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PubMed1994

Genitourinary tuberculosis in Spain: review of 81 cases.

Cases of genitourinary tuberculosis diagnosed at the Hospital Clínico Universitario between January 1978 and December 1989 were studied. Genitourinary tuberculosis was the most frequent type of extrapulmonary tuberculosis diagnosed, accounting for 81 (40.9%) of 198 cases. Fifty-one patients (63%) were men. The mean ages of male and female patients were 48.4 years and 51.1 years, respectively (range, 21-75 years). Cases were widely distributed among most age groups; patients were most often 30-69 years of age. Constitutional symptoms were less frequent than local, urinary tract-related symptoms. Only 23.5% of patients had a known history of tuberculosis. Pyuria plus hematuria with sterile cultures was the commonest urinary finding. The results of intravenous pyelography were abnormal in 95% of cases. Ziehl-Neelsen staining gave positive results in 48% of cases. Cultures became positive after a mean (ISD) of 2.3 +/- 1.5 weeks. Sequelae were documented in 42% of cases, but only one death due to genitourinary tuberculosis was recorded.

Adult↗
PubMed2003

What is the predictive value of urinary symptoms for diagnosing urinary tract infection in women?

OBJECTIVES: Our aim was to determine the probability of correctly diagnosing urinary tract infections (UTIs) from urinary symptoms and signs, studying their sensitivity, specificity and likelihood ratio (LR) when clinical history, signs and reactive strip test results are taken into account. METHODS: An epidemiological analysis with a diagnostic and clinical orientation was carried out in a primary health care setting. The subjects comprised 343 women > or =14 years of age who consulted their family physician for incident urinary tract symptoms. A guided medical examination was carried out using a check-list formulary, reactive strip test, urine culture and the clinical course of all patients. RESULTS: The pre-test probability of having UTI among patients with incident urinary symptoms is 0.484 [95% confidence interval (CI) 0.431-0.536]. Positive LRs for UTI are: painful voiding 1.31 (95% CI 1.12-1.54), urgency 1.29 (95% CI 1.12-1.50), urinary frequency 1.16 (95% CI 1.06-1.28) and tenesmus 1.16 (95% CI 1.02-1.32). The probability of UTI is reduced by the presence of genital discomfort, dyspareunia, vaginal discharge, positive lumbar fist percussion and perineal discomfort. Nitrites on the urine reactive strip test increase the probability of UTI by >5 times, moderate pyuria increases it by >1.5 times, and the presence of both findings does so by >7 times. CONCLUSIONS: In women with urinary symptoms, a thorough clinical examination, together with performance of a reactive strip test during the office visit, improves the chances of detecting UTI.

Adolescent↗
PubMed1976

Pharmacokinetics of amikacin for treatment of urinary tract infections in patients with reduced renal function.

Amikacin (250 mg four times daily for 10 days) was administered intramuscularly to 22 patients with long-standing, severe infections of the urinary tract, in each case superimposed on chronic uropathy or nephropathy. Therapy with amikacin was completely successful in 14 patients (sterile 14-day follow-up urine specimens obtained by suprapubic needle aspiration of the bladder) and partially successful in three (sterile three-day but positive 14-day follow-up urine specimens). Five patients were judged to be treatment failures. Quantitative assessment of pyuria revealed a significant drop in the rate of excretion of white cells to near normal levels not only in patients who were cured but also in others, a finding which suggests that the infectious process had been affected by amikacin in all cases. The course of the disease in individual patients suggested that amikacin therapy can be successful after a long series of failures from treatment of such conditions with other antibiotics. Additional pharmacokinetic studies indicated that the half-life of amikacin may be increased five- to 10-fold in patients with renal insufficiency. A tentative dosage schedule was prepared for patients with various degrees of impaired renal function on the basis of average half-life values.

Aged↗
PubMed1978

Staphylococcus saprophyticus: a frequent cause of acute urinary tract infection among female outpatients.

The frequency of Staphylococcus saprophyticus, formerly Micrococcus subgroup 3, as the cause of bacteriuria is reported. Of 787 consecutive female outpatients with signs of bacteriuria, 173 (22.0%) yielded S. saprophyticus, predominantly in pure culture and in high counts. In the age group 16--25 years, this organism was demonstrated in no less than 42.3%. In hospitalized women and in men with signs of bacteriuria, on the other hand, S. saprophyticus was a rare finding (0.9% and 0.5%, respectively). The figures in female outpatients aged 15--30 years were similar over a three-year period, but higher during summer and fall as compared with those in winter and spring. The patients regularly had rather severe symptoms of acute urinary tract infections with dysuria and often loid pain. Hematuria and pyuria were common. All strains of S. saprophyticus had a fairly even and high susceptibility to antimicrobial agents except nalidixic acid. Recurrent infections were common. The origin of this infection is still obscure.

Acute Disease↗
PubMed1981

Characteristics of Serratia marcescens containing a plasmid coding for gentamicin resistance in nosocomial infections.

Strains of gentamicin-resistant Serratia marcescens (GRSM) that originated in a crowded neurosurgical close observation unit (COU) became established during a 2.5-year interval at several affiliated hospitals in Charleston, South Carolina. Most patients with GRSM had colonization or infection of the urinary tract associated with indwelling bladder catheters. Infected patients in the COU more often had pyuria and less often received systemic steroids than COU patients not harboring GRSM. However, length of stay, use of urinary catheters, exposure to systemic antibiotics, and exposure to gentamicin were not significantly different between the two groups. Of the strains of GRSM, 92% contained a conjugative 41-megadalton plasmid tht encoded resistance to ampicillin, carbenicillin, tetracycline, kanamycin, gentamicin, and tobramycin and elaborated similar aminoglycoside 3-acetyltransferases. Seven 41-megadalton plasmids from outbreak strains and a 41-megadalton plasmid from a 1973 isolate of GRSM gave identical DNA fragments after restriction endonuclease digestion.

Aminoglycosides↗
PubMed1984

Clinical characteristics and response to therapy in Egyptian children infected with Schistosoma haematobium.

Forty-one Egyptian students with infections due to Schistosoma haematobium, who were selected by results of a urine screening examination, were evaluated for morbidity and response to chemotherapy. Symptoms associated with infection were hematuria, dysuria, and swimmer's itch. A positive correlation existed between the intensity of infection and frequency of exposure to water. Laboratory abnormalities included eosinophilia (41), anemia (9), hematuria (38), pyuria (33), and proteinuria (8). Three of 26 subjects had abnormalities intravenous pyelograms: hydroureter, bladder polyp , and bladder calcification. The bladder polyp was noted also by sonography. Cure rates were 66.7% in 18 subjects treated with two 10-mg/kg doses of trichlorfon and were 89.5% in 19 subjects given three doses. Those not cured had an average reduction in ova excretion of 96%. Follow-up at 12 months of 33 subjects showed that nine had S. haematobium ova in urine, although 75% admitted to exposure to canal or irrigation water in the interim.

Adolescent↗
PubMed1989

Absence of infectious HIV-1 in the urine of seropositive viremic subjects.

Urine and peripheral blood samples from 48 human immunodeficiency virus type 1 (HIV-1) seropositive individuals (38 adults and 10 children) were evaluated for the presence of HIV-1 by cocultivation and for HIV-1 p24 antigen by ELISA. None of the urine samples contained replication-competent HIV-1; 41 (85%) of 48 simultaneously obtained peripheral blood mononuclear cell samples contained replication-competent HIV-1. None of 26 urine samples available for analysis contained HIV-1 p24 antigen as determined by ELISA; 12 (34%) of 35 simultaneously obtained peripheral blood samples had detectable serum HIV-1 p24 antigen. Two of the individuals studied had HIV nephropathy, three had pyuria, and five had microscopic hematuria. Culture sensitivity was maximal when mycostatin (and not amphotericin B) was used as an antifungal agent. Our findings indicate that urine from HIV-1-seropositive individuals is unlikely to contain infectious HIV-1. This would imply that the risk of transmission of HIV-1 by urine is low to nonexistent.

Adult↗
PubMed1991

Dependence among host response parameters used to diagnose urinary tract infection.

The host-response parameters fever, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) are activated in concert by cytokines such as interleukin-6 (IL-6). Il-6 is secreted in response to Escherichia coli infection of the urinary tract. This study tested the hypothesis that the level of fever, CRP, and ESR is coregulated in individual patients. Body temperature, CRP, ESR, pyuria, and renal concentrating capacity were analyzed in 692 children with first-time urinary tract infections. The association of the parameters was evaluated by correlation and multiple regression analysis. The body temperature, CRP, and ESR were significantly correlated (r = .54, .58, and .58; P less than .001), and variation in CRP and ESR explained approximately 40% of the variation in fever. In contrast, the renal concentrating capacity and pyruia were weakly or not at all correlated with the febrile response (r = -.22; P less than .001), and less than 10% of the variation in renal concentrating capacity was explained by the other parameters. The results suggest that fever, CRP, and ESR describe the same aspect of the host response to UTI.

Adolescent↗
PubMed1994

Human experimentation with Neisseria gonorrhoeae: rationale, methods, and implications for the biology of infection and vaccine development.

Neisseria gonorrhoeae infection is limited to the human host. Experimental urethral infection in male volunteers was used to study different aspects of the infection. Urethral installation of a variety of gonococcal variants (10(4)-10(6)) led to infection in 27 subjects, who developed pyuria and shed bacteria in urine before urethritis developed 1-6 days after gonococcal inoculation. The incubation period was affected by the inoculation procedure and size of the inoculum. Subjects were treated with intramuscular ceftriaxone (250 mg) if urethritis developed or at 6 days after inoculation. Urine cultures became negative within several hours of therapy, and symptoms resolved within 1 day of therapy. Infected patients suffered no major complications. Experimental male urethral gonococcal infection provides a unique opportunity to understand the biology and immunology of gonococcal infection and is an efficient method to test gonococcal vaccine candidates.

Adolescent↗
PubMed1983

Clinical experience with ceftazidime in urology in Japan.

Ceftazidime was given in a total of 563 cases of urinary tract infections in Japan. The efficacy rate was found to be 75% in the 537 assessable cases. In 464 cases of complicated urinary tract infection, the efficacy rate was 78% when it was assessed according to a unified protocol after 5 days' treatment. Bacterial eradication rate and pyuria clearance rate in these cases were 67% and 33%, respectively. Adverse events were noted in 1.4% and abnormal laboratory findings in 2.8% or less. From these findings, ceftazidime was considered to be very effective in urinary tract infections, with safely comparable to that of other drugs, and to be particularly useful for infections caused by Pseudomonas aeruginosa and Serratia marcescens.

Aged↗
PubMed1991

The pharmacokinetics of lomefloxacin in elderly patients with urinary tract infection following daily dosing with 400 mg.

Eleven elderly patients (mean age 83 years; range 75-90) with microbiologically proven urinary tract infections were given 400 mg lomefloxacin as a single daily dose for up to seven days. On the first and final day of treatment blood was taken at timed intervals and drug concentration-time curves plotted. Blood was also taken immediately before each of the other doses for assay of pre-dose concentrations. The mean (+/- S.D.) peak serum concentration of lomefloxacin on the first day was 4.8 mg/l (+/- 1.5) observed at a mean of 156 min (+/- 88) and on the final day was 6.3 mg/l (+/- 2.5) at a mean of 119 min (+/- 68). The mean serum half-life on the first day was 10.0 h (+/- 2.8) and on the final day 10.3 h (+/- 2.5). The daily pre-dose serum concentrations of lomefloxacin showed no accumulation of the drug. No serious adverse events were reported and all patients were cured although two had persistent pyuria. It is suggested that a once daily dose of 400 mg lomefloxacin is suitable for the elderly and that no dosage modification is needed in this patient group.

Aged↗
PubMed1996

Comparative efficacy of sparfloxacin versus ciprofloxacin in the treatment of complicated urinary tract infection.

A total of 686 adult patients with complicated urinary tract infections were enrolled in a double-blind, randomised, multicentre study to compare sparfloxacin (200 mg loading dose on day 1 followed by 100 mg daily) with ciprofloxacin (500 mg orally twice daily) for 10 to 14 days. Urinary tract infection was defined as pyuria and bacteriuria (cfu > or = 10(5)/mL). Evaluations were performed at four time-points. The clinical efficacy of the two antibacterial agents was equivalent at the end of treatment: clinical cure in 88.6% of the intent-to-treat population and 87.3% in the evaluable population treated with sparfloxacin compared to 85.4% and 84.8% of the intent-to-treat and evaluable populations, respectively, treated with ciprofloxacin. The clinical results were also equivalent at follow-up. The bacteriological efficacy of the two agents was not equivalent. At the end of treatment, bacteriological cure was observed in 72.6% of the intent-to-treat and 72.1% of the evaluable populations treated with sparfloxacin and in 81.4% and 80.8% of the intent-to-treat and evaluable populations, respectively, treated with ciprofloxacin. The difference was primarily because of a higher number of persisting pathogens, which included Enterobacteriaceae other than Escherichia coli, Pseudomonas aeruginosa and enterococci, which exhibited moderate susceptibility to sparfloxacin. Tolerability was similar in the two treatment groups.

Adolescent↗
PubMed2005

Long-term outcome of a low-dose intravesical bacillus Calmette-Guerin therapy for carcinoma in situ of the bladder: results after six successive instillations of 40 mg BCG.

BACKGROUND: In Japan, bacillus Calmette-Guerin (BCG: Tokyo 172 strain) instillation is generally performed at a dose of 80 mg once weekly for eight consecutive weeks; however, many adverse effects including severe ones have been reported. We employed a dose of 40 mg once a week for six consecutive weeks in principle for carcinoma in situ (CIS) of the bladder, and retrospectively evaluated its effectiveness and safety. METHODS: A total of 43 patients with CIS of the bladder were treated by this method and followed-up for a subsequent 12-79 months (median, 54 months). The patients consisted of 35 males and eight females aged 45-87 years (mean, 67.5 years). Intravesical BCG instillation at a dose of 40 mg was conducted once a week for six consecutive weeks. RESULTS: A complete response (CR) was achieved in 84% of the patients, in whom the recurrence-free rate was 72.4% after 3 years and 61.9% after 5 years. The median CR duration was 37.5 months. Two patients underwent total cystectomy, but none died of bladder cancer. As adverse effects, bladder irritation symptoms were observed in 48.8%, pyuria in 46.5%, macroscopic hematuria in 18.6% and fever (>37.5 degrees C) in 9.3%. There were no severe adverse effects requiring discontinuation of drug administration. CONCLUSION: Our present study corroborated both the effectiveness and safety of low-dose BCG therapy for CIS of the bladder. This therapy warrants further study by prospective randomized trials in the future.

Administration, Intravesical↗
PubMed1999

Renal zygomycosis: an under-diagnosed cause of acute renal failure.

BACKGROUND: Invasive zygomycosis (mucormycosis) occurs predominantly in immunocompromised patients in whom it carries a grave prognosis. While renal involvement is not so uncommon in disseminated infection, isolated renal zygomycosis is rare. METHODS AND RESULTS: Forty-five patients with systemic zygomycosis were seen over a 12-year period from January 1986 to December 1997. Among these, 18 had renal involvement, nine with disseminated disease and nine with isolated renal zygomycosis. No underlying predisposing disease was identified in the majority of patients (72%). Renal involvement was confirmed at autopsy in 13 and by ante-mortem renal biopsy in five patients. The infection involved one kidney in five patients and was bilateral in the remaining. The manifestations included fever, flank pain, haematuria and pyuria with evidence of enlarged non-functioning kidneys on computerised tomography (CT). Of those with bilateral disease, 12 (92.3%) had anuric acute renal failure. Anti-fungal therapy was given to six patients (amphotericin B in mean total dose of 1.1 g) and of these only two with unilateral disease who also underwent nephrectomy survived while all the other 16 died. CONCLUSION: This study shows that renal zygomycosis has emerged as a cause of acute renal failure in the last decade since no patient with renal involvement was identified at our centre prior to 1986 even though autopsies have been done regularly in patients dying of unknown causes. Bilateral renal zygomycosis should be suspected in any patient who presents with haematuria, flank pain and otherwise unexplained anuric renal failure. Characteristic CT findings and an early renal biopsy can confirm the diagnosis and help in effective management of this serious disease.

Acute Kidney Injury↗
PubMed2005

Kawasaki disease presenting with hemorrhagic pleural effusion.

Hemorrhagic pleural effusion associated with Kawasaki disease KD is very rare and has not been reported in the medical literature. We describe a 5-year-old male with incomplete (atypical) KD who presented with fever and severe respiratory distress due to bilateral pleural effusions. Other features included unilateral cervical lymphadenopathy, swelling of the hands and feet followed by periungual desquamation, elevated erythrocyte sedimentation rate, thrombocytosis and sterile pyuria. Pleural fluid analysis revealed a hemorrhagic exudative effusion. Therapy with high-dose i.v. immunoglobulin resulted in dramatic clinical improvement and resolution of pleural effusion. An echocardiogram obtained at presentation and at 6 weeks of illness was normal. Pediatricians should be aware that hemorrhagic pleural effusion can be a presenting manifestation of KD.

Child, Preschool↗
PubMedDate not supplied

Hyperlactatemia and hemolysis in G6PD deficiency after nitrofurantoin ingestion.

A 69-year-old man with glucose-6-phosphate dehydrogenase deficiency was treated with nitrofurantoin for pyuria. Four days later he presented with metabolic acidosis due to excess lactic acid, a decline in curculating hemoglobin, reticulocytosis, elevated serum transaminase levels, and hyperbilirubinemia. The drug was withdrawn and the hyperlactatemia subsided in three days without specific treatment. In vitro, nitrofurantoin is capable of stimulating erythrocyte glucose utilization aand lactate production, and inhibiting the generation of reduced glutathione. In vivo, this drug is capable of producing hemolysis in susceptible subjects and hepatocellular injury. The temporal proximity of drug ingestion and hemolysis, increased glucose utilization, lactate excess, and hepatic insufficiency suggests that nitrofurantoin may have been responisble for precipitating the clinical and chemical abnormalities observed.

Aged↗
PubMed1991

Case report: disseminated Mycobacterium gordonae infection in a nonimmunocompromised host.

Mycobacterium gordonae is considered the least pathogenic of the Runyon Group II mycobacteria, although there are now well-documented reports of infection varying from localized soft tissue infection to disseminated life threatening diseases. We report a 40-year-old Pakistani housewife, treated in childhood for tuberculosis, who presented with severe systemic illness, fever, ascites, hepatomegaly, persistent dysuria with sterile pyuria, pulmonary disease, and anorexia with weight loss. Liver biopsy histology showed multiple granulomata and multiple isolation of M. gordonae from sputum and urine, in keeping with disseminated mycobacterial infection. She had dramatic response to antituberculosis therapy with streptomycin, isoniazid, rifampicin, and pyrazinamide. No evidence existed for disturbed humoral or cellular immunity and HIV infection. This represents the fifth reported case of disseminated M. gordonae infection, the first from the Arabian Gulf. It was treated successfully with standard antituberculosis regimen.

Adult↗
PubMed1999

The value of Ga-67 renal SPECT in diagnosing and monitoring complete and incomplete treatment in children with acute pyelonephritis.

PURPOSE: This study evaluated the utility of Ga-67 renal SPECT for diagnosing acute pyelonephritis (APN) in children and monitoring them. METHODS: Seventy-one children (ages 1 week to 12 years) who were thought clinically to have APN were included in the study. The disease was considered present if the patients had all of the following: fever (38.5 degrees C), pyuria (leukocyte counts/per high-power field > or = 10), and a positive result of a urinary culture or blood culture. Tc-99m DMSA, Ga-67 renal SPECT, and voiding cystourethrography were performed, with informed consent from the patients' parents, within 3 days after hospitalization. Three months after treatment, Tc-99m DMSA and Ga-67 renal SPECT were repeated in those patients who had abnormal results of the initial Ga-67 renal SPECT. RESULTS: In the diagnostic study, Ga-67 renal SPECT was superior to DMSA renal SPECT in detecting lesions (97% vs. 79%). Three children had false-negative results with Ga-67 renal SPECT. Seventeen kidneys were negative with Tc-99m DMSA but positive with Ga-67 renal SPECT. No patients had any Ga-67 uptake on post-therapy imaging. However, 32 of 107 kidneys (30%) had permanent renal scars. In these 107 kidneys, 78 (73%) were associated with high-grade vesicoureteral reflux (VUR; VUR grade > or = 3) and 29 (27%) with low-grade or no VUR. CONCLUSIONS: High-grade VUR tends to be associated more with APN than has been reported by others, probably because of an underestimation of APN by ultrasonography or DMSA. Ga-67 renal SPECT is sensitive and useful not only in diagnosis but also for monitoring and follow-up of children with clinical suspicion of APN, especially in those with equivocal results after DMSA renal SPECT studies.

Acute Disease↗