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PubMed1995

[Fluconazole in treatment of urinary candidiasis. Experience with 24 patients].

Since fluconazole achieves high urine concentrations, we assessed its usefulness in the treatment of urinary candidiasis. We studied 24 patients (8 male) aged 23 to 97 years old, that presented pyuria with a negative urine culture for bacteria and fungal colony counts in urine of 10(4) CFU/ml or more. Isolated strains were Candida albicans in 20 cases, Candida kefyr in one case, Candida glabrata in one case and Candida spp in two cases. All patients were treated with fluconazole in doses of 50 to 100 mg/day for 2 to 4 weeks. The fungus was eradicated in 21 patients (88%), the infection persisted in two (8.5%) and one had a relapse (4.2%). Two patients had transient elevations of transaminases, one had abdominal pain and one, a purpuric syndrome without thrombocytopenia in whom the drug was discontinued. It is concluded that fluconazole is efficacious and safe in the treatment of urinary candidiasis.

Adult↗
PubMed1976

Abnormalities of urinary sediment and renal failure following sulfinpyrazone therapy.

A patient with recurrent thrompophlebitis had sterile pyuria with white blood cell casts and transient, mild renal failure during therapy with sulfinpyrazone. These abnormalities resolved on cessation of therapy, but similar changes in the urinary sediment recurred during therapy with sulfinpyrazone. These abnormalities resolved on cessation of therapy, but similar changes in the urinary sediment recurred during a second course of sulfinpyrazone therapy.

Acute Kidney Injury↗
PubMed1998

[Pathological horseshoe kidney. 30 case reports].

The authors report a series of 30 horseshoe kidneys observed over a 20-year period. This series consisted of 20 men (66.6%) and 10 women (33.4%) with a mean age of 35 years (20-65 years). The clinical features were dominated by abdominolumbar pain (22 cases), haematuria (12 cases) and pyuria (2 cases). Horseshoe kidney was associated with renal stones (20 cases), ureteropelvic junction syndrome (8 cases), upper urinary tract tumour (1 case). Treatment was surgical depending on the aetiology. The objective of this study was to analyse the epidemiological and diagnostic features of this disease, as well as the therapeutic features specific to each uropathy associated with horseshoe kidney.

Abdominal Pain↗
PubMed1981

Clinical analgesic nephropathy.

Analgesic nephropathy is recognized worldwide, but the differences in incidence in various countries, or regions, remain unexplained. Analgesic compounds may cause both functional and structural renal damage. This damage may be related to depletion of glutathione and renal vasoconstriction (probably mediated through prostaglandin depletion) and to the fact that the concentrations of glutathione and prostaglandins and their metabolites in the kidneys are manyfold their concentrations in plasma. Most patients with analgesic nephropathy are middle-aged women with histories of peptic ulcer, anemia, psychiatric disorders, headaches, and arthralgias. Investigations often show pyuria, some bacteriuria, and impaired concentrating ability, as well as other abnormalities of tubular function; caliceal abnormalities on intravenous pyelography are also frequent. It is important to discover these patients; evidence exists that with cessation of drug ingestion, renal function may stabilize and, in some cases, may improve.

Analgesics↗
PubMed2000

The differentiation of classic Kawasaki disease, atypical Kawasaki disease, and acute adenoviral infection: use of clinical features and a rapid direct fluorescent antigen test.

OBJECTIVE: To compare the clinical and laboratory features of children with Kawasaki disease with those with acute adenoviral infection, which may mimic Kawasaki disease. DESIGN: We retrospectively compared the medical records of children with Kawasaki disease and atypical Kawasaki disease with those of children with acute adenoviral infection. All children included were initially evaluated because their primary care physicians were concerned that they might have Kawasaki disease. The utility of a rapid direct fluorescent antigen test for adenovirus was evaluated. Thirty-six children with Kawasaki disease (23 with classic and 13 with atypical presentations) and 7 patients with acute adenoviral infection were studied. SETTING: A tertiary care pediatric hospital. RESULTS: Children with Kawasaki disease were more likely to have conjunctivitis (36 of 36 vs 4 of 7), strawberry) tongues (23 of 36 vs 1 of 7), perineal peeling (19 of 36 vs 0 of 7), and distal extremity changes (22 of 36 vs 0 of 7) than those with acute adenoviral infection. Children with acute adenoviral infection were more likely to have purulent conjunctivitis (3 of 7 vs 1 of 36) and exudative pharyngitis (3 of 7 vs 1 of 35). In addition to pyuria (13 of 26 vs 0 of 6), patients with Kawasaki disease had higher mean white blood cell counts (15.3 +/- 3.5 vs 11.5 +/- 6.0 x 10(9)/L), erythrocyte sedimentation rates (56 vs 42 mm/h), platelet counts (426 vs 259 x 10(9)/L), and levels of alanine aminotransferase (101 vs 18 U/L) than those with acute adenoviral infection. Children with Kawasaki disease had lower mean albumin levels (32 vs 36 g/L). A rapid antigen test for adenovirus had a specificity and sensitivity of 100% compared with viral culture. CONCLUSIONS: Kawasaki disease and acute adenoviral infection can present with many of the same clinical characteristics. A rapid direct fluorescent antigen assay for adenovirus may be a helpful adjunctive test for distinguishing acute adenoviral infection from Kawasaki disease.

Acute Disease↗
PubMed2001

Reliability of the urinalysis for predicting urinary tract infections in young febrile children.

BACKGROUND: Urinary tract infections (UTIs) are a common source of bacterial infection among young febrile children. Clinical variables affecting the sensitivity of the urinalysis (UA) as a screen for UTI have not been previously investigated. The limited sensitivity of the UA for detecting a UTI requires that a urine culture be obtained in some children regardless of the UA result; however, a proper urine culture requires an invasive procedure, so the criteria for its use should be optimized. OBJECTIVES: To determine how the sensitivity of the standard UA as a screening test for UTI varies with age, and to determine the clinical situation that necessitates the collection of a urine culture regardless of the UA result. METHODS: Retrospective medical record review of patients younger than 2 years with fever (>/=38 degrees C) seen in the emergency department during a period of 65 months. All urine cultures were reviewed for the collection method, isolates, and colony counts. A UA result was considered positive if the presence of 1 of the following was detected: leukocyte esterase, nitrite, or pyuria (>/=5 white blood cells per high power field). Patients who had a paired UA and urine culture were used to calculate the sensitivity, specificity, and likelihood ratios of the UA. The prevalence of UTIs was also subcategorized by age, race, sex, and fever. RESULTS: Medical records of 37 450 febrile children younger than 2 years were reviewed. Forty-four percent were girls. Median age and temperature were 10.6 months and 38.8 degrees C. A total of 11 089 patients (30%) had urine cultures obtained. The sensitivity of the UA was 82% (95% confidence interval [CI], 79%-84%) and did not vary by age subgroups. The specificity of UA was 92% (95% CI, 91%-92%). The likelihood ratios for a positive UA and negative UA were 10.6 (95% CI, 10.0-11.2) and 0.19 (95% CI, 0.18-0.20), respectively. Prevalence of UTI was 2.1% overall (2.9% for girls and 1.5% for boys, respectively). Among girls, the prevalence of UTI was 5.0% in white patients, 2.1% in Hispanic patients, and 1.0% in black patients. Among boys, the prevalence was 2.2% in Hispanic patients, 1.4% in white patients, and 0.8% in black patients. Higher prevalence was also seen among patients with a temperature at or above 39 degrees C compared with those whose temperature was between 38.0 degrees C and 38.9 degrees C. The greatest prevalence of UTI (13%) was found among white girls younger than 6 months with a temperature at or greater than 39 degrees C. The posttest probability of a UTI in the presence of a negative UA can be calculated using the negative likelihood ratio and the patient-specific prevalence of UTI. When the prevalence of UTI is 2%, 1 UA among 250 will produce a false-negative test result. CONCLUSIONS: The sensitivity of the standard UA is 82% (95% CI, 79%-84%) and does not vary with age in febrile children younger than 2 years. The prevalence of UTI varies by age, race, sex, and temperature. A negative likelihood ratio and estimates of prevalence can be used to calculate the risk of missing a UTI due to a false-negative UA result.

Black or African American↗
PubMed1976

Mucocutaneous lymph node syndrome in the United States.

Sixteen patients with an unusual and distinct symptom complex were encountered during a four-year period. Principal features of this syndrome are (1) fever lasting more than seven days; (2) conjunctival injection; (3) changes in the mouth consisting of erythema of the oropharynx, "strawberry tongue", and erythema of the lips; (4) indurative edema of hands and feet with palm and sole erythema followed by desquamation of the fingertips; and (5) an erythematous rash. Associated features were lymphadenopathy, pyuria, aseptic meningitis, diarrhea, arthritis, and arthralgia. Although usually a self-limited illness, one patient died with massive coronary artery thrombosis on the 19th day of illness. This syndrome appears to be clinically and pathologically similar to mucocutaneous lymph node syndrome, an illness prevalent in Japan but previously unrecognized by American clinicians. Pathologic features suggest a relationship to infantile periarteritis nodosa.

Arthritis, Juvenile↗
PubMed1985

Bacterial and viral pathogens causing fever in infants less than 3 months old.

We studied 182 sick, febrile (temperature greater than 38 degrees C) infants less than 3 months of age, who presented at our Tripler Army Medical Center, Honolulu, during a one-year period, to determine the relative causes of fever in this age group. Blood, cerebrospinal fluid, urine, nasopharyngeal secretions, and stool specimens were cultured for bacterial and viral pathogens. Paired acute and convalescent sera were collected to serologically confirm infection in infants from whom viral isolations were obtained only from the nasopharynx or stool. A viral pathogen was isolated in 75 infants (41%) and a bacterial pathogen was isolated in 27 infants (15%). Nonpolio enteroviruses were the most common pathogens demonstrated. They were isolated from 64 infants (35%), and 40 (62%) of these infants had aseptic meningitis, the most frequently made diagnosis. Urinary tract infection was the most common bacterial infection observed. It occurred in 20 infants (11%) and was most often seen without associated pyuria in uncircumcised male infants. Salmonellosis, the second most common bacterial infection, was observed in six infants (3%), and two of these did not have diarrhea or other gastrointestinal tract symptoms. No infant had septicemia and only one infant had bacterial (group B streptococcal) meningitis.

Bacterial Infections↗
PubMed1997

Use of ultrasonography in the detection of ureteric reflux in children suspected of having urinary infection.

The present study investigated whether ultrasonography was effective in detecting ureteric reflux in children suspected of having urinary infection. Seventeen children with febrile episodes and pyuria were enrolled. The ultrasound examination revealed ballooning of the renal pelvis during bladder contraction in 4 children, dilatation of the distal ureters in 6, and small kidney in 2. Cystography was performed on the 6 children with these ultrasound abnormalities and 1 child with two episodes of suspected urinary infection. Four children showed reflux. All of the 4 children had been found to have renal pelvic ballooning on ultrasound. None of the 10 children who did not undergo cystography had recurrence of urinary infection or significant bacteriuria during a median follow-up period of 12 months. Thus, scanning during bladder contraction was effective in detecting significant ureteric reflux.

Bacterial Infections↗
PubMed1982

Intestinovesical fistula in a patient with chronic lymphocytic leukemia: case report and literature review.

A case of intestinovesical fistula secondary to leukemic infiltration is described. The patient was known to have chronic lymphocytic leukemia and had been receiving chemotherapy fo ten months. She presented complaining of nausea, vomiting and vague abdominal pain. She initially denied genitourinary tract symptoms, although admitting urinalysis revealed pyuria, hematuria and bacteriuria. Urine cultures repeatedly grew E. coli despite broad spectrum antibiotic therapy. She eventually developed fecalant material in her urine and pneumaturia. Cystoscopy revealed a fistulous tract. At surgery an ileovesical fistula was found and histopathology showed lymphocytic leukemic infiltration. Intestinovesical fistulas are uncommon. Congenital, traumatic, inflammatory and solid neoplastic etiologies are well established in the literature. No previous cases have been attributed to hematologic malignancies. Since higher remission rates and longer periods of remission are being achieved with chemotherapy, and since fistula symptomatology may present quite subtly, awareness of this association may expedite diagnosis.

Aged↗
PubMed1989

Detection of bladder carcinoma in females by flow cytometry and cytology.

The sensitivity of bladder wash flow cytometry (BWFCM), voided urinary cytology (VUC), and cytology of catheterized urine obtained at the time of cystoscopy (CUC) were reviewed on all women evaluated for bladder cancer at Memorial Sloan-Kettering Cancer Center between June 1985 and December 1986. This comprised sixty-four episodes of pathologically proven bladder cancer in 48 women. Considering positive and suspicious results jointly the sensitivities of BWFCM, CUC and 3 VUC were 75%, 64% and 56%, respectively. If only positive results were considered (i.e., suspicious results considered as negative), the sensitivities of BWFCM, CUC and 3 VUC were 64%, 31% and 32%, respectively. The sensitivities of these tests are less than for a predominantly male population, presumably related to the presence of squamous epithelium and greater frequency of pyuria. However, bladder wash flow cytometry and conventional cytology are still a very valuable addition to cystoscopic examination, and the combination of BWFCM with conventional cytology is more sensitive than either procedure alone.

Adult↗
PubMed1979

Effect of short-term high-dose treatment with methenamine hippurate on urinary infection in geriatric patients with an indwelling catheter. IV. Clinical evaluation.

An evaluation has been made of the clinical and laboratory effects of short-term (34 days), high-dose (2g x 3 daily) treatment with methenamine hippurate (MH) of 14 geriatric patients with an indwelling catheter and clinical features of urinary tract infection. During MH treatment the number of catheter changes was halved, each catheter remaining in situ for an average of 12.0 days as compared to 6.2 days in the pre-treatment control period and 5.2 days in the post-treatment control period; the difference is significant (p = 0.008; Friedman two-way analysis of variance). Urine pH was reduced (pH 7.0--6.5--7.0; p = 0.01) and the standard bicarbonate in blood was slightly elevated (24.1--25.7--25.0 mmol/l; p= 0.008) during the MH treatment period, when compared to pre- and post-treatment control periods. It is suggested that MH treatment reduced the complications associated with indwelling catheters due to reduction in urine pH, bacteriuria, and pyuria. Blockage of catheters is thought to be due to intraluminal salt precipitations with trapping of clumps, and is primarily not correlated with urine viscosity.

Aged↗
PubMed1995

Acute tubulointerstitial nephritis in association with Yersinia pseudotuberculosis infection.

A 4-year-old girl was diagnosed as having acute renal failure due to tubulointerstitial nephritis. The girl presented with remittent fever, vomiting and non-oliguric acute renal failure with sterile pyuria and tubular reabsorptive dysfunction. Ultrasound examination revealed that the kidneys were markedly enlarged with diffuse hyperechogenicity in the cortex when the abnormal renal function was present and were restored in size and echogenicity when the renal function normalised. A diagnosis of Yersinia pseudotuberculosis infection was based on a rise in haemagglutination titres against the organism.

Acute Disease↗
PubMed1995

The possible role of granulocyte elastase in renal damage from acute pyelonephritis.

During acute inflammatory processes, extracellular release of granulocyte elastase can contribute to subsequent tissue damage. To test our hypothesis that extracellular elastase release during acute pyelonephritis may contribute to subsequent renal parenchymal damage, we compared the intracellular and extracellular activities of the lysozyme elastase of human polymorphonuclear cells (PMN) when incubated in vitro with bacterial strains causing renal infection that led to either renal damage or no damage. Urine bacterial cultures were obtained from patients with acute pyelonephritis (flank pain, costovertebral angle tenderness, fever > 38 degrees C, bacteriuria, pyuria, and leukocytosis). Renal damage was demonstrated by cortical scarring on followup intravenous pyelography and/or diminished function on 131iodine hippuran renal scan. Mean extracellular elastase activity (mu units/PMN) was 0.15 for unstimulated PMN, 0.07 for PMN stimulated by bacteria not associated with renal damage, and 1.20 for the PMN stimulated by strains associated with renal damage. Mean intracellular elastase activity (mu units/PMN) was 3.73 for unstimulated PMN, 3.48 for PMN stimulated by bacteria not associated with renal damage, and 3.31 for the PMN stimulated by strains associated with renal damage. Extracellular granulocyte elastase activity was thus significantly higher (P = 0.0001) in PMN stimulated by bacterial strains associated with renal damage. Extracellular release of elastase may contribute to the pathogenesis of renal damage in pyelonephritis.

Acute Disease↗
PubMed1990

Urinary infection in the 1990's: the state of the art.

Growing points and problem areas in the field of urinary tract infections are critically surveyed. It is concluded that there is a particular need for advances in rapid tests for bacteriuria (to distinguish between symptomatic patients who are infected and those who are not) and for the determination of antibiotic sensitivity of infecting organisms. The aetiology of the "urethral syndrome" (dysuria and/or frequency without a significant bacteriuria) is still obscure although it is becoming clear what suggested possible causes are not responsible for it. Another unresolved problem is whether or not to treat asymptomatic bacteriuria in all groups of patients especially the elderly, and in the absence of pyuria. Similarly it is still not decided what are the optimal lengths of time and dosages of antibiotics to treat various types of urinary infections. Finally, difficulties involved in preventing infections of in-dwelling catheters, and the possibility of obtaining a protective vaccine are discussed.

Anti-Infective Agents, Urinary↗
PubMed1993

Increased levels of urinary interleukin-6 in Kawasaki disease.

Kawasaki disease (KD) often presents with abnormal urinary findings, such as aseptic pyuria, mild proteinuria and microscopic haematuria. In this study, we measured urinary interleukin-6 (IL-6) by a sensitive sandwich ELISA assay using mouse monoclonal antibodies against recombinant IL-6 to elucidate the role of IL-6 in the pathogenesis of renal lesions in KD. Serum IL-6 levels were increased in acute KD as well as in febrile controls. Importantly, urinary IL-6 levels were consistently elevated in patients with acute KD, but much lower in febrile controls. Urinary IL-6 levels returned steadily to normal during the convalescent phase. In addition to IL-6, urinary levels of N-acetyl-beta-D-glucosaminidase (NAG) and beta 2-microglobulin (beta 2-mg) were also elevated during the acute phase of this disease. Eosinophils and macrophages were identifiable in urinary sediments from these patients. The increased levels of urinary IL-6 in combination with increased NAG and beta 2-mg seemed to suggest the presence of certain renal parenchymal lesions with cellular infiltration during the acute phase of the disease. IL-6 may serve as clinically useful parameter for the detection and monitoring of the renal involvement in KD.

Acetylglucosaminidase↗
PubMed1993

Controversies in the laboratory diagnosis of community-acquired urinary tract infection.

Urine samples constitute the largest single category of specimens examined in most medical microbiology laboratories. The everyday nature and apparent simplicity of urinary tract infection belies the intense debate and controversy regarding the optimal methods of collection, transport and processing of urine specimens and reporting of results. There is considerable variation in the interpretation of quantitative culture results between laboratories and the etiology of abacterial cystitis remains unclear. Microscopy to detect pyuria provides information on an important indicator of inflammation and it has been proposed that detection of urinary antibody may provide similar information. Neither of these indices of host response is suitable for use in a screening test for urinary infection however, although they may usefully contribute to the interpretation of significance of culture results. The development of screening tests and automated systems continues, but at present microscopy and culture remain the most important techniques for laboratory diagnosis. However, these techniques have so far failed to provide an etiological diagnosis for abacterial cystitis and this remains a major area for research.

Adult↗
PubMed1993

Urinary tract infection with Corynebacterium urealyticum in South Africa.

Corynebacterium urealyticum has been well documented as a urinary pathogen in Europe. The purpose of this study was to investigate the incidence and clinical relevance of Corynebacterium urealyticum as a urinary pathogen in a predominantly Third World population (South Africa) and to attempt to increase the isolation rate by culturing urine specimens on a selective medium. Two methods were used to isolate Corynebacterium urealyticum from urine specimens. Blood agar plates from routine urine cultures of 7,912 urine specimens were incubated for 48 hours and 1,281 specimens were cultured on a selective medium as well as on routine media. The antimicrobial susceptibility of all isolates of Corynebacterium urealyticum was tested. The yield of Corynebacterium urealyticum on blood agar was three isolates in three patients (0.038% of 7,912), all of whom had pyuria, alkaline urine and risk factors for Corynebacterium urealyticum infection. Use of selective media increased the yield of Corynebacterium urealyticum to 15 of 1,281 specimens (1.17%), however 73% of these urine samples yielded other pathogens and none had an alkaline pH which could not be attributed to the presence of another urealytic pathogen. All isolates were susceptible to vancomycin and 92.6% susceptible to norfloxacin. The pathogenic potential of Corynebacterium urealyticum was confirmed in South African patients, but the incidence of infection was low. The use of a selective medium is therefore not cost-effective in all cases but could be used selectively on the basis of typical urine findings and patient criteria.

Adult↗