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Annals of Coloproctology Jul 2021Meckel diverticulum is a common congenital malformation of the gastrointestinal tract and can cause complications such as ulceration, hemorrhage, intussusception, and...
Meckel diverticulum is a common congenital malformation of the gastrointestinal tract and can cause complications such as ulceration, hemorrhage, intussusception, and perforation. This report describes a very rare complication of an enterovesical fistula associated with chronic Meckel diverticulum. A 51-year-old male presented with over 10 years of persistent pyuria. Tests were performed to rule out malignancy, including serum prostate-specific antigen level, urine cytology, bacterial culture, cystoscopy, and bladder computed tomography. An enterovesical fistula was identified, and laparoscopic exploration was performed. The findings suggested enterovesical fistula formation caused by chronic inflammation at the tip of a Meckel diverticulum. Segmental resection of the small bowel including the diverticulum and primary repair of the urinary bladder along with partial cystectomy were performed. The postoperative clinical course was uneventful. An enterovesical fistula is a very rare complication resulting from chronic inflammation of a Meckel diverticulum.
PubMed: 32178494
DOI: 10.3393/ac.2019.01.18 -
Australian Journal of General Practice Apr 2021Recurrent urinary tract infections (rUTIs) and recurrent cystitis symptoms without infection occur commonly in women and present frequently in general practice.
BACKGROUND
Recurrent urinary tract infections (rUTIs) and recurrent cystitis symptoms without infection occur commonly in women and present frequently in general practice.
OBJECTIVE
The aim of this article is to provide a management approach to the assessment and treatment of recurrent cystitis symptoms in women with rUTIs as well as women who have negative urine cultures.
DISCUSSION
Five common clinical scenarios are discussed with different approaches to treatment: true rUTIs with positive urine cultures, women with variable urine cultures (some positive and some negative), women with negative urine cultures who have pyuria +/- haematuria, women with completely normal urine cultures and women with ongoing symptoms after a definite UTI. Red flags signalling the need for early referral to a urologist for further assessment are discussed. Both non-antibiotic and antibiotic-related strategies to treat women with rUTIs are available.
Topics: Anti-Bacterial Agents; Cystitis; Female; Humans; Recurrence; Urinalysis; Urinary Tract Infections
PubMed: 33786541
DOI: 10.31128/AJGP-11-20-5728 -
Infection Control and Hospital... Feb 2023Clinicians and laboratories routinely use urinalysis (UA) parameters to determine whether antimicrobial treatment and/or urine cultures are needed. Yet the performance...
BACKGROUND
Clinicians and laboratories routinely use urinalysis (UA) parameters to determine whether antimicrobial treatment and/or urine cultures are needed. Yet the performance of individual UA parameters and common thresholds for action are not well defined and may vary across different patient populations.
METHODS
In this retrospective cohort study, we included all encounters with UAs ordered 24 hours prior to a urine culture between 2015 and 2020 at 3 North Carolina hospitals. We evaluated the performance of relevant UA parameters as potential outcome predictors, including sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). We also combined 18 different UA criteria and used receiver operating curves to identify the 5 best-performing models for predicting significant bacteriuria (≥100,000 colony-forming units of bacteria/mL).
RESULTS
In 221,933 encounters during the 6-year study period, no single UA parameter had both high sensitivity and high specificity in predicting bacteriuria. Absence of leukocyte esterase and pyuria had a high NPV for significant bacteriuria. Combined UA parameters did not perform better than pyuria alone with regard to NPV. The high NPV ≥0.90 of pyuria was maintained among most patient subgroups except females aged ≥65 years and patients with indwelling catheters.
CONCLUSION
When used as a part of a diagnostic workup, UA parameters should be leveraged for their NPV instead of sensitivity. Because many laboratories and hospitals use reflex urine culture algorithms, their workflow should include clinical decision support and or education to target symptomatic patients and focus on populations where absence of pyuria has high NPV.
Topics: Female; Humans; Pyuria; Bacteriuria; Urinary Tract Infections; Retrospective Studies; Urinalysis; Reflex; Urine
PubMed: 36625063
DOI: 10.1017/ice.2022.315 -
Pediatric Nephrology (Berlin, Germany) Oct 2023To determine whether urine neutrophil gelatinase-associated lipocalin (uNGAL) might be superior to pyuria for detecting urinary tract infection (UTI) regardless of urine...
BACKGROUND
To determine whether urine neutrophil gelatinase-associated lipocalin (uNGAL) might be superior to pyuria for detecting urinary tract infection (UTI) regardless of urine specific gravity (SG) in young children.
METHODS
We conducted a retrospective analysis of children aged < 3 years who were evaluated for UTI with urinalysis, urine culture, and uNGAL measurements during a 5-year period. Sensitivity, specificity, likelihood ratios (LRs), predictive values (PVs), area under the curves (AUCs) of uNGAL cut-off levels, and various microscopic pyuria thresholds for detecting UTI were calculated for dilute (SG < 1.015) and concentrated urine (SG ≥ 1.015).
RESULTS
Of 456 children included, 218 had UTI. The diagnostic value of urine white blood cell (WBC) concentration to define UTI changed with urine SG. For detecting UTI, uNGAL cut-off of 68.4 ng/mL had higher AUC values than pyuria ≥ 5 WBCs/high power field (HPF) for dilute and concentrated urine samples (both P < 0.05). Positive LR and PV and specificity of uNGAL were all greater than those of pyuria ≥ 5 WBCs/HPF regardless of urine SG, although the sensitivity of pyuria ≥ 5 WBCs/HPF was higher than that of uNGAL cut-off for dilute urine (93.8% vs. 83.5%) (P < 0.05). At uNGAL ≥ 68.4 ng/mL and ≥ 5 WBCs/HPF, posttest probabilities of UTI were 68.8% and 57.5% for dilute urine and 73.4% and 57.3% for concentrated urine, respectively.
CONCLUSIONS
Urine SG can affect the diagnostic performance of pyuria for detecting UTI and uNGAL might be helpful for identifying UTI regardless of urine SG in young children. A higher resolution version of the Graphical abstract is available as Supplementary information.
Topics: Child; Child, Preschool; Humans; Lipocalin-2; Pyuria; Retrospective Studies; Specific Gravity; Urinalysis; Urinary Tract Infections
PubMed: 37074426
DOI: 10.1007/s00467-023-05957-3 -
The Journal of Family Practice Mar 2020A CT scan pointed to a surgical emergency. But what surgeons found was not the small bowel obstruction they were expecting. (Review)
Review
A CT scan pointed to a surgical emergency. But what surgeons found was not the small bowel obstruction they were expecting.
Topics: Abdominal Pain; Abscess; Diagnosis, Differential; Emergency Service, Hospital; Female; Fever; Follow-Up Studies; Humans; Hysterectomy; Intestinal Obstruction; Laparoscopy; Middle Aged; Ovarian Diseases; Pelvic Inflammatory Disease; Pyuria; Risk Assessment; Salpingo-oophorectomy; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 32182293
DOI: No ID Found -
PloS One 2021Visceral Leishmaniasis (VL) is a neglected tropical disease endemic to several countries including Ethiopia. Outside of Africa, kidney involvement in VL is frequent and...
BACKGROUND
Visceral Leishmaniasis (VL) is a neglected tropical disease endemic to several countries including Ethiopia. Outside of Africa, kidney involvement in VL is frequent and associated with increased mortality. There is however limited data on acute kidney injury (AKI) in VL patients in East-Africa, particularly in areas with high rates of HIV co-infection. This study aims to determine the prevalence, characteristics and associated factors of AKI in VL patients in Northwest Ethiopia.
METHODS
A hospital based retrospective patient record analysis was conducted including patients treated for VL from January 2019 to December 2019 at the Leishmaniasis Research and Treatment Center (LRTC), Gondar, Ethiopia. Patients that were enrolled in ongoing clinical trials at the study site and those with significant incomplete data were excluded. Data was analyzed using SPSS version 20. P values were considered significant if < 0.05.
RESULTS
Among 352 VL patients treated at LRTC during the study period, 298 were included in the study. All were male patients except two; the median age was 23 years (IQR: 20-27). The overall prevalence of AKI among VL patients was 17.4% (confidence interval (CI): 13.6%-22.2%). Pre-renal azotemia (57%) and drug-induced AKI (50%) were the main etiologies of AKI at admission and post-admission respectively. Proteinuria and hematuria occurred in 85% and 42% of AKI patients respectively. Multivariate logistic regression revealed HIV co-infection (adjusted odds ratio (AOR): 6.01 95% CI: 1.99-18.27, p = 0.001) and other concomitant infections (AOR: 3.44 95% CI: 1.37-8.65, p = 0.009) to be independently associated with AKI.
CONCLUSION
AKI is a frequent complication in Ethiopian VL patients. Other renal manifestations included proteinuria, hematuria, and pyuria. HIV co-infection and other concomitant infections were significantly associated with AKI. Further studies are needed to quantify proteinuria and evaluate the influence of AKI on the treatment course, morbidity and mortality in VL patients.
Topics: Acute Kidney Injury; Adolescent; Adult; Coinfection; Ethiopia; HIV Infections; Humans; Leishmaniasis; Leishmaniasis, Visceral; Middle Aged; Odds Ratio; Retrospective Studies; Risk Factors; Young Adult
PubMed: 34101727
DOI: 10.1371/journal.pone.0252419 -
Journal of the American Animal Hospital... Sep 2022The study evaluated leukocyte esterase (LE) and nitrite reagent pad usefulness in canine urine using multiple time endpoints and decision thresholds. Whole and...
The study evaluated leukocyte esterase (LE) and nitrite reagent pad usefulness in canine urine using multiple time endpoints and decision thresholds. Whole and sedimented urine samples from 116 client-owned dogs were analyzed with reagent strips from four manufacturers. Results for LE and nitrite were recorded every 30 s up to 150 s using "trace" and "+" positive thresholds and compared to microscopic urine sediment analysis and culture results. Sedimented urine assessed at 150 s with a "trace" positive threshold for LE had significantly or trending higher sensitivity (brand dependent) for pyuria detection compared with manufacturer recommendations. Using these parameters, LE sensitivity and negative likelihood ratio were 66.67-89.47%, and 0.13-0.37, respectively. Following manufacturer recommendations, LE specificity and positive likelihood ratio were 96.91-100% and 17.02-30.63, respectively. Nitrite performance for pyuria and bacteriuria detection was poor for all conditions. LE reagent pads are a useful screening test for pyuria detection using sedimented urine and a "trace" positive threshold at 150 s, whereas LE use with traditional manufacturer recommendations is a good confirmatory test for pyuria detection. Nitrite reagent pads are not useful for pyuria or bacteriuria detection.
Topics: Animals; Bacteriuria; Carboxylic Ester Hydrolases; Dog Diseases; Dogs; Nitrites; Pyuria; Reagent Strips; Sensitivity and Specificity; Urinary Tract Infections
PubMed: 36049239
DOI: 10.5326/JAAHA-MS-7233 -
The Journal of Small Animal Practice Apr 2022To determine the effect of urine-specific gravity (USG) on using microscopic evaluation of bacteriuria to predict urine culture results in dogs and cats.
OBJECTIVE
To determine the effect of urine-specific gravity (USG) on using microscopic evaluation of bacteriuria to predict urine culture results in dogs and cats.
MATERIALS AND METHODS
We performed a retrospective medical record review of canine and feline patients that had a urinalysis and urine culture performed simultaneously. The sensitivity, specificity, positive predictive value and negative predictive value of microscopic bacteriuria for predicting urine culture results were calculated, stratified by USG. Multivariable regression was performed to test the effect of USG, pyuria, haematuria and species on the agreement between microscopic bacteriuria and culture results.
RESULTS
A total of 481 dogs and 291 cats with paired urinalysis and urine culture results were included in the study. Microscopic bacteriuria had moderate sensitivity (76% in dogs, 64% in cats) and high specificity (97% in dogs, 96% in cats) for predicting urine culture bacterial growth. Samples with rod bacteria were more likely to have bacterial growth than those with cocci (OR=Infinity, 95% CI 4.8 - Infinity). As compared to isosthenuric+hyposthenuric samples (USG ≤1.012), agreement was lower in moderately concentrated (OR=0.44, 95% CI 0.19 to 0.91) samples. Absence of bacteriuria, pyuria and haematuria had a high negative predictive value for no bacterial growth (96%).
CLINICAL SIGNIFICANCE
Microscopic bacteriuria has a high specificity in predicting urine culture results, regardless of USG. The finding that microscopic bacteriuria has better agreement with urine culture results in isosthenuric+hyposthenuric urine argues against reflex culture in these samples, especially if pyuria and haematuria are also absent. Urine microscopy can aid clinicians in determining the likelihood of urine culture growth.
Topics: Animals; Bacteriuria; Cat Diseases; Cats; Dog Diseases; Dogs; Female; Hematuria; Male; Microscopy; Pyuria; Retrospective Studies; Specific Gravity; Urinalysis; Urinary Tract Infections; Urine
PubMed: 34897695
DOI: 10.1111/jsap.13456 -
Journal of Microbiology, Immunology,... May 2024Urine leukocyte count under microscopy is one of the most frequently used routine screening tests for urinary tract infection (UTI). Nevertheless, it is observed that...
BACKGROUND
Urine leukocyte count under microscopy is one of the most frequently used routine screening tests for urinary tract infection (UTI). Nevertheless, it is observed that pyuria is lacking in 10-25% of children with UTI. This study aims to determine the factors related to pyuria-negative UTI in young infants aged under four months old.
METHOD
This retrospective cross-sectional study was conducted on 157 patients aged under 4 months old with UTI. All subjects had paired urinalysis and urine culture, which were collected via transurethral catheterization. According to the results of their urinalysis, the patients were then classified as UTI cases with pyuria and UTI cases without pyuria. The clinical characteristics and outcomes of both groups were analyzed.
RESULT
Among the 157 UTI patients, the prevalence of pyuria-negative UTI was 44%. Significant risk factors associated with pyuria-negative UTI included non-E.coli pathogens, younger age, shorter duration of fever prior to hospital visit, lower white blood cell (WBC) count upon hospital visit, and absence of microscopic hematuria.
CONCLUSIONS
We found that non-E.coli uropathogens were the strongest factor related to pyuria-negative UTI. The absence of pyuria cannot exclude the diagnosis of UTI in young infants, and it's reasonable to perform both urinalysis and urine culture as a part of the assessment of febrile or ill-looking young infants.
PubMed: 38845335
DOI: 10.1016/j.jmii.2024.05.008 -
BMC Urology Sep 2021Genitourinary tuberculosis (GUTB) is known to cause high rates of structural organ damage, however, literature on its biochemical manifestations is limited....
BACKGROUND
Genitourinary tuberculosis (GUTB) is known to cause high rates of structural organ damage, however, literature on its biochemical manifestations is limited. Additionally, local studies in the Philippine setting, where cases are rampant, are few and dated. This study aimed to determine the serologic and urinary profile of patients with GUTB admitted at a tertiary hospital within January 2009 to March 2020 and their association with short-term outcomes.
METHODS
This retrospective study included 112 patients with laboratory-confirmed GUTB (i.e., positivity in acid-fast smear, polymerase chain reaction, culture, or histology). Demographic data, clinical characteristics, laboratory and radiologic findings, histopathology reports, treatment, and short-term outcomes were recorded.
RESULTS
Bladder (54.5%) and kidney (36.4%) were the most affected organs. The male:female ratio was 1:1.15, and the mean age was 35.79 ± 18.29 years. Weakness (14.29%) was the most common chief complaint. A majority presented with anemia (83.04%), while several had leukocytosis (41.96%) and thrombocytosis (26.79%). Hypoalbuminemia (58.10%), impairment of renal function (36.94%), and electrolyte abnormalities such as hyponatremia (50.93%), hypercalcemia (20.19%), and hypokalemia (21.82%) were common. Proteinuria (67.96%) and pyuria (67.96%) were the most frequent abnormal findings, followed by hematuria (51.46%), acidic urine (45.63%) and low specific gravity (31.07%). Age, leukocytosis, and the need for pressors were all significantly associated with mortality (p values of <0.001, 0.010, and <0.001, respectively).
CONCLUSIONS
The young age at presentation with severe clinical and laboratory manifestations may reflect local epidemiology as TB continues to be widespread in the country. Apart from the more commonly cited abnormalities in literature, multiple electrolyte imbalances and urinary concentration defects were also observed in many cases, possibly indicating tubulointerstitial involvement-a complication increasingly mentioned in case reports. As several patient characteristics were found to be associated with the high mortality rates observed in the study, further research is recommended to explore predictive modeling.
Topics: Adolescent; Adult; Age of Onset; Aged; Aged, 80 and over; Anemia; Child; Child, Preschool; Female; Humans; Hypoalbuminemia; Hypokalemia; Infant; Infant, Newborn; Leukocytosis; Male; Middle Aged; Philippines; Retrospective Studies; Tertiary Care Centers; Thrombocytosis; Treatment Outcome; Tuberculosis, Urogenital; Young Adult
PubMed: 34503465
DOI: 10.1186/s12894-021-00888-3