Dr. David Eiffrig wrote a column about urinary tract infections: “Emergency physician Erika Kube, M.D. mentioned in 2021 in the Columbus Dispatch, “Altered mental status is often the only symptom of a UTI in an elderly person. Behavior such as increased confusion, hallucinations, agitation, dizziness, falls and poor motor skills are often mistaken for early stages of dementia, but all can be caused by a UTI.” Also called delirium, this rapid worsening of the mental state is more common than you’d think. It’s found in nearly 30% of older folks with UTIs.” Are these cases all from bacterial infections or are those people with UTIs showing dementia symptoms a subset with viral infections, either alone or along with bacterial infection as well?

This is a useful insight because many UTIs are viral and never diagnosed as such. There may well be a concomitant bacterial pathogen present also, because there will be an undermining of local defenses by a chronic viral presence and because there are often bacteria from the environment gaining entry to the urinary tract. The ongoing battle with a virus will make it easier for invading bacteria to get a foothold as well. So this is a confounding factor that will cause much confusion and that is the case here. Viral infections are every bit as important, and in some ways more insidious, because they will not be surmounted as readily with antibiotics, and so this is the reason for many chronic UTIs that are poorly managed, because they are actually viral, as the primary pathogen, and not effectively treated through prescription drug management.