 fc0 sc0 ls4 ws15">e <span class="blank _3"> </span>enterotoxinas, <span class="blank _3"> </span>que <span class="blank _3"> </span>se <span class="blank _3"> </span>correlacionam <span class="blank _3"> </span>com <span class="blank _6"> </span>o <span class="blank _3"> </span>tipo <span class="blank _6"> </span>de </div><div class="t m0 x1b hd yb8 ff4 fs5 fc0 sc0 ls4 ws15">diarreia qu<span class="blank _1"> </span>e causam. <span class="blank _1"> </span>Em geral, <span class="blank _1"> </span>as <span class="blank _1"> </span>estirpes invasivas <span class="blank _1"> </span>e </div><div class="t m0 x1b hd yb9 ff4 fs5 fc0 sc0 ls4 ws15">citotóxicas <span class="blank _6"> </span>produzem <span class="blank _6"> </span>uma <span class="blank _6"> </span>diarreia <span class="blank _6"> </span>inflamatória <span class="blank _6"> </span>cha<span class="blank _1"> </span>-</div><div class="t m0 x1b hd yd8 ff4 fs5 fc0 sc0 ls4 ws15">mada <span class="ff2 ws42">disenteria</span>, com le<span class="blank _0"></span>ucócitos e possivelme<span class="blank _0"></span>nte san-</div><div class="t m0 x1b hd yba ff4 fs5 fc0 sc0 ls4 ws15">gue nas <span class="blank _1"> </span>feze<span class="blank _0"></span>s. <span class="blank _1"> </span>A<span class="blank _0"></span>s <span class="blank _1"> </span>estirpes produtoras de enterotoxinas </div><div class="t m0 x1b hd ybb ff4 fs5 fc0 sc0 ls4 ws15">causam uma <span class="blank _4"> </span><span class="ff2 lsc">diarreia <span class="blank _4"> </span>aquosa</span><span class="ls47"> <span class="ls11">na<span class="blank _1"> </span> <span class="blank _4"> </span>q<span class="ls6">ual<span class="blank _0"></span> a <span class="blank _4"> </span>per<span class="blank _0"></span>da de </span></span></span></div><div class="t m0 x1b hd ybc ff4 fs5 fc0 sc0 ls4 ws15">fluidos <span class="blank _3"> </span>é <span class="blank _3"> </span>a <span class="blank _3"> </span>princi<span class="blank _0"></span>pal <span class="blank _3"> </span>característ<span class="blank _0"></span>ica. <span class="blank _3"> </span>Algumas <span class="blank _3"> </span>estir<span class="blank _0"></span>pes, </div><div class="t m0 x1b hd ybd ff4 fs5 fc0 sc0 ls4 ws15">como <span class="blank _6"> </span><span class="ff8 ls6 wsd">Salmone<span class="blank _0"></span>lla<span class="ff4 ls4 ws15"> <span class="blank _6"> </span>Typhi, <span class="blank _6"> </span>têm <span class="blank _5"> </span>aind<span class="blank _0"></span>a <span class="blank _6"> </span>a <span class="blank _5"> </span>capacida<span class="blank _0"></span>de <span class="blank _6"> </span>d<span class="blank _1"> </span>e </span></span></div><div class="t m0 x1b hd ybe ff4 fs5 fc0 sc0 ls4 ws15">invadir o organismo a<span class="blank _0"></span>través da mucosa intest<span class="blank _0"></span>inal, cau-</div><div class="t m0 x1b hd ybf ff4 fs5 fc0 sc0 ls4 ws15">sando danos em v<span class="blank _0"></span>ários órgãos. </div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pfa" class="pf w0 h0" data-page-no="a"><div class="pc pca w0 h0"><img fetchpriority="low" loading="lazy" class="bi x15 y23f w1 h3c" alt src="https://files.passeidireto.com/e78ed9d7-0969-4804-95c1-3a92effc5fc9/bga.png" alt="Pré-visualização de imagem de arquivo"><div class="c x16 y4f w5 h13"><div class="t m1 x17 h14 y50 ff2 fs7 fc1 sc0 ls4 ws15">Aula 6 </div></div><div class="c xb y51 w6 h15"><div class="t m0 x18 h16 y52 ff2 fs8 fc1 sc0 ls4 ws15">Infecção Urinária </div></div><div class="t m0 x19 h16 y53 ff2 fs8 fc0 sc0 lsd ws16">172<span class="ls4 ws15"> </span></div><div class="t m0 x1 h2 y54 ff1 fs0 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h11 y239 ffb fs5 fc2 sc0 ls4 ws15">DIAGNÓSTICO<span class="blank _0"></span> </div><div class="t m0 x1 hd y8c ff4 fs5 fc0 sc0 ls4 ws15">A <span class="blank _1"> </span>cultura <span class="blank _3"> </span>é <span class="blank _1"> </span>o <span class="blank _3"> </span>mé<span class="blank _0"></span>todo <span class="blank _1"> </span>p<span class="blank _1"> </span>rimário <span class="blank _1"> </span>de <span class="blank _3"> </span>di<span class="blank _0"></span>agnóstico. <span class="blank _1"> </span>Todas </div><div class="t m0 x1 hd y8d ff4 fs5 fc0 sc0 ls4 ws15">as <span class="blank _9"> </span>Enterobacter<span class="ls7 ws19">ale</span>s <span class="blank _7"> </span>são <span class="blank _d"> </span>rapidamente <span class="blank _7"> </span>i<span class="blank _1"> </span>soladas <span class="blank _9"> </span>nos </div><div class="t m0 x1 hd y8e ff4 fs5 fc0 sc0 ls4 ws15">meios <span class="blank _1"> </span>de <span class="blank _3"> </span>rotina <span class="blank _1"> </span>em <span class="blank _3"> </span>quase <span class="blank _1"> </span>quaisquer <span class="blank _1"> </span>condições <span class="blank _3"> </span>de <span class="blank _1"> </span>in<span class="blank _1"> </span>-</div><div class="t m0 x1 hd y8f ff4 fs5 fc0 sc0 ls4 ws15">cubação. <span class="blank _1"> </span>Meios <span class="blank _3"> </span>selectivos <span class="blank _1"> </span>como <span class="blank _3"> </span>o <span class="blank _1"> </span>meio <span class="blank _3"> </span>de <span class="blank _1"> </span>M<span class="blank _1"> </span>acCo<span class="blank _0"></span>n<span class="blank _1"> </span>-</div><div class="t m0 x1 hd y90 ff4 fs5 fc0 sc0 ls4 ws15">key <span class="blank _3"> </span>são <span class="blank _6"> </span>c<span class="blank _1"> </span>omummente <span class="blank _3"> </span>usados <span class="blank _3"> </span>p<span class="blank _1"> </span>ara <span class="blank _3"> </span>o <span class="blank _6"> </span>i<span class="blank _1"> </span>solame<span class="blank _0"></span>nto <span class="blank _6"> </span>pri<span class="blank _1"> </span>-</div><div class="t m0 x1 hd y91 ff4 fs5 fc0 sc0 ls4 ws15">mário e <span class="blank _4"> </span>para<span class="blank _0"></span> separar <span class="blank _4"> </span>r<span class="blank _0"></span>apidamente as espécies. Por </div><div class="t m0 x1 hd y92 ff4 fs5 fc0 sc0 ls4 ws15">exemplo, <span class="blank _1"> </span>as <span class="blank _1"> </span>espécies <span class="blank _1"> </span>de <span class="blank _1"> </span><span class="ff8 ls13 ws3f">Klebsiell<span class="blank _0"></span>a<span class="ff4 ls18 ws15"> <span class="ls9">e <span class="blank _3"> </span><span class="ff8 ls4">Escherichi<span class="blank _0"></span>a <span class="blank _1"> </span>coli<span class="ff4"> </span></span></span></span></span></div><div class="t m0 x1 hd y93 ff4 fs5 fc0 sc0 ls4 ws15">tipicamente ferme<span class="blank _0"></span>ntam lactose e formam colónias áci-</div><div class="t m0 x1 hd y94 ff4 fs5 fc0 sc0 ls4 ws15">das <span class="blank _3"> </span>(o <span class="blank _1"> </span>meio <span class="blank _1"> </span>torna-se <span class="blank _1"> </span>rosado) <span class="blank _1"> </span>n<span class="blank _1"> </span>este<span class="blank _0"></span> <span class="blank _3"> </span>m<span class="blank _0"></span>eio, <span class="blank _1"> </span>enquanto <span class="blank _1"> </span>as </div><div class="t m0 x1 hd y95 ff4 fs5 fc0 sc0 ls4 ws15">espécies de <span class="ff8 ls6 wsd">Shigella</span><span class="ls49"> <span class="ls8">e de <span class="blank _1"> </span><span class="ff8 ls6 ws43">Salmone<span class="blank _0"></span>lla<span class="ff4 ls4 ws15"> não <span class="blank _1"> </span>o fazem, e o<span class="blank _1"> </span> </span></span></span></span></div><div class="t m0 x1 hd y96 ff4 fs5 fc0 sc0 ls4 ws15">meio permanece amarelo. Outros meios, como o <span class="blank _1"> </span>meio </div><div class="t m0 x1 hd y97 ff8 fs5 fc0 sc0 ls6 wsd">Salmo<span class="blank _0"></span>nell<span class="blank _0"></span>a<span class="ls4 ws3">-<span class="ls11 ws15">Shigell<span class="blank _1"> </span>a <span class="blank _1"> </span><span class="ff4 ls4">(SS) p<span class="blank _1"> </span>ermitem distinguir <span class="blank _1"> </span>est<span class="blank _0"></span>irpes </span></span></span></div><div class="t m0 x1 hd y98 ff4 fs5 fc0 sc0 ls4 ws15">pela <span class="blank _1"> </span>sua <span class="blank _1"> </span>capacidade de <span class="blank _1"> </span>produzir <span class="blank _1"> </span>sulfureto d<span class="blank _1"> </span>e hi<span class="blank _1"> </span>drogé-</div><div class="t m0 x1 hd y99 ff4 fs5 fc0 sc0 ls4 ws15">nio <span class="blank _6"> </span>através <span class="blank _5"> </span>d<span class="blank _0"></span>a <span class="blank _6"> </span>produção <span class="blank _6"> </span>de <span class="blank _5"> </span>um <span class="blank _3"> </span>p<span class="blank _1"> </span>ig<span class="blank _0"></span>mento <span class="blank _6"> </span>preto. <span class="blank _5"> </span>Por<span class="blank _0"></span> </div><div class="t m0 x1 hd y9a ff4 fs5 fc0 sc0 ls4 ws15">exemplo, grande parte das estirpes d<span class="blank _1"> </span>e <span class="ff8 ls6">Salmo<span class="blank _0"></span>nell<span class="blank _0"></span>a <span class="ff4 wsd">pro<span class="ls4">-</span></span></span></div><div class="t m0 x1 hd y9b ff4 fs5 fc0 sc0 ls4 ws15">duz <span class="blank _1"> </span>tal <span class="blank _1"> </span>composto, <span class="blank _1"> </span>ao <span class="blank _1"> </span>contrário <span class="blank _1"> </span>das <span class="blank _1"> </span>estirpes <span class="blank _1"> </span>de <span class="blank _1"> </span><span class="ff8 ls11 wsa">Sh ig el <span class="ls4">-</span></span></div><div class="t m0 x1 hd y9c ff8 fs5 fc0 sc0 ls1d ws17">la<span class="ff4 ls3">.</span><span class="ls4b ws15"> <span class="ff4 ls4">Meios <span class="blank _5"> </span>altamente <span class="blank _5"> </span>selectivos <span class="blank _5"> </span>são <span class="blank _5"> </span>necessários <span class="blank _5"> </span>para </span></span></div><div class="t m0 x1 hd yd7 ff4 fs5 fc0 sc0 ls4 ws15">distinguir <span class="blank _3"> </span>os <span class="blank _3"> </span>agente<span class="blank _0"></span>s <span class="blank _3"> </span>patogénicos <span class="blank _3"> </span>inte<span class="blank _0"></span>stinais <span class="blank _3"> </span>entre <span class="blank _3"> </span>to-</div><div class="t m0 x1 hd y9e ff4 fs5 fc0 sc0 ls4 ws15">das as Entero<span class="blank _0"></span>bacter<span class="ls7 ws19">ale<span class="ls36 ws2e">s.</span></span> </div><div class="t m0 x9 hd y9f ff4 fs5 fc0 sc0 ls4 ws15">As Enterobacterales p<span class="blank _1"> </span>odem ser <span class="blank _1"> </span>distinguidas entre <span class="blank _1"> </span>si </div><div class="t m0 x1 hd ya0 ff4 fs5 fc0 sc0 ls4 ws15">através <span class="blank _1"> </span>de <span class="blank _1"> </span>vários <span class="blank _1"> </span>testes <span class="blank _1"> </span>bioquímicos, <span class="blank _1"> </span>que <span class="blank _1"> </span>h<span class="blank _1"> </span>oje <span class="blank _1"> </span>em <span class="blank _1"> </span>dia </div><div class="t m0 x1 hd ya1 ff4 fs5 fc0 sc0 ls4 ws15">se <span class="blank _1"> </span>processam <span class="blank _3"> </span>com <span class="blank _1"> </span>uma <span class="blank _3"> </span>rapidez<span class="blank _0"></span> <span class="blank _3"> </span>suficie<span class="blank _0"></span>nte <span class="blank _3"> </span>para <span class="blank _1"> </span>tornar </div><div class="t m0 x1 hd ya2 ff4 fs5 fc0 sc0 ls4 ws15">tal procedimento <span class="blank _0"></span>prático no dia-a-<span class="ls6 wsd">dia<span class="blank _0"></span>.<span class="ls4 ws15"> </span></span></div><div class="t m0 x9 h3d ya3 ff8 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x9 hd ya4 ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x2b h14 y240 ff2 fs7 fc1 sc0 ls37 ws15">Men<span class="blank _0"></span>s<span class="blank _0"></span>ag<span class="blank _0"></span>en<span class="blank _0"></span>s<span class="blank _0"></span> a<span class="blank _0"></span> R<span class="blank _0"></span>et<span class="blank _0"></span>er<span class="ls4"> </span></div><div class="t m0 x1 h17 y241 ff2 fs6 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1 h10 y242 ff2 fs5 fc0 sc0 ls4 ws15">Ordem Enterob<span class="blank _0"></span>acterales </div><div class="t m0 x1 he y243 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">São bacilos G<span class="blank _0"></span>ram-negativo que po<span class="blank _0"></span>dem viver </span></span></div><div class="t m0 x9 hd y244 ff4 fs5 fc0 sc0 ls4 ws15">livremente ou se<span class="blank _0"></span>r parte da flora come<span class="blank _0"></span>nsal de </div><div class="t m0 x9 hd y245 ff4 fs5 fc0 sc0 ls4 ws15">humanos e outros a<span class="blank _0"></span>nimais. </div><div class="t m0 x1 he y1d3 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">Inclui vários gé<span class="blank _0"></span>neros medicame<span class="blank _0"></span>nte importantes, </span></span></div><div class="t m0 x9 hd y1d4 ff4 fs5 fc0 sc0 ls4 ws15">como <span class="ff8 ws44">Escherichi<span class="blank _0"></span>a<span class="ff4 ls21 ws15">, </span><span class="ls11 ws1f">Salmone ll a<span class="ff4 ls21 ws15">, </span><span class="ls13 wsf">Klebsi<span class="blank _0"></span>ella<span class="ff4 ls9 ws15">, </span><span class="ls11 wsb">Shige ll a<span class="ff4 ls4 ws15"> </span></span></span></span></span></div><div class="t m0 x9 hd y246 ff4 fs5 fc0 sc0 ls9 ws15">e <span class="ff8 ls4 ws3">Proteus</span><span class="ls4">, entre muitos outro<span class="blank _0"></span>s. </span></div><div class="t m0 x1 he y247 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">Ferme<span class="blank _0"></span>ntam a glicose e, com raras e<span class="blank _0"></span>xcepçõe<span class="blank _0"></span>s, são </span></span></div><div class="t m0 x9 hd y248 ff4 fs5 fc0 sc0 ls4 ws3">oxidase-<span class="ls6 wsd">neg<span class="blank _0"></span>ativas<span class="blank _0"></span><span class="ls3 ws15"> <span class="ls8">e red<span class="blank _1"> </span>uz<span class="ls4">em nitratos e<span class="blank _0"></span> nitritos. </span></span></span></span></div><div class="t m0 x1 he y249 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">Crescem rapidame<span class="blank _0"></span>nte em meios simpl<span class="blank _0"></span>es, em </span></span></div><div class="t m0 x9 hd y24a ff4 fs5 fc0 sc0 ls4 ws15">condições de ae<span class="blank _0"></span>robiose ou de an<span class="blank _0"></span>aerobiose. </div><div class="t m0 x1 he y42 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">O LPS é<span class="blank _0"></span> chamado antigénio O, os <span class="blank _0"></span>polissacáridos d<span class="blank _0"></span>a </span></span></div><div class="t m0 x9 hd y24b ff4 fs5 fc0 sc0 ls4 ws15">cápsula ou biofilme<span class="blank _0"></span> são chama<span class="blank _0"></span>dos antigénio K<span class="blank _0"></span>, e os </div><div class="t m0 x9 hd y24c ff4 fs5 fc0 sc0 ls4 ws15">flagelos (pre<span class="blank _0"></span>sentes apenas nas e<span class="blank _0"></span>stirpes móve<span class="blank _0"></span>is) são </div><div class="t m0 x9 hd y24d ff4 fs5 fc0 sc0 ls4 ws15">chamados antigé<span class="blank _0"></span>nio H. Estes antigé<span class="blank _0"></span>nios são usados </div><div class="t m0 x9 hd y24e ff4 fs5 fc0 sc0 ls4 ws15">em combinação <span class="blank _0"></span>num sistema de t<span class="blank _0"></span>ipagem que </div><div class="t m0 x9 hd y24f ff4 fs5 fc0 sc0 ls4 ws15">permite disting<span class="blank _0"></span>uir vários sero<span class="blank _0"></span>tipos numa única </div><div class="t m0 x9 hd y38 ff4 fs5 fc0 sc0 ls4 ws15">espécie. </div><div class="t m0 x1 he y250 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">Produzem v<span class="blank _0"></span>árias exotoxinas protei<span class="blank _0"></span>cas, entre el<span class="blank _0"></span>as </span></span></div><div class="t m0 x9 hd y251 ff4 fs5 fc0 sc0 ls7 ws15">citotox<span class="blank _0"></span>inas e e<span class="blank _0"></span>ntero<span class="blank _0"></span>toxinas.<span class="ls4"> </span></div><div class="t m0 x1 he y153 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">Colonizam o intest<span class="blank _0"></span>ino de humanos e v<span class="blank _0"></span>ários animais, </span></span></div><div class="t m0 x9 hd y252 ff4 fs5 fc0 sc0 ls4 ws15">a partir de onde po<span class="blank _0"></span>dem atingir os l<span class="blank _0"></span>ocais onde </div><div class="t m0 x9 hd y253 ff4 fs5 fc0 sc0 ls4 ws15">causam doença. </div><div class="t m0 x1 he y254 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> </span><span class="ff8 ls6 wsd">Salmo<span class="blank _0"></span>nell<span class="blank _0"></span>a<span class="ff4 ls3 ws15"> <span class="ls9">e </span></span>Shigel<span class="blank _0"></span>la<span class="ff4 ls4 ws15"> não pe<span class="blank _0"></span>rtencem à flo<span class="blank _0"></span>ra </span></span></div><div class="t m0 x9 hd y255 ff4 fs5 fc0 sc0 ls4 ws15">comensal human<span class="blank _0"></span>a, mas podem ex<span class="blank _0"></span>istir estados <span class="blank _0"></span>de </div><div class="t m0 x9 hd y256 ff4 fs5 fc0 sc0 ls6 wsd">porta<span class="blank _0"></span>dor.<span class="ls4 ws15"> </span></div><div class="t m0 x1b he y126 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">Causam um espe<span class="blank _0"></span>ctro muito alarg<span class="blank _0"></span>ado de doenças. A<span class="blank _0"></span>s </span></span></div><div class="t m0 x1c hd y127 ff4 fs5 fc0 sc0 ls4 ws15">principais são as<span class="blank _0"></span> infecções do tracto<span class="blank _0"></span> urinário e as </div><div class="t m0 x1c hd y128 ff4 fs5 fc0 sc0 ls4 ws15">infecções gastroi<span class="blank _0"></span>ntestinais, mas <span class="blank _0"></span>podem causar </div><div class="t m0 x1c hd y129 ff4 fs5 fc0 sc0 ls4 ws15">também infecçõ<span class="blank _0"></span>es da pele e<span class="blank _0"></span> tecidos mole<span class="blank _0"></span>s, </div><div class="t m0 x1c hd y12a ff4 fs5 fc0 sc0 ls4 ws15">pneumonias, me<span class="blank _0"></span>ningite, entre outr<span class="blank _0"></span>as. </div><div class="t m0 x1b he y257 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff4 ls4">A cultura é o méto<span class="blank _0"></span>do mais usa<span class="blank _0"></span>do para o </span></span></div><div class="t m0 x1c hd y220 ff4 fs5 fc0 sc0 ls4 ws15">diagnóstico. São<span class="blank _0"></span> frequentemen<span class="blank _0"></span>te usados meios </div><div class="t m0 x1c hd y12d ff4 fs5 fc0 sc0 ls4 ws15">selectivos e difere<span class="blank _0"></span>nciais como o meio<span class="blank _0"></span> de </div><div class="t m0 x1c hd y12e ff4 fs5 fc0 sc0 ls4 ws15">MacConkey<span class="blank _0"></span> e o meio SS, mas a i<span class="blank _0"></span>dentificação </div><div class="t m0 x1c hd y12f ff4 fs5 fc0 sc0 ls4 ws15">definitiva é fe<span class="blank _0"></span>ita com testes bio<span class="blank _0"></span>químicos. </div><div class="t m0 x1b hd y130 ff4 fs5 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1b h3e y258 ff4 fsd fc0 sc0 ls4 ws15"> </div><div class="t m0 x1b h14 y259 ff2 fs7 fc2 sc0 ls20 ws15">Ident<span class="blank _1"> </span>ificaçã<span class="blank _1"> </span>o <span class="ls4e">Bioquím<span class="blank _0"></span>ica <span class="ls4c">de </span></span></div><div class="t m0 x1b h14 y25a ff2 fs7 fc2 sc0 ls4f ws45">Entero ba c t er<span class="blank _1"> </span><span class="ls46 ws46">ale<span class="ls4 ws15">s<span class="blank _1"> </span> </span></span></div><div class="t m0 x1b h17 y25b ff2 fs6 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1b hd y25c ff4 fs5 fc0 sc0 ls4 ws15">No passado a identif<span class="blank _0"></span>icação dos bacilos G<span class="blank _0"></span>ram-<span class="ls6 wsd">neg<span class="blank _0"></span>ativo<span class="ls4 ws15"> </span></span></div><div class="t m0 x1b hd y25d ff4 fs5 fc0 sc0 ls4 ws15">baseava-se <span class="blank _3"> </span>na <span class="blank _3"> </span>realização <span class="blank _3"> </span>de <span class="blank _6"> </span>provas <span class="blank _3"> </span>bioquímicas, <span class="blank _3"> </span>que </div><div class="t m0 x1b hd y25e ff4 fs5 fc0 sc0 ls4 ws15">eram <span class="blank _3"> </span>realizadas <span class="blank _6"> </span>em <span class="blank _6"> </span>tubos <span class="blank _6"> </span>de <span class="blank _6"> </span>ensaio <span class="blank _3"> </span>e <span class="blank _6"> </span>por <span class="blank _6"> </span>isso <span class="blank _6"> </span>eram </div><div class="t m0 x1b hd y25f ff4 fs5 fc0 sc0 ls4 ws15">muito <span class="blank _5"> </span>demo<span class="blank _0"></span>radas. <span class="blank _5"> </span>Hoje <span class="blank _5"> </span>e<span class="blank _0"></span>m <span class="blank _5"> </span>dia <span class="blank _5"> </span>e<span class="blank _0"></span>xistem <span class="blank _5"> </span>me<span class="blank _0"></span>ios <span class="blank _5"> </span>mais </div><div class="t m0 x1b hd y260 ff4 fs5 fc0 sc0 ls4 ws15">rápidos, <span class="blank _3"> </span>que <span class="blank _3"> </span>passaram <span class="blank _3"> </span>pela <span class="blank _3"> </span>miniaturiz<span class="blank _0"></span>ação <span class="blank _3"> </span>dos <span class="blank _3"> </span>testes </div><div class="t m0 x1b hd y261 ff4 fs5 fc0 sc0 ls4 ws15">bioquímicos d<span class="blank _1"> </span>e modo <span class="blank _1"> </span>a <span class="blank _1"> </span>originar <span class="blank _1"> </span>placas <span class="blank _1"> </span>multiteste qu<span class="blank _1"> </span><span class="ls9">e </span></div><div class="t m0 x1b hd y262 ff4 fs5 fc0 sc0 ls4 ws15">poupam <span class="blank _1"> </span>muito <span class="blank _3"> </span>tempo <span class="blank _1"> </span>e <span class="blank _1"> </span>espaço. <span class="blank _3"> </span>Mais <span class="blank _1"> </span>tarde <span class="blank _3"> </span>fo<span class="blank _0"></span>ram <span class="blank _3"> </span>de-</div><div class="t m0 x1b hd y263 ff4 fs5 fc0 sc0 ls4 ws15">senvolv<span class="blank _0"></span>idos meios automáticos, e actualmente dispõe-</div><div class="t m0 x1b hd y264 ff4 fs5 fc0 sc0 ls4 ws15">-se <span class="blank _1"> </span>a<span class="blank _1"> </span>té <span class="blank _1"> </span>de <span class="blank _3"> </span>meios <span class="blank _3"> </span>de <span class="blank _1"> </span>amplificação <span class="blank _1"> </span>d<span class="blank _1"> </span>e <span class="blank _1"> </span>ácidos <span class="blank _3"> </span>nucleicos </div><div class="t m0 x1b hd y265 ff4 fs5 fc0 sc0 ls4 ws15">para este tipo de diagnósticos. A<span class="blank _0"></span>pesar de tudo, mesmo </div><div class="t m0 x1b hd y195 ff4 fs5 fc0 sc0 ls4 ws15">com <span class="blank _1"> </span>a <span class="blank _1"> </span>utilização <span class="blank _1"> </span>de <span class="blank _1"> </span>meios <span class="blank _1"> </span>modernos <span class="blank _1"> </span>rápidos <span class="blank _1"> </span>na <span class="blank _3"> </span><span class="ls3a ws47">iden</span>-</div><div class="t m0 x1b hd y196 ff4 fs5 fc0 sc0 ls4 ws15">tificação <span class="blank _3"> </span>das <span class="blank _3"> </span>bactérias<span class="blank _0"></span>, <span class="blank _3"> </span>que <span class="blank _3"> </span>no <span class="blank _3"> </span>caso <span class="blank _3"> </span>das <span class="blank _3"> </span>Enterobacte-</div><div class="t m0 x1b hd y197 ff4 fs5 fc0 sc0 ls1f ws40">rale<span class="ls4 ws15">s <span class="blank _6"> </span>o<span class="blank _1"> </span>fe<span class="blank _0"></span>recem <span class="blank _6"> </span>a <span class="blank _5"> </span>identificação <span class="blank _6"> </span>em <span class="blank _5"> </span>4-24 <span class="blank _6"> </span>horas <span class="blank _5"> </span>(<span class="ls7 ws19">com<span class="blank _0"></span><span class="ls4">-</span></span></span></div><div class="t m0 x1b hd y198 ff4 fs5 fc0 sc0 ls4 ws15">forme <span class="blank _3"> </span>o <span class="blank _6"> </span>sistema <span class="blank _6"> </span>utilizado), <span class="blank _6"> </span>muitas <span class="blank _3"> </span>vezes <span class="blank _6"> </span>informação </div><div class="t m0 x1b hd y266 ff4 fs5 fc0 sc0 ls4 ws15">suficiente <span class="blank _1"> </span>é <span class="blank _3"> </span>conseg<span class="blank _0"></span>uida <span class="blank _3"> </span>com <span class="blank _1"> </span>os <span class="blank _1"> </span>métod<span class="blank _1"> </span>os <span class="blank _1"> </span>bioquímicos </div><div class="t m0 x1b he y267 ff4 fs5 fc0 sc0 ls4 ws15">tradicionais. <span class="blank _5"> </span>Estes podem se<span class="blank _0"></span>r <span class="ffa ls4d">–</span><span class="ls3c"> <span class="ls8">e são <span class="blank _4"> </span><span class="ffa ls4d">–</span></span></span> <span class="blank _5"> </span>usados na </div><div class="t m0 x1b hd y268 ff4 fs5 fc0 sc0 ls6 ws15">prátic<span class="blank _0"></span>a <span class="blank _6"> </span>diária<span class="blank _0"></span> <span class="blank _5"> </span>no<span class="blank _0"></span> <span class="blank _5"> </span>L<span class="blank _0"></span>abo<span class="blank _0"></span>ratór<span class="blank _0"></span>io <span class="blank _6"> </span>para <span class="blank _6"> </span>identif<span class="blank _0"></span>icaç<span class="blank _0"></span>ão <span class="blank _6"> </span>pre<span class="ls4">-</span></div><div class="t m0 x1b hd y269 ff4 fs5 fc0 sc0 ls4 ws15">suntiva dos isolados.<span class="blank _0"></span> </div><div class="t m0 x1c hd y26a ff4 fs5 fc0 sc0 ls4 ws15">Vários <span class="blank _1"> </span>métodos <span class="blank _1"> </span>tradicion<span class="blank _0"></span>ais <span class="blank _1"> </span>podem <span class="blank _1"> </span>ser <span class="blank _1"> </span>usados <span class="blank _1"> </span>para </div><div class="t m0 x1b hd y26b ff4 fs5 fc0 sc0 ls4 ws15">identificar <span class="blank _9"> </span>presuntivamen<span class="blank _0"></span>te <span class="blank _9"> </span>Enterobacter<span class="ls7 ws19">ale</span>s. <span class="blank _9"> </span>Estes </div><div class="t m0 x1b hd y26c ff4 fs5 fc0 sc0 ls4 ws15">assentam <span class="blank _7"> </span>em <span class="blank _7"> </span>característ<span class="blank _0"></span>icas <span class="blank _7"> </span>metaból<span class="blank _0"></span>icas <span class="blank _7"> </span>diferentes </div><div class="t m0 x1b hd y26d ff4 fs5 fc0 sc0 ls4 ws15">para <span class="blank _1"> </span>estabele<span class="blank _0"></span>cer <span class="blank _1"> </span>um <span class="blank _1"> </span>diagnóstico. <span class="blank _1"> </span>Alguns <span class="blank _1"> </span>destes méto-</div><div class="t m0 x1b hd y26e ff4 fs5 fc0 sc0 ls4 ws15">dos são explicados e<span class="blank _0"></span>m detalhe no <span class="ff2 fc3">Apê<span class="blank _0"></span>ndice III<span class="ff4 fc0">. </span></span></div><div class="t m0 x1b hc y26f ff4 fs6 fc0 sc0 ls4 ws15"> </div><div class="t m0 x1b he y270 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff2 lse">Utili<span class="blank _1"> </span>zação <span class="blank _3"> </span>de <span class="blank _3"> </span>glí<span class="blank _1"> </span>cidos.<span class="ff4 ls4"> <span class="blank _3"> </span>Existe <span class="blank _3"> </span>uma <span class="blank _3"> </span>grande <span class="blank _3"> </span>diversi-</span></span></span></div><div class="t m0 x1c hd y271 ff4 fs5 fc0 sc0 ls6 wsd">dade<span class="blank _0"></span><span class="ls4 ws15"> <span class="blank _3"> </span>na <span class="blank _1"> </span>utilização <span class="blank _1"> </span>de <span class="blank _3"> </span>gl<span class="blank _0"></span>ícidos. <span class="blank _3"> </span>No<span class="blank _0"></span> <span class="blank _3"> </span>e<span class="blank _0"></span>ntanto, <span class="blank _1"> </span>a <span class="blank _3"> </span>maior </span></div><div class="t m0 x1c hd y272 ff4 fs5 fc0 sc0 ls4 ws15">distinção <span class="blank _3"> </span>é <span class="blank _5"> </span>e<span class="blank _0"></span>ntre <span class="blank _6"> </span>os <span class="blank _6"> </span>fermentadore<span class="blank _0"></span>s <span class="blank _6"> </span>de <span class="blank _6"> </span>lactose <span class="blank _6"> </span>e <span class="blank _6"> </span>os </div><div class="t m0 x1c hd y234 ff4 fs5 fc0 sc0 ls6 wsd">não<span class="ls4 ws15">-fe<span class="blank _0"></span>rmentadores <span class="blank _3"> </span>d<span class="blank _1"> </span>e <span class="blank _3"> </span>lactose. <span class="blank _6"> </span>O <span class="blank _5"> </span><span class="ff2">m<span class="blank _0"></span>eio <span class="blank _6"> </span>de <span class="blank _6"> </span>Kligler<span class="ff4 ls21">, </span></span></span></div><div class="t m0 x1c hd y235 ff4 fs5 fc0 sc0 ls11 ws15">ou <span class="blank _6"> </span>a <span class="blank _5"> </span>s<span class="blank _0"></span>ua <span class="blank _6"> </span>va<span class="blank _1"> </span>riante <span class="blank _6"> </span>TSI <span class="blank _6"> </span>(<span class="ff8 ls4">Tripl<span class="blank _1"> </span>e <span class="blank _3"> </span>Sugar <span class="blank _3"> </span>Iron <span class="blank _6"> </span>Agar</span><span class="ls1f">),<span class="blank _1"> </span> <span class="blank _3"> </span>é </span></div><div class="t m0 x1c hd y236 ff4 fs5 fc0 sc0 ls4 ws15">um <span class="blank _5"> </span>meio <span class="blank _6"> </span>muito <span class="blank _5"> </span>utilizado <span class="blank _6"> </span>para <span class="blank _5"> </span>compree<span class="blank _0"></span>nder <span class="blank _5"> </span>o <span class="blank _6"> </span>pa<span class="blank _1"> </span>-</div><div class="t m0 x1c hd y21b ff4 fs5 fc0 sc0 ls6 ws15">drão de<span class="blank _0"></span> util<span class="ls4">iza<span class="blank _0"></span>ção de glícidos, incluin<span class="blank _0"></span>do a fermenta-</span></div><div class="t m0 x1c hd y237 ff4 fs5 fc0 sc0 ls4 ws15">ção <span class="blank _5"> </span>da la<span class="blank _0"></span>ctose. <span class="blank _5"> </span>Também <span class="blank _5"> </span>o <span class="ff2 ls50">mei<span class="blank _1"> </span>o <span class="blank _c"> </span>d<span class="blank _1"> </span>e <span class="blank _c"> </span>M<span class="blank _1"> </span>ac<span class="blank _1"> </span>Co<span class="blank _1"> </span>n<span class="blank _1"> </span>key<span class="blank _1"> </span></span> </div><div class="t m0 x1c hd y238 ff4 fs5 fc0 sc0 ls4 ws15">detecta a fermentação de l<span class="blank _0"></span>actose, o que o torna mui-</div><div class="t m0 x1c hd y21e ff4 fs5 fc0 sc0 ls2 ws15">to im<span class="blank _0"></span>porta<span class="blank _0"></span>nt<span class="ls4">e no isolame<span class="blank _0"></span>nto de Enterobacte<span class="blank _0"></span>rale<span class="ls36 ws2e">s.</span> </span></div><div class="t m0 x1b he y273 ffd fs5 fc0 sc0 ls31"><span class="ff7 ls32 ws15"> <span class="ff2 ls4">Metabolism<span class="blank _0"></span>o da <span class="blank _1"> </span>glicose.<span class="ff4"> Existem várias <span class="blank _1"> </span>vias meta-</span></span></span></div><div class="t m0 x1c hd y1e4 ff4 fs5 fc0 sc0 ls4 ws15">bólicas <span class="blank _1"> </span>que <span class="blank _3"> </span>as <span class="blank _1"> </span>bactérias <span class="blank _1"> </span>podem <span class="blank _3"> </span>usar <span class="blank _1"> </span>para <span class="blank _1"> </span>metaboli-</div><div class="t m0 x1c hd y1e5 ff4 fs5 fc0 sc0 ls4 ws15">zar <span class="blank _3"> </span>a <span class="blank _6"> </span>glicose. <span class="blank _6"> </span>Estas <span class="blank _6"> </span>vias <span class="blank _3"> </span>produzem <span class="blank _3"> </span>produtos <span class="blank _6"> </span>finais </div><div class="t m0 x1c hd y1af ff4 fs5 fc0 sc0 ls4 ws15">diferentes, <span class="blank _3"> </span>que <span class="blank _3"> </span>podem <span class="blank _3"> </span>ser <span class="blank _3"> </span>detectados <span class="blank _3"> </span>para <span class="blank _3"> </span>identifi-</div><div class="t m0 x1c hd y1b0 ff4 fs5 fc0 sc0 ls4 ws15">car <span class="blank _3"> </span>o <span class="blank _6"> </span>isolado. <span class="blank _3"> </span>Dois <span class="blank _3"> </span>testes <span class="blank _3"> </span>usad<span class="blank _1"> </span>os <span class="blank _3"> </span>para <span class="blank _3"> </span>este <span class="blank _3"> </span>fim <span class="blank _3"> </span>i<span class="blank _1"> </span>n-</div><div class="t m0 x1c hd y1b1 ff4 fs5 fc0 sc0 ls4 ws15">cluem a <span class="blank _1"> </span><span class="ff2 lsc">prova<span class="blank _1"> </span> do<span class="blank _1"> </span> ver<span class="blank _1"> </span>m<span class="blank _0"></span>elho<span class="blank _1"> </span> de <span class="blank _1"> </span>metilo<span class="blank _1"> </span><span class="ff4 ls3b"> <span class="ls8">e <span class="blank _1"> </span>o <span class="blank _1"> </span></span></span><span class="ls4">teste <span class="blank _1"> </span>de </span></span></div><div class="t m0 x1c hd y1b2 ff2 fs5 fc0 sc0 lse ws10">Voges<span class="ls4 ws48">-Proskauer<span class="ff4 ws15">. </span></span></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div>
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