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The American Journal of Emergency... Jun 2019Pleural trichomonosis is clinically rare, and very few cases of trichomonal empyema have been reported so far. A rare case of an 81-year-old woman with pyopeumothorax...
Pleural trichomonosis is clinically rare, and very few cases of trichomonal empyema have been reported so far. A rare case of an 81-year-old woman with pyopeumothorax presenting with recurrent fever and macroscopic pyuria was present. Microscopic examination of the pleural effusion showed mobile flagellated protozoa which molecular methods identified as Tetratrichomonas. In addition, Streptococcus anginosus was discovered in pleural fluid cultures. Treatment with imipenem/cilastatin and metronidazole successfully eliminated the pathogens and led to relief of clinical symptoms. In the context of a review of the relevant literature, the clinical application of molecular methods in the diagnosis of pleural trichomonosis is underlined.
Topics: Aged, 80 and over; Antiprotozoal Agents; Cilastatin; Empyema, Pleural; Female; Humans; Imipenem; Metronidazole; Pleural Effusion; Pneumothorax; Streptococcal Infections; Streptococcus anginosus; Trichomonadida; Trichomonas Infections
PubMed: 31023584
DOI: 10.1016/j.ajem.2019.03.029 -
Annals of Emergency Medicine Oct 2022
Topics: Fever; Humans; Male; Pyuria; Urinary Tract Infections
PubMed: 36153059
DOI: 10.1016/j.annemergmed.2022.05.033 -
Archives of Iranian Medicine Oct 2016Xanthogranulomatous pyelonephritis is a chronic destructive granulomatous inflammation of the kidney. This pathology was firstly described in 1916 and a small number of...
INTRODUCTION
Xanthogranulomatous pyelonephritis is a chronic destructive granulomatous inflammation of the kidney. This pathology was firstly described in 1916 and a small number of patient series were reported in the literature. In this study, we aimed to report the patients with xanthogranulomatous pyelonephritis in our nephrectomy cases.
METHODS
The patients who underwent nephrectomy and were diagnosed with xanthogranulomatous pyelonephritis in our hospital database were reviewed retrospectively. Preoperative laboratory results, radiological imaging findings, patients' age and history of predisposing diseases were recorded.
RESULTS
A total of 13 cases of xanthogranulomatous pyelonephritis treated in our hospital from January 2003 to December 2015 were included in the study, consisting of 7 male and 6 female patients with a mean age of 56 ± 16.09 years. In urine analyse, pyuria was positive in 6 patients (46.15%) and leukocytosis was detected in one patient (7.7%). The disease site was the right kidney in 4 patients (30.7%) and the left kidney in 9 patients (69.23%). Radiological findings of the patients were pyonephrosis, renal ectasia, pyelonephritis, hydronephrosis, renal tumor, xanthogranulomatous pyelonephritis and non-functioning kidney with renal calculi. All patients were treated by open surgical techniques and perioperative and postoperative complications did not occur. Partial and radical nephrectomy was performed in one patient and the other patients were treated with simple nephrectomy.
CONCLUSION
Xanthogranulomatous pyelonephritis is an uncommon histologic variant of the kidney for patients who are surgically treated for pyelonephritis. Early diagnosis and treatment is very important for decreasing morbidity and mortality. Although radical surgery is the main treatment of choice for patients with diffuse xanthogranulomatous pyelonephritis, nephron sparing surgery is an alternative for patients who have the focal form, if technically possible.
Topics: Adult; Databases, Factual; Female; Humans; Hydronephrosis; Iran; Kidney; Kidney Neoplasms; Male; Middle Aged; Nephrectomy; Nephrolithiasis; Pyelonephritis, Xanthogranulomatous; Retrospective Studies
PubMed: 27743436
DOI: No ID Found -
Current Opinion in Pediatrics Jun 2017The approach to febrile young infants remains challenging. This review serves as an update on the care of febrile infants less than 90 days of age with a focus on the... (Review)
Review
PURPOSE OF REVIEW
The approach to febrile young infants remains challenging. This review serves as an update on the care of febrile infants less than 90 days of age with a focus on the changing epidemiology of serious bacterial infection (SBI), refinement of management strategies based on biomarkers, and the development of novel diagnostics.
RECENT FINDINGS
There is high variability in the emergency department management of febrile young infants without significant differences in outcomes. C-reactive protein (CRP) and procalcitonin have emerged as valuable risk-stratification tests to identify high-risk infants. When interpreting automated urinalyses for suspected urinary tract infection (UTI), urine concentration influences the diagnostic value of pyuria. Novel diagnostics including RNA biosignatures and protein signatures show promise in better identifying young febrile infants at risk of serious infection.
SUMMARY
The majority of febrile infants with an SBI will have a UTI but the diagnosis of invasive bacterial infection in infants continues to be challenging. The use of procalcitonin and CRP as biomarkers in prediction algorithms facilitates identification of low-risk infants.
Topics: Algorithms; Bacterial Infections; Biomarkers; Decision Support Techniques; Emergency Service, Hospital; Fever; Humans; Infant; Infant, Newborn; Prognosis; Risk Assessment; Urinary Tract Infections
PubMed: 28323666
DOI: 10.1097/MOP.0000000000000492 -
Urology Annals 2023Epididymo-orchitis (EO) is a common urological condition. In endemic areas, EO may be the presenting picture of brucellosis. Early suspicion and proper diagnosis is...
INTRODUCTION
Epididymo-orchitis (EO) is a common urological condition. In endemic areas, EO may be the presenting picture of brucellosis. Early suspicion and proper diagnosis is necessary for patient recovery.
OBJECTIVE
The aim of our study is to identify early predictors of EO.
PATIENTS AND METHODS
We retrospectively collected the data of all patients who were treated at the Urology Unit, Farwaniya Hospital, with acute EO above the age of 12 years between April 2017 and February 2019. Data from electronic and hardcopy files were gathered and analyzed. The diagnosis of acute EO was based on clinical, laboratory, and radiological findings. A total of 120 patients under the diagnosis of EO, epididymitis, and orchitis were reviewed. Thirty-one patients were tested for based on the history of animal contact, ingestion of unpasteurized dairy products, or persistent fever for more than 48 h. of those patients, 11 tested positive for orchitis.
RESULTS
A comparison between -positive and -negative patients regarding age, presence of fever, complete blood count (CBC) parameters, pyuria, and abscess formation was made. In the group, 72% of the patients had a history of animal contact compared to 33% in non- group ( = 0.006). When comparing CBC parameters in the two groups, group had statistically significant lower total leukocytic count and neutrophil count (mean ± standard deviation [SD]) 13.07 ± 4.22, 6.4 ± 9.98 versus negative group 17.35 ± 5.28, 7.8 ± 10.53, and values were 0.037 and 0.004, respectively. group showed lymphocytosis (mean ± SD) 25.95 ± 9.78 versus non- group 13.22 ± 8.05 and < 0.01.
CONCLUSION
orchitis constituted 9% of the orchitis patients treated in our hospital. Patients with a history of animal contact, EO with lymphocytosis, and relative neutropenia should raise the suspicion for orchitis in endemic areas.
PubMed: 37304522
DOI: 10.4103/ua.ua_178_21 -
The American Journal of Clinical... Jun 2016Urinary tract infections (UTIs) are among the most common bacterial infections and are often treated with antibiotics. Concerns about multidrug-resistant uropathogens... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Urinary tract infections (UTIs) are among the most common bacterial infections and are often treated with antibiotics. Concerns about multidrug-resistant uropathogens have pointed to the need for safe and effective UTI-prevention strategies such as cranberry consumption.
OBJECTIVE
We assessed the effects of the consumption of a cranberry beverage on episodes of clinical UTIs.
DESIGN
In this randomized, double-blind, placebo-controlled, multicenter clinical trial, women with a history of a recent UTI were assigned to consume one 240-mL serving of cranberry beverage/d (n = 185) or a placebo (n = 188) beverage for 24 wk. The primary outcome was the clinical UTI incidence density, which was defined as the total number of clinical UTI events (including multiple events per subject when applicable) per unit of observation time.
RESULTS
The dates of the random assignment of the first subject and the last subject's final visit were February 2013 and March 2015, respectively. The mean age was 40.9 y, and characteristics were similar in both groups. Compliance with study product consumption was 98%, and 86% of subjects completed the treatment period in both groups. There were 39 investigator-diagnosed episodes of clinical UTI in the cranberry group compared with 67 episodes in the placebo group (antibiotic use-adjusted incidence rate ratio: 0.61; 95% CI: 0.41, 0.91; P = 0.016). Clinical UTI with pyuria was also significantly reduced (incidence rate ratio: 0.63; 95% CI: 0.40, 0.97; P = 0.037). One clinical UTI event was prevented for every 3.2 woman-years (95% CI: 2.0, 13.1 woman-years) of the cranberry intervention. The time to UTI with culture positivity did not differ significantly between groups (HR: 0.97; 95% CI: 0.56, 1.67; P = 0.914).
CONCLUSION
The consumption of a cranberry juice beverage lowered the number of clinical UTI episodes in women with a recent history of UTI. This study was registered at clinicaltrials.gov as NCT01776021.
Topics: Adult; Aged; Beverages; Double-Blind Method; Female; Fruit; Humans; Middle Aged; Phytotherapy; Placebos; Pyuria; Urinary Tract Infections; Vaccinium macrocarpon
PubMed: 27251185
DOI: 10.3945/ajcn.116.130542 -
Clinical Infectious Diseases : An... Apr 2021Asymptomatic bacteriuria and pyuria in healthy women often trigger inappropriate antimicrobial treatment, but there is a paucity of data on their prevalence and... (Observational Study)
Observational Study
BACKGROUND
Asymptomatic bacteriuria and pyuria in healthy women often trigger inappropriate antimicrobial treatment, but there is a paucity of data on their prevalence and persistence.
METHODS
To evaluate the prevalence and persistence of asymptomatic bacteriuria and pyuria in women at high risk of recurrent urinary tract infection, we conducted an observational cohort study in 104 healthy premenopausal women with a history of recurrent urinary tract infection with daily assessments of bacteriuria, pyuria, and urinary symptoms over a 3-month period.
RESULTS
The mean age of participants was 22 years, and 74% were white. Asymptomatic bacteriuria events (urine cultures with colony count ≥105 CFU/mL of a uropathogen on days with no symptomatic urinary tract infection diagnosed) occurred in 45 (45%) women on 159 (2.5%) of 6283 days. Asymptomatic bacteriuria events were most commonly caused by Escherichia coli, which was present on 1.4% of days, with a median duration of 1 day (range, 1-10). Pyuria occurred in 70 (78%) of 90 evaluable participants on at least 1 day and 25% of all days on which no symptomatic urinary tract infection was diagnosed. The positive predictive value of pyuria for E. coli asymptomatic bacteriuria was 4%.
CONCLUSIONS
In this population of healthy women at high risk of recurrent urinary tract infection, asymptomatic bacteriuria is uncommon and, when present, rarely lasts more than 2 days. Pyuria, on the other hand, is common but infrequently associated with bacteriuria or symptoms. These data strongly support recommendations not to screen for or treat asymptomatic bacteriuria or pyuria in healthy, nonpregnant women.
Topics: Adult; Bacteriuria; Escherichia coli; Female; Humans; Pyuria; Urinalysis; Urinary Tract Infections; Young Adult
PubMed: 32179902
DOI: 10.1093/cid/ciaa274 -
Clinical Infectious Diseases : An... Jun 2023Pre-existing lower urinary tract symptoms (LUTS), cognitive impairment, and the high prevalence of asymptomatic bacteriuria (ASB) complicate the diagnosis of urinary...
BACKGROUND
Pre-existing lower urinary tract symptoms (LUTS), cognitive impairment, and the high prevalence of asymptomatic bacteriuria (ASB) complicate the diagnosis of urinary tract infection (UTI) in older women. The presence of pyuria remains the cornerstone of UTI diagnosis. However, >90% of ASB patients have pyuria, prompting unnecessary treatment. We quantified pyuria by automated microscopy and flowcytometry to determine the diagnostic accuracy for UTI and to derive pyuria thresholds for UTI in older women.
METHODS
Women ≥65 years with ≥2 new-onset LUTS and 1 uropathogen ≥104 colony-forming units (CFU)/mL were included in the UTI group. Controls were asymptomatic and classified as ASB (1 uropathogen ≥105 CFU/mL), negative culture, or mixed flora. Patients with an indwelling catheter or antimicrobial pretreatment were excluded. Leukocyte medians were compared and sensitivity-specificity pairs were derived from a receiver operating characteristic curve.
RESULTS
We included 164 participants. UTI patients had higher median urinary leukocytes compared with control patients (microscopy: 900 vs 26 leukocytes/µL; flowcytometry: 1575 vs 23 leukocytes/µL; P < .001). Area under the curve was 0.93 for both methods. At a cutoff of 264 leukocytes/µL, sensitivity and specificity of microscopy were 88% (positive and negative likelihood ratio: 7.2 and 0.1, respectively). The commonly used cutoff of 10 leukocytes/µL had a poor specificity (36%) and a sensitivity of 100%.
CONCLUSIONS
The degree of pyuria can help to distinguish UTI in older women from ASB and asymptomatic controls with pyuria. Current pyuria cutoffs are too low and promote inappropriate UTI diagnosis in older women. Clinical Trials Registration. International Clinical Trials Registry Platform: NL9477 (https://trialsearch.who.int/Trial2.aspx?TrialID=NL9477).
Topics: Humans; Female; Aged; Pyuria; Urinary Tract Infections; Bacteriuria; Sensitivity and Specificity; ROC Curve
PubMed: 36806580
DOI: 10.1093/cid/ciad099 -
Journal of the College of Physicians... Apr 2020To find parameters for differential diagnosis between Brucella epididymo-orchitis (BEO) and non-brucella epididymo-orchitis (NBEO) cases with comparison of BEO and...
OBJECTIVE
To find parameters for differential diagnosis between Brucella epididymo-orchitis (BEO) and non-brucella epididymo-orchitis (NBEO) cases with comparison of BEO and NBEO in terms of inflammatory markers, full urinalysis (FU) for pyuria, and abscess formation (AF).
STUDY DESIGN
Descriptive study.
PLACE AND DURATION OF STUDY
Agri State Hospital Urology and Infectious Disease Clinics, between January 2014 and November 2017.
METHODOLOGY
Data of the patients, who were diagnosed with epididymo-orchitis, were divided in BEO and NBEO groups on the basic of serum agglutination test. Parameters including age, white blood cell neutrophil, lymphocyte, monocyte, platelet, mean platelet volume, C-reactive protein (CRP), neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio, platelet / lymphocyte ratio, and FU. The values were statistically compared.
RESULTS
One hundred and thirty-eight (138) patients were found eligible for the study. Twenty-three (23) of these patients (16.66%) had BEO, and 115 (83.33%) had NBEO. BEO vs. NBEO cases were significantly different regarding mean age (26.17 ±8.15 vs. 48.53 ±21.78 years, p=0.0001) and frequency of pyuria (3,13.04%) vs. 89 (77.39%, p=0.001). However CRP values i.e. 6.07 ±6.59 vs. 6.07 ±5.85 mg/dl (p=0.999) was not significantly different.
CONCLUSION
BEO cases are often younger and do not have pyuria or abscess formation. High frequency of pyuria was found in NBEO cases. CRP levels cannot be used in the differential diagnosis between BEO and NBEO cases. Key Words: Abscess formation, Brucella epididymo-orchitis, C-reactive protein, Orchiectomy, Pyuria.
Topics: Brucella; Brucellosis; Epididymitis; Humans; Male; Orchitis; Retrospective Studies
PubMed: 32513361
DOI: 10.29271/jcpsp.2020.04.403 -
Praxis Jan 2017
Randomized Controlled Trial
Topics: Aged; Capsules; Double-Blind Method; Female; Homes for the Aged; Humans; Nursing Homes; Phytotherapy; Pyuria; Treatment Failure; Urinary Tract Infections; Vaccinium macrocarpon
PubMed: 28103171
DOI: 10.1024/1661-8157/a002575