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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 -
Experimental and Therapeutic Medicine Mar 2023With the increase in percutaneous interventions such as percutaneous nephrolithotomy (PCNL) for renal lithiasis, infectious complications are becoming more frequent. The...
With the increase in percutaneous interventions such as percutaneous nephrolithotomy (PCNL) for renal lithiasis, infectious complications are becoming more frequent. The present study performed a systematic Medline and Embase databases search, using the following words: 'PCNL' [MeSH Terms] AND ['sepsis' (All Fields) OR 'PCNL' (All Fields)] AND ['septic shock' (All Fields)] AND ['urosepsis' (MeSH Terms) OR 'Systemic inflammatory response syndrome (SIRS)' (All Fields)]. Because of the technological advances in endourology, articles published between 2012 and 2022 were searched. Of the 1,403 results of the search, only 18 articles, representing 7,507 patients in which PCNL was performed, met the criteria to be included in the analysis. All authors applied antibiotic prophylaxis to all patients and, in some cases, the infection was treated preoperatively in those with positive urine cultures. According to the analysis of the present study, the operative time has been significantly longer in patients who developed SIRS/sepsis post-operatively (P=0.0001) with the highest heterogeneity (I=91%) compared with other factors. Patients with a positive preoperative urine culture had a significantly higher risk of developing SIRS/sepsis following PCNL (P=0.00001), OD=2.92 (1.82, 4.68) and there was also a high degree of heterogeneity (I=80%). Performing a multi-tract PCNL also increased the incidence of postoperative SIRS/sepsis (P=0.00001), OD=2.64 (1.78, 3.93) and the heterogeneity was a little smaller (I=67%). Diabetes mellitus (P=0.004), OD=1.50 (1.14, 1.98), I=27% and preoperative pyuria (P=0.002), OD=1.75 (1.23, 2.49), I=20%, were other factors that significantly influenced postoperative evolution. A total of two factors analyzed, body mass index and patient's age, did not influence the outcome, P=0.45, I=58% and P=0.98, I=63%.
PubMed: 36793328
DOI: 10.3892/etm.2023.11809 -
Hinyokika Kiyo. Acta Urologica Japonica Jan 2023A 70-year-old-man was referred with urination pain and pyuria. Prostate specific antigen was 10.6 ng/ml, and urine culture was Escherichia coli. The abdominal...
A 70-year-old-man was referred with urination pain and pyuria. Prostate specific antigen was 10.6 ng/ml, and urine culture was Escherichia coli. The abdominal ultrasonography showed irregular low echo at the right lobe of prostate. Prostate magnetic resonance imaging (MRI) showed an extracapsular infiltrated prostate tumor in the right lobe. Levofloxacin was administered and prostate biopsy was performed. The pathological examination revealed that the prostate tissue was filled with inflammatory cells and had lost its glandular duct structure. The patient was diagnosed with malacoplakia of the prostate. Four months after prostate biopsy, prostate MRI imaging showed disappearance of the extracapsular infiltration in right peripheral zone.
Topics: Male; Humans; Aged; Prostate; Malacoplakia; Prostatic Neoplasms; Prostate-Specific Antigen; Biopsy; Magnetic Resonance Imaging
PubMed: 36727457
DOI: 10.14989/ActaUrolJap_69_1_19 -
Frontiers in Pediatrics 2022Kawasaki disease (KD) is an acute idiopathic systemic vasculitis with a self- limiting course that predominantly affects children under 5 years old, particularly in the...
INTRODUCTION
Kawasaki disease (KD) is an acute idiopathic systemic vasculitis with a self- limiting course that predominantly affects children under 5 years old, particularly in the East Asian countries. Nevertheless, to date, the data on KD in Malaysia are limited. This study aimed to evaluate the epidemiology, clinical features, treatment, and outcomes of KD among the pediatric patients admitted to Hospital Canselor Tunku Muhriz (HCTM), Kuala Lumpur, Malaysia.
METHOD
A retrospective cohort study of 66,500 pediatric patients presented at HCTM from the year 2004 to 2021 was conducted.
RESULTS
62 KD cases out of 66,500 pediatric admissions were reported, with a male-to-female ratio of 1.58 to 1. Majority of KD patients (95.0%) were younger than 5 years old. Prior infection was reported in 5 KD patients (8.1%). Apart from the classical features, manifestations of various organ systems including cardiovascular (16.1%), gastrointestinal (43.5%), neurological (1.61%), musculoskeletal (1.61%), and genitourinary (17.7%) systems were observed. There was a significant association between sterile pyuria and coronary artery aneurysm (CAA) ( < 0.05). Interestingly, abnormal liver parameters ( < 0.05) and incomplete KD ( < 0.05) were significantly related to IVIG resistance.
DISCUSSION
The presence of family history, immunological disorder, and previous infection in our KD patients suggested that there is a possibility of genetic, immunological, and infectious roles in the pathophysiology of KD. IVIG resistance is more likely to occur in KD patients with hepatic dysfunction or incomplete KD presentation. These findings highlighted the significant contribution of laboratory parameters to the prognosis of KD, prompting more in-depth research on the KD scoring systems and their relevance in this country.
PubMed: 36714643
DOI: 10.3389/fped.2022.1090928 -
Cureus Dec 2022Acute focal bacterial nephritis (AFBN) is a radiologically diagnosed acute localized kidney infection that appears in the continuum between a perinephric abscess and...
Acute focal bacterial nephritis (AFBN) is a radiologically diagnosed acute localized kidney infection that appears in the continuum between a perinephric abscess and renal abscess. We report an unusual case of AFBN presenting without pyuria or positive urine cultures. A 42-year-old woman with chronic lower back pain who regularly used nonsteroidal anti-inflammatory drugs was admitted to our hospital with right-sided abdominal distention, fever, chills, and pain extending from the right lower abdomen to the back since two days. The physical examination revealed no abdominal or costovertebral angle tenderness. Urinalysis was negative. Abdominal ultrasound was notable for an indistinct nodular shadow (32 × 25 mm) on the upper pole of the right kidney. Abdominal contrast-enhanced computed tomography revealed a wedge-shaped area with a minimal uptake of the contrast in the right kidney. The patient was admitted to the hospital, and antimicrobial therapy was started for AFBN. Antibiotics were administered intravenously for one week and orally for two weeks. No relapse of symptoms was observed during the four-month follow-up period. This case report suggests the importance of considering AFBN as a differential diagnosis for cases of idiopathic fever and lateral pain or back pain, even when pyuria and urine culture test results are negative.
PubMed: 36712746
DOI: 10.7759/cureus.32942 -
Journal of Veterinary Internal Medicine Mar 2023No recent studies have evaluated the association between clinical signs of lower urinary tract disease (LUTD) and positive urine culture in dogs with diabetes mellitus.
BACKGROUND
No recent studies have evaluated the association between clinical signs of lower urinary tract disease (LUTD) and positive urine culture in dogs with diabetes mellitus.
OBJECTIVE
Determine the prevalence of subclinical bacteriuria (ie, positive urine culture without signs of LUTD) in dogs with diabetes mellitus.
ANIMALS
One hundred seven dogs with diabetes mellitus were evaluated at a university veterinary hospital.
METHODS
Retrospective study evaluating diabetic dogs with a single sample paired urinalysis and urine culture. Relationship between the presence of signs of LUTD, pyuria, and bacteriuria and urine culture results were compared using Fisher exact testing.
RESULTS
Fifteen dogs (14%) had a positive urine culture via cystocentesis or free catch, of which 8 (53%) had pyuria, and 4 (27%) had signs of LUTD. Of the 88 dogs (82%) without signs of LUTD, 11 (13%) had a positive culture. A significant association was found between a positive urine culture and pyuria (OR infinity; 95% CI 20.34-infinity, P < .00001) and bacteriuria (OR infinity; 95% CI 164.4-infinity, P < .00001). No association was found between urine culture results and signs of LUTD (OR 1.87; 95% CI 0.59-6.85, P = .46).
CONCLUSION AND CLINICAL IMPORTANCE
Subclinical bacteriuria occurred in this cohort of dogs, and our findings reinforce the recommendation that urine cultures should not be routinely performed in diabetic dogs particularly if pyuria and bacteriuria are absent.
Topics: Dogs; Animals; Bacteriuria; Retrospective Studies; Pyuria; Prevalence; Urinalysis; Diabetes Mellitus; Urinary Tract Infections; Dog Diseases
PubMed: 36708199
DOI: 10.1111/jvim.16634 -
Biologics : Targets & Therapy 2023Dysregulation of both cellular and humoral immune responses is central in systemic lupus erythematosus (SLE) pathogenetic mechanisms. Proinflammatory cytokines, such as...
BACKGROUND
Dysregulation of both cellular and humoral immune responses is central in systemic lupus erythematosus (SLE) pathogenetic mechanisms. Proinflammatory cytokines, such as interleukin 23 (IL23), and their roles in promoting such dysregulation have recently been highly considered. This research compared IL23 serum levels in 85 Egyptian SLE patients and 85 healthy controls. Then, IL23 level was correlated to various SLE disease parameters, disease activity, and damage indices.
RESULTS
IL23 serum levels were significantly elevated in SLE patients versus healthy individuals. Furthermore, IL23 levels were positively correlated with SLE disease activity index (SLEDAI) and were positively correlated with arthritis, seizures, consumption of complements (C3, C4), and with parameters of nephritis (hematuria, pyuria, casts, and proteinuria). A positive correlation was also found between IL23 levels and oral prednisolone dose.
CONCLUSION
IL23 has higher levels in the serum of SLE patients, and is correlated to activity of the disease, especially lupus nephritis. Further researchis needed to explore its exact role in SLE pathogenesis and whether it can be considered a potential biomarker or therapeutic target in SLE.
PubMed: 36698375
DOI: 10.2147/BTT.S389021 -
Frontiers in Immunology 2022Immune checkpoint inhibitors (ICIs), including anti-cytotoxic T lymphocyte-associated protein 4 (anti-CTLA4) and anti-programmed death cell protein 1 (anti-PD-1), are... (Review)
Review
Immune checkpoint inhibitors (ICIs), including anti-cytotoxic T lymphocyte-associated protein 4 (anti-CTLA4) and anti-programmed death cell protein 1 (anti-PD-1), are increasingly prescribed in metastatic carcinoma therapy. ICI-related kidney injury is gradually recognized by clinicians. However, immune-related ureteritis and cystitis easily go undiagnosed. We report three cases of PD-1 monoclonal antibody (mAb)-related ureteritis and cystitis. We further carried out a review of the literature about ICI-related ureteritis and cystitis. The cases in our reports manifest urinary irritation, sterile pyuria, gross hematuria, hydronephrosis, dilation of the ureters, and acute kidney injury. Urinary irritation improved effectively; urinalysis and renal function returned to normal after glucocorticoid therapy. During ICI therapy, urinalysis and renal function and urinary imaging examination are recommended to be monitored regularly. It contributes to identify immune-related ureteritis/cystitis earlier to efficiently alleviate urinary symptoms and immunologic urinary tract injury through glucocorticoid therapy while avoiding the abuse of antibiotics.
Topics: Humans; Immune Checkpoint Inhibitors; Glucocorticoids; Inflammation; Urinary Tract Infections; Cystitis; Gastrointestinal Diseases
PubMed: 36685488
DOI: 10.3389/fimmu.2022.1051577 -
Nihon Hinyokika Gakkai Zasshi. the... 2022(Objective) The etiology of acute epididymitis in children remains poorly understood. Several studies have demonstrated that urine tests are negative in the majority of...
(Objective) The etiology of acute epididymitis in children remains poorly understood. Several studies have demonstrated that urine tests are negative in the majority of children with acute epididymitis, and the condition is self-limiting. The need for radiological evaluation of the urinary tract in children with acute epididymitis is still debatable. The aim of this study was to describe clinical and imaging findings in children with acute epididymitis. (Methods) We identified 47 children with acute epididymitis at our institute between 2017 and 2021.We retrospectively reviewed their clinical features and radiological and laboratory data. All children underwent ultrasonography of the kidney and urinary tract. (Results) Median patient age was 9 years (range, 6 months-16 years) and 60% of the cases occurred between the ages of 7 and 12 years. Thirteen children (28%) had a past history of genitourinary malformations. The common malformations were hypospadias in eight children and bladder dysfunction in three. Ultrasound revealed no new urinary tract abnormalities in the remaining 34 children. Urinalysis were performed in 27 children, nine of whom (33%) had pyuria. Urine culture was positive in two children. Of the nine children with genitourinary malformations, eight had pyuria. All 18 children without genitourinary malformations had a negative urinalysis except for one patient (p< 0.0001). (Conclusions) Acute epididymitis is a common cause of acute scrotum in pediatric patients. In this study, one-third of acute epididymitis cases presented pyuria, and about 30% had a past history of genitourinary malformations. The presence of pyuria was associated with a past history of genitourinary malformations. For children with no previous genitourinary malformations, routine use of ultrasound for the detection of urinary tract abnormalities is questionable due to the low yield.
Topics: Male; Child; Humans; Infant; Epididymitis; Pyuria; Retrospective Studies; Urologic Diseases; Kidney; Acute Disease
PubMed: 36682808
DOI: 10.5980/jpnjurol.113.22 -
Nephrology, Dialysis, Transplantation :... Aug 2023Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a remarkable kidney tropism. While kidney effects are common in severe coronavirus disease 2019...
BACKGROUND
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a remarkable kidney tropism. While kidney effects are common in severe coronavirus disease 2019 (COVID-19), data on non-severe courses are limited. Here we provide a multilevel analysis of kidney outcomes after non-severe COVID-19 to test for eventual kidney sequela.
METHODS
This cross-sectional study investigates individuals after COVID-19 and matched controls recruited from the Hamburg City Health Study (HCHS) and its COVID-19 program. The HCHS is a prospective population-based cohort study within the city of Hamburg, Germany. During the COVID-19 pandemic the study additionally recruited subjects after polymerase chain reaction-confirmed SARS-CoV-2 infections. Matching was performed by age, sex and education. Main outcomes were estimated glomerular filtration rate (eGFR), albuminuria, Dickkopf3, haematuria and pyuria.
RESULTS
A total of 443 subjects in a median of 9 months after non-severe COVID-19 were compared with 1328 non-COVID-19 subjects. The mean eGFR was mildly lower in post-COVID-19 than non-COVID-19 subjects, even after adjusting for known risk factors {β = -1.84 [95% confidence interval (CI) -3.16 to -0.52]}. However, chronic kidney disease [odds ratio (OR) 0.90 (95% CI 0.48-1.66)] or severely increased albuminuria [OR 0.76 (95% CI 0.49-1.09)] equally occurred in post-COVID-19 and non-COVID-19 subjects. Haematuria, pyuria and proteinuria were also similar between the two cohorts, suggesting no ongoing kidney injury after non-severe COVID-19. Further, Dickkopf3 was not increased in the post-COVID-19 cohort, indicating no systematic risk for ongoing GFR decline [β = -72.19 (95% CI -130.0 to -14.4)].
CONCLUSION
While mean eGFR was slightly lower in subjects after non-severe COVID-19, there was no evidence for ongoing or progressive kidney sequela.
Topics: Humans; COVID-19; SARS-CoV-2; Albuminuria; Cohort Studies; Prospective Studies; Pandemics; Hematuria; Pyuria; Cross-Sectional Studies; Kidney; Disease Progression
PubMed: 36657383
DOI: 10.1093/ndt/gfad008