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PubMed1981

Urinary tract infections due to Staphylococcus saprophyticus biotype 3.

Staphylococcus saprophyticus biotype 3 (Micrococcus subgroup 3 or M3) has usually been shown to be the second commonset cause of urinary tract infections in European women who are not in hospital. It generally causes pyuria and symptoms as severe as those caused by Escherichia coli. Unlike S. epidermidis it is seldom found as a contaminant in midstream urine specimens, and almost exclusively infects women in their reproductive years. However, S. saprophyticus is seldom differentiated from S. epidermidis in Canadian clinical laboratories. Urinary isolates of S. saprophyticus were presumptively differentiated from other coagulase-negative Micrococcaceae by their resistance to novobiocin as demonstrated by a simple disc susceptibility test that misidentified the infecting organism in only 3.4% of specimens. These novobiocin-resistant, coagulase-negative organisms caused similar proportions of the urinary tract infections in young women in York, England and Vancouver -- 6.6% and 6.9% respectively. In York these organisms were associated with significantly greater pyuria than novobiocin-sensitive organisms or bile-tolerant streptococci but not S. aureus or Enterobacteriaceae. In both communities novobiocin-sensitive, coagulase-negative Micrococcaceae were appreciably more resistant to penicillin than novobiocin-resistant organisms. Thus, differentiating S. saprophyticus from novobiocin-sensitive, coagulase-negative organisms provides information that is clinically useful, particularly for primary care practitioners working in the community or in outpatient clinics.

Adult↗
PubMed1981

An epidemiological study of urinary tract infections in Benghazi, Libya.

Two groups of patients comprised 100 males and 100 females were investigated. All patients were more than 15 years of age and presented to the medical outpatient department with urinary tract symptoms. Fifty six male and female patients had no significant bacteriuria despite symptoms similar to those observed in 144 bacteriuric patients. Pyuria was observed in both bacteriuric and non-bacteriuric patients. Escherichia coli was the most common pathogen isolated from clinical specimens and was followed by Proteus sp. and Staph epidermidis. Escherichia coli was the main cause of acute urinary tract infection in adult females, while Proteus sp. caused a significantly greater proportion of symptomatic infections in males. Streptococcus faecalis was isolated only from males, and irrespective of chemotherapy. Infections with Staph epidermidis resembled the coliform ones, especially in the nature and severity of symptoms and in the degree of pyuria. Although E. coli and Proteus sp. were more predominant in our patients a wider range of resistant bacteria was involved. This development of resistance to antibacterial agents may be due to the frequent prescription of these agents by the general practitioners in public health clinics, dispensing of antibiotics by private pharmacies to the general public without medical prescriptions, and the misusage of these antibiotics by the general population.

Adolescent↗
PubMed1995

The usage of Andrographis paniculata following Extracorporeal Shock Wave Lithotripsy (ESWL).

One hundred consecutive cases with renal stones less than 3 cm in size and normal renal function underwent ESWL from January to March 1994. Out of these, 50 were given Andrographis paniculata tablets (250 mg), 4 tablests tid, 25 were given cotrimoxazole 2 tablets bid and 25 received norfloxacin 200 mg bid, started immediately after ESWL and continued for 5 days. All tolerated the treatment well and none had complications. At one month follow-up, pre- and post-ESWL pyuria, hematuria and proteinuria among the Andrographis paniculata group were 84, 58, 72, 40, 52, 22 per cent; the cotrimoxazole group 88, 64, 84, 64, 56, 44 per cent and the norfloxacin group 92, 56, 72, 40 per cent and 56, 28 per cent respectively. The results showed that post ESWL pyuria and hematuria in patients receiving Andrographis peniculata were reduced to 0.69 and 0.55 time of pre ESWL value. We think that this herbal medicine is beneficial in the treatment of post ESWL urinary tract infection. Besides the herbal drug given to eighteen previously sulfa sensitized patients resulted in no allergic reaction.

Adult↗
PubMed1995

Diagnostic value of urine cytology and urine carcinoembryonic antigen (CEA) level in the distinction between bladder cancer and urinary tract infection.

In the retrospective investigation we estimated the CEA levels in urine and urine cytology in 293 patients with urinary bladder cancer (group I) and in 129 patients with urinary tract infection (group II). An increased CEA level was found in 212 cases of bladder cancer and in 109 cases of urinary infection. Neoplastic cells in urine sediment were identified in 254 cases in the first group, while in the second, multiple inflammatory cells and pyuria were diagnosed in 55 and 56 cases, respectively. The combined examination (increased CEA level and/or positive cytology of the urine sediment) allowed for the diagnosis of neoplastic disease in 270 patients in the first group and infection diseases in 123 patients in the second group. After surgical therapy an increased urine CEA level and neoplastic cells in the urine cytology were found in 1 case which was then confirmed histopathologically. In the group with urinary infection an increased CEA level in urine, after antiphlogistic therapy, was found in 5 cases, inflammatory cells in 12 cases, pyuria in 8 cases and suspect cells were found in 6 cases in the group with urinary infection. In specimens from these cases, after electroresection, bladder cancer was diagnosed in 2, and cystitis cystica type changes in 2 cases.

Carcinoembryonic Antigen↗
PubMed1996

Long-term stone recurrence rate after extracorporeal shock wave lithotripsy.

PURPOSE: We followed patients who were stone-free after extracorporeal shock wave lithotripsy (ESWL) to investigate the factors that contributed to recurrent calculi. MATERIALS AND METHODS: For longer than 5 years 903 patients without residual fragments 3 months after ESWL were enrolled in this study. Plain abdominal films and/or excretory urograms were evaluated every 6 months for recurrent stones on the side of ESWL. Patients who presented with colic pain or other complaints and who were suspected of having recurrent stones were also examined. Stone recurrence rates were calculated with the Kaplan-Meier method. We assessed the influence of patient age; size, location, composition and configuration of the original stones, and pyuria after ESWL on stone recurrence. RESULTS: Mean followup was 25 months and stones recurred in 183 of 903 renal units (20.3%). Kaplan-Meier recurrence rates were 6.7, 28.0 and 41.8% after 1, 3 and 5 years, respectively. There was a significant correlation between stone recurrence and multiple stones on one hand, and pyuria after ESWL on the other hand. Stones recurred most frequently in the lower calix. Recurrent stones were passed without intervention in 33 cases, while ESWL was repeated in 53. CONCLUSIONS: These data demonstrate the importance of long-term followup and the search for an effective prophylactic therapy to prevent recurrence.

Adolescent↗
PubMedDate not supplied

[Diagnostic yield of various urine tests in urinary tract infections].

OBJECTIVES: 1. To determine the value of pyuria and bacteriuria by high-power field (hpf) in centrifuged urine and of tests with reactive strips for determining leukocyte estearase activity and nitrites in the diagnosis of urinary tract infection (UTI). 2. To establish the ideal cut-off point for these tests. DESIGN: Comparative survey. SETTING: Second level health care unit of the Instituto Mexicano del Seguro Social. PATIENTS AND METHODS: A total of 105 patients were prospectively studied, with or without urinary symptoms, seen in the emergency ward. MEASUREMENTS: A clinical history and physical exploration was done in each patient. A urine sample was used for microscopic analysis for determining leukocytes and bacteria using hpf microscopy; the urine leukocytes count was assayed as well as leukocyte estearase and nitrites using reactive strips. All samples were subjected to urine culture. Urine samples were obtained using a Nelaton probe in 65% of the patients and the rest using the midstream urination technique. RESULTS: Forty patients (38%) were identified as UTI cases based on clinical and laboratory criteria (urine culture and leukocyte count). The best cut-off point for number of leukocytes was 8 per hpf and for bacteriuria it was 2+ per hpf and for leukocyte estearase it was 1+. The sensitivity, specificity and predictive values of the pyuria hpf, bacteriuria by hpf and leukocyte estearase by reactive strip were comparable. The nitrites had a lower sensitivity than the other tests (p < 0.05). The negative predictive value of the nitrites was less than the microscopic bacteriuria (74% vs 85%, p = 0.005). The combination of positive tests in leukocytes and bacteriuria increased the specificity and the positive predictive value (99% and 96% respectively) when compared to the individual tests. CONCLUSIONS: The diagnostic performance of leukocyte estearase by reactive strips was similar to the microscopy of leukocytes and bacteria but the nitrite test had a lower performance. The combination of the leukocytes and bacteriuria measured by hpf appears to be very useful in the diagnosis of UTI.

Adolescent↗
PubMed1996

Nephrolithiasis as a presenting feature of chronic sarcoidosis: a prospective study.

BACKGROUND AND AIM OF THE WORK: The presentation of sarcoidosis with renal stones has never been evaluated in a prospective study. DESIGN: We have studied 110 consecutive patients with histologically proven sarcoidosis, first seen in the years 1993-1994 in the Milan Sarcoid Clinic. Those who had renal stones preceding or suggesting the diagnosis of sarcoidosis, and those who had evidence of renal calculi at presentation, were studied up to 31 December 1995 with serial evaluation of calcaemia, calciuria and serum 1,25 (OH)2D3 and are the basis of this report. RESULTS: Four patients had had calculi a long time ago and probably unrelated to their sarcoidosis. Three patients had a previous history of recurrent colic with calculi. In one further patient the occurrence of calculi suggested the diagnosis. In three other patients pyuria or microscopic haematuria at the presentation of pulmonary sarcoidosis led to the diagnosis of asymptomatic calculi. All the above seven patients had features of chronic disease and required long term corticosteroid therapy. Four of them required lithotripsy or pyelotomy before starting steroid therapy. Another had further calculi during the follow-up, and an episode of hydronephrosis requiring lithotripsy, due to poor compliance to corticosteroid therapy. Another patient had a single stone during follow-up in spite of proper therapy. In all the others prednisone was useful to control the disease. Summing up the results of a previous similar but retrospective study from our clinic, we can describe the full spectrum of nephrolithiasis at presentation of sarcoidosis, as it appears from the examination of 729 consecutive patients seen over 17 years (1978-1994), with a further follow-up of at least one year (see Conclusions). CONCLUSIONS: 1. Renal stones may be the presentation of sarcoidosis in 3.6% of cases, but the etiology may go unrecognized for many years in most of them. 2. There are asymptomatic renal stones at presentation in a further 2.7%: pyuria or microscopic haematuria may suggest such an occurrence. 3. Renal calculi appear to be a marker of chronicity, with long term corticosteroid therapy required in most cases. 4. A diagnosis of sarcoidosis should always be considered when patients present with renal calculi of unknown origin.

Adult↗
PubMed1996

[Does renal mycobacteriosis exist?].

Urinary mycobacteriosis is rare although nontuberculous mycobacteria (NTM) are frequently isolated from the urine. 63 patients (pts) with NTM isolated from the urine were followed up 1 to 8 years; the most frequent complaint was low back discomfort (91% pts), while the leading laboratory findings were pyuria (72%) and microscopic hematuria (57%). Intermittent proteinuria was present in the minority (35%) showing nonnephrotic range. IVP revealed pathologic findings in 72% of the pts. During follow up none of the pts have had clinical or laboratory progression of the disease. Standard antituberculosis therapy has been applied in 22 pts, only 4 with satisfactory response. -Evidence of NTM does not exclude search for other possible causes of hematuria or pyuria; -renal mycobacteriosis, even if it does exist as an entity, is not as aggressive as tuberculosis; -standard treatment regimen for tuberculosis does not have positive effects in majority and susceptibility testing is necessary.

Humans↗
PubMed1998

Screening for urinary tract infection in children with cancer.

Neutropaenia and immunosuppression place children on treatment for malignancies at a high risk for infections. We undertook to determine the prevalence of urinary tract infection (UTI) in children on treatment for cancer at the Kenyatta National Teaching and Referral hospital. With the understanding that many laboratories in the rural areas of the country lack appropriate facilities for confirmation of UTI, it was also important to evaluate simple and inexpensive screening methods against a "gold standard" in this cross sectional study. One hundred and eighty six children between the ages of five and 14 years admitted in Kenyatta hospital with leukaemia or lymphoma were enrolled. Besides clinical evaluation, urinalysis and culture and sensitivity were performed on all the subjects. Urine culture was considered the "gold standard" for diagnosis for UTI. The prevalence of UTI was 8.1% (CI = 6.1, 10.1). Only five out of 15 patients were symptomatic. E. coli and klebsiella spp. were responsible for 93.4% of the infections. Presence of pyuria, defined as five or more pus cells per high power field, had a sensitivity of 80.0%, specificity of 97.1% and a positive predictive value of 70.6% while comparative values associated with a positive nitrite test were 60%, 97.7% and 96%. Other clinical and laboratory tests had low sensitivity. UTI is a relatively frequent infection in children on cancer treatment. Screening for pyuria is simple, inexpensive and an accurate method of diagnosing UTI in children on treatment for lymphohaematopoietic malignancies in situations where facilities for urine culture are unavailable.

Adolescent↗
PubMed1976

Quantitative urinalysis. Diagnosing urinary tract infection in men.

Using a hemocytometer, we determined the number of white blood cells (WBCs) per milliliter in uncentrifuged urine specimens. Uninfected urine usually contained less than or equal to 10(3) WBCs per milliliter, although up to 8 X 10(3) WBCs per milliliter were observed. Infected urine regularly contained greater than 10(4) WBCs per milliliter, and the mean WBC count per millimeter for urine from infected patients was 3.1 X 10(5). The absence of pyuria thus provides strong evidence against the presence of urinary tract infection. Similar results were obtained in patients who had indwelling catheters, suggesting that bacteriuria reflects the presence of infection rather than colonization. Valid data are easily obtainable by quantitative urinalysis of uncentrifuged urine specimens. There are obvious differences in WBCs per milliliter, with little overlap between infected and uninfected urine. This method of analysis should replace traditional means of counting WBCs per visual field in a centrifuged, resuspended urine sediment.

Adult↗
PubMed1990

Surgical presentation of Kawasaki disease (mucocutaneous lymph node syndrome).

Five patients with Kawasaki disease (mucocutaneous lymph node syndrome) are reported whose varied presentations included acute abdominal pain, peripheral arterial aneurysms, digital gangrene and sterile pyuria and whose presenting pathology ranged from hydrops of the gallbladder to enteric pseudo-obstruction. As the complications of the disease can usually be managed without resort to surgery, which is associated with a mortality rate of up to 25 per cent, the recognition of Kawasaki disease will prevent hazardous and unnecessary laparotomy.

Abdominal Pain↗
PubMed1975

Diagnosis and importance of asymptomatic bacteriuria in adults.

There are now laboratory means of screening and identifying people who, although they are free from the signs of urinary tract infection, fit into abnormal groups owing to the high numbers of bacteria and leukocytes in their urine. Chronic bacteriuria and pathologic pyuria, with or without symptoms, have important physiologic and pathologic consequences. It is the physicians opportunity to recognize and treat these asymptomatic as well as symtomatic urinary tract infections. If untreated and uncorrected the result, with progressive frequency over a period of 10-15 years, is increased morbidity, especially with pregnancies, structural damage to the kidneys, kidney stones, uremia, hypertension, and premature death.

Adult↗
PubMed1990

Fosfomycin trometamol in a single dose versus norfloxacin for seven days in the treatment of uncomplicated urinary infections in general practice.

The efficacy and tolerability of fosfomycin trometamol in a single dose of 3 g was compared with norfloxacin 400 mg b.i.d. for seven days in the treatment of adult female patients with uncomplicated urinary infections. 158 female patients with a mean age of 30 years who presented symptoms of dysuria and frequency with documented pyuria and bacteriuria on urinalysis (greater than or equal to 10(5) cfu/ml of urine) were initially included in the study. The total number of clinically and bacteriologically evaluable patients was 111, of which 61 received fosfomycin trometamol and 50 norfloxacin. One to two days after the double blind medication schedule for seven days, 55 of 60 patients (92%) in the fosfomycin trometamol group and 48 of 50 patients (96%) in the norfloxacin group were clinically cured. 37 patients without significant bacteriuria showed a clinical cure rate of over 90% in both therapy groups. Two to three days after the single dose treatment with fosfomycin trometamol the initial infecting pathogen was eradicated in 60 of the 61 patients (98%). One to two days after a seven day treatment with norfloxacin 48 of 50 patients (96%) showed an eradication of the initial infecting pathogen. Six weeks after the start of therapy 39/60 patients (65%) and 32/49 (65%) in the fosfomycin trometamol and norfloxacin groups respectively, remained free from urinary infection. The reinfection rate in both treatment groups was approximately 25%. The relapse rate in the post treatment evaluation period of four weeks was relatively low in both therapy groups, 5/49 patients (10%) in the norfloxacin group and 3/55 patients (6%) in the fosfomycin trometamol group, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Criteria for the diagnosis of urinary tract infection and for the assessment of therapeutic effectiveness.

Three parameters--urinary symptoms, pyuria, and bacteriuria--can be used independently or in combination to define the presence of urinary tract infection. Using these parameters, several approaches to defining urinary infection in various clinical contexts are discussed. Similarly, approaches to the definition and classification of therapeutic outcomes after antimicrobial treatment are explored. Further research is needed to more precisely evaluate the effectiveness of various criteria for diagnosis and cure of urinary infection.

Bacteriuria↗
PubMedDate not supplied

The admission urinalysis: impact on patient care.

Although urinalysis is one of the most frequently ordered tests in primary care, its usefulness in screening has not been demonstrated. A retrospective review of 1,607 admission urinalyses for inpatients in a referral/community hospital identified 861 as clinically indicated and 746 as routine. Routine urinalyses were abnormal less frequently than clinically indicated urinalyses (18.1% vs 39.6%) and when abnormal, were responded to less often (33.3% vs 75.4%). Forty-five (6.0%) of the routine urinalyses yielded an abnormality that led to diagnostic action. Of these, 18 were normal on repeat testing and 17 were considered unlikely to represent significant disease. Therefore, only ten (1.3%) of the routine urinalyses affected patient therapy. In eight of these cases, the abnormality was pyuria, of which six proved to be asymptomatic bacteriuria. The admission urinalysis as a routine test had little impact on patient care in the authors' institution.

Adolescent↗
PubMed1977

Chronic renal vein thrombosis.

Twenty-eight patients with demonstrated chronic renal vein thrombosis were studied. In seven, only small venous channels were involved; in 21, both small and large veins were thrombosed. A constellation of findings occurred with such frequency in these patients that we believe it virtually diagnostic of renal venous obstruction. These findings include the nephrotic syndrome, great variability in proteinuria and glomerular filtration rate, pulmonary embolization, sterile pyuria, hematuria, hyperchloremic acidosis, decreased renal tubular threshold for glucose and increased fibrin degradation products. These findings are an indication for definitive angiographic and biopsy procedures. Prolonged anticoagulant therapy was generally very effective.

Adolescent↗
PubMed1976

Sulfacytine in uncomplicated urinary tract infections. Double-blind comparison with sulfisoxazole.

A new sulfonamide, sulfacytine, was compared in a double-blind study with sulfisoxazole in 132 patients with uncomplicated urinary tract infections. At the doses used, 1Gm. per day of sulfacytine of 4 Gm. per day sulfisoxazole, bacteriologic success (decrease of pathogenic organisms from greater than or equal to 100,000 to less than or equal to 1,000 per milliliter of urine) was demonstrated in approximately 90 per cent of the patients. Clinical success (subsidence of the symptoms, frequency of urination, and dysuria, and reduction of pyuria from greater than or equal to 10 to less than 10 white blood cells per high-power field) occurred in 85 to 90 per cent. Six patients in the sulfacytine group and 9 in the sulfisoxazole group reported adverse experiences. Drug was discontinued or administration interrupted because of adverse experiences in 4 sulfacytine patients and 6 sulfisoxazole patients. Laboratory values generally remained normal, but 1 patient in each medication group had decreases in white blood cells that might have been attributable to drug. On the basis of this study sulfacytine appears to be an effective drug for the treatment of uncomplicated urinary tract infections.

Clinical Trials as Topic↗
PubMedDate not supplied

Association of sexual activity and bacteriuria in women with non-insulin-dependent diabetes mellitus.

A group of 215 patients with non-insulin-dependent diabetes mellitus (NIDDM) (147 women and 68 men) were selected by home interview, and accepted to undergo clinical examination including urine culture, in order to determine the frequency of bacteriuria and its possible associations with clinical and laboratory findings. Bacteriuria was found in 17.7% of women and 1.5% of men. Univariate and multivariate analysis performed for the group of women revealed sexual intercourse and pyuria as the only factors associated with the frequency of bacteriuria. It was concluded that asymptomatic bacteriuria may be associated with sexual activity in women with NIDDM.

Analysis of Variance↗