RESUMEN
Corynebacterium species, typically considered contaminants in urine culture, can cause encrusted cystitis (EC), a form of chronic urinary tract infection causing pain, bladder necrosis, renal failure, and death. Delayed diagnosis is common due to its rarity and the fastidious nature of Corynebacterium urealyticum. Reported mostly in elderly and immunocompromised patients, EC is rare in pediatric patients. A female adolescent on high dose steroids developed persistent dysuria after urinary catheterization. Abnormal bladder ultrasound and characteristic cystoscopy led to the diagnosis of EC. Appropriate treatment instituted 4 months from onset of dysuria led to an excellent response.
Asunto(s)
Infecciones por Corynebacterium/complicaciones , Corynebacterium , Cistitis/microbiología , Disuria/microbiología , Adolescente , Femenino , HumanosRESUMEN
Ureaplasma urealyticum is a bacterial species correlated with urethritis in healthy individuals and invasive infections in immunocompromised patients. We describe a 20-year-old female with a history of remote heart transplant on everolimus, mycophenolate, and rituximab presenting with progressive urinary tract symptoms, renal failure, and neurologic symptoms. An extensive workup ultimately identified U urealyticum infection, and the patient successfully recovered after a course of azithromycin and doxycycline.
Asunto(s)
Disuria/microbiología , Enfermedades del Sistema Nervioso/microbiología , Pielonefritis/complicaciones , Pielonefritis/diagnóstico , Insuficiencia Renal/microbiología , Infecciones por Ureaplasma/complicaciones , Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Doxiciclina/uso terapéutico , Disuria/etiología , Femenino , Humanos , Huésped Inmunocomprometido , Masculino , Enfermedades del Sistema Nervioso/etiología , Pielonefritis/tratamiento farmacológico , Pielonefritis/microbiología , Insuficiencia Renal/etiología , Infecciones por Ureaplasma/microbiología , Ureaplasma urealyticum , Adulto JovenRESUMEN
BACKGROUND Influenza B viruses cause seasonal epidemics of respiratory illness, circulating concurrently with influenza A viruses. However, virological and clinical knowledge of influenza B viruses is less well advanced than for influenza A, and in particular, complications associated with influenza B infection are not as commonly reported. Complications of influenza B infection predominantly include neurological and musculoskeletal pathologies, while a review of the literature shows that bacterial infections associated with influenza B viruses often involve Gram-positive organisms, with a smaller subset featuring Gram-negative species. CASE REPORT In this case report we highlight an uncomplicated infection of the urinary tract by Escherichia coli immediately following influenza B infection, in an otherwise healthy adult white male with no prior history of urinary tract infection or structural abnormalities of the renal tract. CONCLUSIONS Bacterial infections complicating influenza B infection may include organisms not commonly associated with the respiratory system, such as Escherichia coli. In addition, bacterial complications of influenza B infection may affect non-respiratory systems, including the genitourinary tract.
Asunto(s)
Cistitis/diagnóstico , Cistitis/microbiología , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/diagnóstico , Escherichia coli/aislamiento & purificación , Virus de la Influenza B/aislamiento & purificación , Gripe Humana/complicaciones , Adulto , Tos/virología , Cistitis/complicaciones , Disuria/microbiología , Fiebre/virología , Hematuria/microbiología , Humanos , MasculinoRESUMEN
PURPOSE: To evaluate the effect of cranberry extract (PAC-A ~ proanthocyanidin-A) on the in vitro bacterial properties of uropathogenic (E. coli) and its efficacy/tolerability in patients with subclinical or uncomplicated recurrent UTI (r-UTI). MATERIALS AND METHODS: After obtaining clearance from the ethics committee and administering a written informed consent, 72 patients with r-UTI were enrolled as per protocol (November 2011 to March 2013) in this prospective study, to randomly receive (PAC-A: group I, 36) or (placebo: group II, 36), for 12 weeks. Any change/reduction in the incidence of r-UTI at 12 weeks was construed to be the primary endpoint of this study. RESULTS: After 12 weeks, bacterial adhesion scoring decreased (0.28)/(2.14) in group I/II (p < 0.001); 32/36 (88.8 %) and 2/36 (5.5 %) in groups I and II, respectively, turned MRHA negative (p < 0.001); biofilm (p < 0.01) and bacterial growth (p < 0.001) decreased in group I; microscopic pyuria score was 0.36/2.0 in group I/II (p < 0.001); r-UTI decreased to 33.33 versus 88.89 % in group I/II (p < 0.001); mean subjective dysuria score was 0.19 versus 1.47 in group I/II (p < 0.001), while mean urine pH was 5.88 versus 6.30 in group I/II (p < 0.001). No in vitro antibacterial activity of cranberry could be demonstrated, and no adverse events were noted. CONCLUSIONS: The overall efficacy and tolerability of standardized cranberry extract containing (PAC-A) as a food supplement were superior to placebo in terms of reduced bacterial adhesion; bacterial MRHA negativity; urine pH reduction; and in preventing r-UTI (dysuria, bacteriuria and pyuria). Larger randomized controlled trials are needed to elucidate the precise role, exact dose and optimal duration of PAC-A therapy in patients at risk of r-UTI.
Asunto(s)
Infecciones por Escherichia coli/prevención & control , Fitoterapia , Extractos Vegetales/uso terapéutico , Infecciones Urinarias/prevención & control , Vaccinium macrocarpon/química , Administración Oral , Adolescente , Adulto , Anciano , Adhesión Bacteriana/efectos de los fármacos , Biopelículas/efectos de los fármacos , Suplementos Dietéticos , Disuria/microbiología , Escherichia coli/efectos de los fármacos , Infecciones por Escherichia coli/complicaciones , Pruebas de Hemaglutinación , Humanos , Concentración de Iones de Hidrógeno , Persona de Mediana Edad , Extractos Vegetales/farmacología , Estudios Prospectivos , Piuria/microbiología , Recurrencia , Prevención Secundaria , Infecciones Urinarias/microbiología , Orina/química , Adulto JovenRESUMEN
We present an interesting case of Legionnaires' disease masquerading as acute pyelonephritis, with complete absence of respiratory symptoms on admission. A 45-year-old man was diagnosed with Legionnaires' disease 2â days after presenting to hospital with dysuria and right loin pain. He became critically unwell during the hospital admission, with headache, uncontrolled fever, breathlessness, decreasing oxygen saturations and increasing oxygen requirements. A CT pulmonary angiography demonstrated right upper lobar consolidation and Legionella urinary antigen was positive. He was treated with ciprofloxacin and rifampicin and made a full recovery.
Asunto(s)
Enfermedad de los Legionarios/diagnóstico , Pielonefritis/diagnóstico , Antibacterianos/uso terapéutico , Antígenos Bacterianos/orina , Ciprofloxacina/uso terapéutico , Infecciones Comunitarias Adquiridas/diagnóstico , Diagnóstico Diferencial , Disuria/microbiología , Dolor en el Flanco/microbiología , Humanos , Enfermedad de los Legionarios/tratamiento farmacológico , Enfermedad de los Legionarios/inmunología , Masculino , Persona de Mediana Edad , Neumonía/diagnóstico , Rifampin/uso terapéuticoAsunto(s)
Antibacterianos/uso terapéutico , Bacteriemia/complicaciones , Bacteriemia/diagnóstico , Floxacilina/uso terapéutico , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Rifampin/uso terapéutico , Infecciones Estafilocócicas/complicaciones , Anciano de 80 o más Años , Bacteriemia/microbiología , Dolor en el Pecho/microbiología , Confusión/microbiología , Tos/microbiología , Diagnóstico Diferencial , Disnea/microbiología , Disuria/microbiología , Femenino , Humanos , Factores de Riesgo , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Resultado del TratamientoRESUMEN
Positron-emission tomography/computed tomography (PET/CT) has improved cyst infection (CI) management in autosomal dominant polycystic kidney disease (ADPKD). The determinants of kidney and/or liver involvement, however, remain uncertain. In this study, we evaluated clinical and imaging factors associated with CI in kidney (KCI) and liver (LCI) in ADPKD. A retrospective cohort study was performed in hospital-admitted ADPKD patients with suspected CI. Clinical, imaging and surgical data were analyzed. Features of infected cysts were evaluated by PET/CT. Total kidney (TKV) and liver (TLV) volumes were measured by CT-derived multiplanar reconstruction. CI was detected in 18 patients who experienced 24 episodes during an interval of 30 months (LCI in 12, KCI in 10 and concomitant infection in 2). Sensitivities of CT, magnetic resonance imaging and PET/CT were 25.0, 71.4, and 95.0%. Dysuria (P<0.05), positive urine culture (P<0.01), and previous hematuria (P<0.05) were associated with KCI. Weight loss (P<0.01) and increased C-reactive protein levels (P<0.05) were associated with LCI. PET/CT revealed that three or more infected cysts were present in 70% of the episodes. TKV was higher in kidney-affected than in LCI patients (AUC=0.91, P<0.05), with a cut-off of 2502 mL (72.7% sensitivity, 100.0% specificity). TLV was higher in liver-affected than in KCI patients (AUC=0.89, P<0.01) with a cut-off of 2815 mL (80.0% sensitivity, 87.5% specificity). A greater need for invasive procedures was observed in LCI (P<0.01), and the overall mortality was 20.8%. This study supports PET/CT as the most sensitive imaging method for diagnosis of cyst infection, confirms the multifocal nature of most hospital-admitted episodes, and reveals an association of kidney and liver volumes with this complication.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Quistes/microbiología , Hospitalización , Riñón/patología , Hígado/patología , Riñón Poliquístico Autosómico Dominante/microbiología , Brasil/epidemiología , Proteína C-Reactiva/análisis , Distribución de Chi-Cuadrado , Quistes/patología , Disuria/microbiología , Hematuria/microbiología , Técnicas para Inmunoenzimas , Hallazgos Incidentales , Hígado/microbiología , Tomografía de Emisión de Positrones , Riñón Poliquístico Autosómico Dominante/mortalidad , Riñón Poliquístico Autosómico Dominante/patología , Estudios Retrospectivos , Sensibilidad y Especificidad , Estadísticas no Paramétricas , Pérdida de PesoRESUMEN
Positron-emission tomography/computed tomography (PET/CT) has improved cyst infection (CI) management in autosomal dominant polycystic kidney disease (ADPKD). The determinants of kidney and/or liver involvement, however, remain uncertain. In this study, we evaluated clinical and imaging factors associated with CI in kidney (KCI) and liver (LCI) in ADPKD. A retrospective cohort study was performed in hospital-admitted ADPKD patients with suspected CI. Clinical, imaging and surgical data were analyzed. Features of infected cysts were evaluated by PET/CT. Total kidney (TKV) and liver (TLV) volumes were measured by CT-derived multiplanar reconstruction. CI was detected in 18 patients who experienced 24 episodes during an interval of 30 months (LCI in 12, KCI in 10 and concomitant infection in 2). Sensitivities of CT, magnetic resonance imaging and PET/CT were 25.0, 71.4, and 95.0%. Dysuria (P<0.05), positive urine culture (P<0.01), and previous hematuria (P<0.05) were associated with KCI. Weight loss (P<0.01) and increased C-reactive protein levels (P<0.05) were associated with LCI. PET/CT revealed that three or more infected cysts were present in 70% of the episodes. TKV was higher in kidney-affected than in LCI patients (AUC=0.91, P<0.05), with a cut-off of 2502 mL (72.7% sensitivity, 100.0% specificity). TLV was higher in liver-affected than in KCI patients (AUC=0.89, P<0.01) with a cut-off of 2815 mL (80.0% sensitivity, 87.5% specificity). A greater need for invasive procedures was observed in LCI (P<0.01), and the overall mortality was 20.8%. This study supports PET/CT as the most sensitive imaging method for diagnosis of cyst infection, confirms the multifocal nature of most hospital-admitted episodes, and reveals an association of kidney and liver volumes with this complication.
Asunto(s)
Quistes/microbiología , Hospitalización , Riñón/patología , Hígado/patología , Riñón Poliquístico Autosómico Dominante/microbiología , Adulto , Brasil/epidemiología , Proteína C-Reactiva/análisis , Distribución de Chi-Cuadrado , Quistes/patología , Disuria/microbiología , Femenino , Hematuria/microbiología , Humanos , Técnicas para Inmunoenzimas , Hallazgos Incidentales , Hígado/microbiología , Masculino , Persona de Mediana Edad , Riñón Poliquístico Autosómico Dominante/mortalidad , Riñón Poliquístico Autosómico Dominante/patología , Tomografía de Emisión de Positrones , Estudios Retrospectivos , Sensibilidad y Especificidad , Estadísticas no Paramétricas , Pérdida de PesoAsunto(s)
Gonorrea/microbiología , VIH/aislamiento & purificación , Neisseria gonorrhoeae/aislamiento & purificación , Adulto , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Disuria/microbiología , Gonorrea/tratamiento farmacológico , Homosexualidad Masculina , Humanos , Masculino , Anamnesis/normas , Relaciones Médico-Paciente , Resultado del TratamientoAsunto(s)
Infecciones por Chlamydia/diagnóstico , Chlamydia trachomatis/aislamiento & purificación , Disuria/microbiología , Gonorrea/diagnóstico , Neisseria gonorrhoeae/aislamiento & purificación , Faringitis/microbiología , Conducta Sexual/estadística & datos numéricos , Tonsilitis/microbiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Técnicas de Amplificación de Ácido NucleicoRESUMEN
Corynebacterium propinquum is usually considered part of the normal human oropharyngeal flora and is rarely responsible for clinical infection. We report here what seems to be the first case of acute purulent urethral discharge in a young Iranian man with urethritis acquired after orogenital contact. Attention should be devoted to less common nondiphtheriae Corynebacterium species for differential diagnosis.
Asunto(s)
Infecciones por Corynebacterium/complicaciones , Infecciones por Corynebacterium/diagnóstico , Corynebacterium/aislamiento & purificación , Disuria/microbiología , Conducta Sexual , Uretritis/complicaciones , Uretritis/microbiología , Adulto , Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Infecciones por Corynebacterium/tratamiento farmacológico , Infecciones por Corynebacterium/microbiología , Infecciones por Corynebacterium/transmisión , Quimioterapia Combinada , Humanos , Masculino , Resultado del Tratamiento , Uretritis/diagnóstico , Uretritis/tratamiento farmacológico , Vancomicina/uso terapéuticoAsunto(s)
Enfermedad por Rasguño de Gato/diagnóstico , Disuria/complicaciones , Fiebre/complicaciones , Cefalea/complicaciones , Adulto , Animales , Bartonella henselae/aislamiento & purificación , Enfermedad por Rasguño de Gato/microbiología , Gatos , Diagnóstico Diferencial , Disuria/diagnóstico , Disuria/microbiología , Fiebre/diagnóstico , Fiebre/microbiología , Cefalea/diagnóstico , Cefalea/microbiología , Humanos , Masculino , Mascotas , Tomografía de Emisión de Positrones , Zoonosis/diagnósticoRESUMEN
Dysuria is a very common symptom, which is taken lightly. It can lead to a diagnosis of disseminated Koch's, which if identified early can prevent permanent sequelae.
Asunto(s)
Disuria/diagnóstico , Tuberculosis de los Genitales Femeninos/diagnóstico , Tuberculosis Renal/diagnóstico , Adulto , Antituberculosos/uso terapéutico , Quimioterapia Combinada , Disuria/tratamiento farmacológico , Disuria/microbiología , Etambutol/uso terapéutico , Femenino , Humanos , Isoniazida/uso terapéutico , Pirazinamida/uso terapéutico , Rifampin/uso terapéutico , Tuberculosis de los Genitales Femeninos/complicaciones , Tuberculosis de los Genitales Femeninos/tratamiento farmacológico , Tuberculosis Renal/complicaciones , Tuberculosis Renal/tratamiento farmacológico , Orina/microbiologíaRESUMEN
Recurrent urinary tract infections, presenting as dysuria or irritative voiding symptoms, are most commonly caused by reinfection with the original bacterial isolate in young, otherwise healthy women with no anatomic or functional abnormalities of the urinary tract. Frequency of sexual intercourse is the strongest predictor of recurrent urinary tract infections in patients presenting with recurrent dysuria. In those who have comorbid conditions or other predisposing factors, recurrent complicated urinary tract infections represent a risk for ascending infection or urosepsis. Escherichia coli is the most common organism in all patient groups, but Klebsiella, Pseudomonas, Proteus, and other organisms are more common in patients with certain risk factors for complicated urinary tract infections. A positive urine culture with greater than 102 colony-forming units per mL is the standard for diagnosing urinary tract infections in symptomatic patients, although culture is often unnecessary for diagnosing typical symptomatic infection. Women with recurrent symptomatic urinary tract infections can be treated with continuous or postcoital prophylactic antibiotics; other treatment options include self-started antibiotics, cranberry products, and behavioral modification. Patients at risk of complicated urinary tract infections are best managed with broad-spectrum antibiotics initially, urine culture to guide subsequent therapy, and renal imaging studies if structural abnormalities are suspected.
Asunto(s)
Antibacterianos/uso terapéutico , Disuria/diagnóstico , Disuria/terapia , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/terapia , Coito , Comorbilidad , Disuria/microbiología , Femenino , Humanos , Factores de Riesgo , Prevención Secundaria , Parejas Sexuales , Espermicidas/uso terapéutico , Sistema Urinario/patología , Sistema Urinario/fisiopatología , Infecciones Urinarias/microbiologíaAsunto(s)
Tuberculosis Renal/diagnóstico , Antituberculosos/uso terapéutico , Cistitis/diagnóstico , Cistitis/microbiología , Diagnóstico Diferencial , Disuria/microbiología , Disuria/patología , Células Epitelioides/microbiología , Células Epitelioides/patología , Granuloma/diagnóstico , Granuloma/tratamiento farmacológico , Granuloma/microbiología , Humanos , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Micosis/diagnóstico , Infecciones por Protozoos/diagnóstico , Coloración y Etiquetado , Tuberculosis Renal/tratamiento farmacológico , Tuberculosis Renal/microbiología , Urinálisis , Orina/citologíaRESUMEN
Urologic complications related to vascular surgery involving the ureter have been well recognized. These include ureteral compression from aneurysms, congenital anomalies such as retrocaval ureter, obstruction from retroperitoneal fibrosis, iatrogenic injury, and ureteric fistulas. Complications involving the bladder are more infrequent. Most of these bladder-related complications involve the use of tunneling devices for synthetic bypass grafts. We report an unusual case of a transvesically placed femoral-femoral bypass graft with delayed presentation. We also reviewed the English literature for experience with diagnosis and treatment of bladder injuries during vascular surgical procedures.
Asunto(s)
Arteriopatías Oclusivas/cirugía , Implantación de Prótesis Vascular/efectos adversos , Disuria/etiología , Oclusión de Injerto Vascular/etiología , Arteria Ilíaca/cirugía , Claudicación Intermitente/cirugía , Vejiga Urinaria/lesiones , Infecciones Urinarias/etiología , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Arteriopatías Oclusivas/complicaciones , Constricción Patológica , Remoción de Dispositivos , Disuria/microbiología , Disuria/terapia , Enterococcus faecalis/aislamiento & purificación , Femenino , Arteria Femoral/cirugía , Oclusión de Injerto Vascular/diagnóstico por imagen , Oclusión de Injerto Vascular/microbiología , Oclusión de Injerto Vascular/terapia , Humanos , Enfermedad Iatrogénica , Hallazgos Incidentales , Claudicación Intermitente/etiología , Masculino , Persona de Mediana Edad , Recurrencia , Reoperación , Vena Safena/trasplante , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vejiga Urinaria/diagnóstico por imagen , Infecciones Urinarias/microbiología , Infecciones Urinarias/terapiaRESUMEN
Many women who suffer from the symptoms of urinary tract infection have a negative urine culture when conventional methods are used. Their condition is described as 'urethral' (or 'dysuria/frequency') syndrome' (US). As they may be indistinguishable clinically from those with positive cultures antibiotics are often prescribed. Their symptoms are usually recurrent and they may receive many courses of treatment. Some women are said to have 'interstitial cystitis' (IC); they have a long history of symptoms and antibacterial treatment. The urine contains white blood cells (pyuria) and biopsy of the bladder wall shows the histological changes of chronic inflammation. Additional culture techniques applied to urine from these two groups of patients consistently yield bacteria, most commonly lactobacilli in those with US. From the urine of women with IC, lactobacilli and some other 'fastidious' bacteria are isolated from catheter specimens and also from bladder wall biopsies. These bacteria are known to be constituents of the mixed commensal flora of the distal one-third of the urethra. It is proposed that these two syndromes are different stages in the natural history of UTI, and that antibacterial agents, by selection of resistant bacteria in the urethral commensal flora, are an important aetiological factor. It is possible that these bacteria may invade the paraurethral glands via their ducts - a situation analogous to invasion of the prostate in men. There is a considerable body of evidence supporting this hypothesis, but as it all emanates from one centre it needs to be confirmed elsewhere. Acceptance would bring great clinical benefit and considerable financial savings. A laboratory protocol which requires only small additional expenditure, and a clinical management regimen are proposed. At present, much antibacterial treatment is prescribed and many patients undergo radiological and invasive investigations such as cystoscopy and urethral dilatation, the latter incurring the risk of post-instrumentation UTI. There is evidence that 'US' responds gradually if antibiotics are withheld. 'IC' is a more difficult problem because bacteria may have invaded the bladder wall. Carefully targeted antibacterial treatment given for at least 10-14 days might be effective, but there are no data on this. Rational management of 'US' might prevent the development of 'IC'. A recent thorough review of published work on this condition states that the aetiology is still unknown. It appears, however, that no attempt has been made in any recent studies to use urine culture techniques capable of detecting bacteria other than the recognised aerobic pathogens.
Asunto(s)
Cistitis Intersticial/microbiología , Disuria/microbiología , Lactobacillus/fisiología , Uretra/microbiología , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiología , Antibacterianos/uso terapéutico , Cistitis Intersticial/etiología , Disuria/etiología , Femenino , Humanos , Infecciones Urinarias/complicaciones , Infecciones Urinarias/orinaRESUMEN
OBJECTIVES: To examine the prevalence of Mycoplasma genitalium in a large number of male patients attending a sexually transmitted infections (STI) clinic and to determine if there is an association with objective non-gonococcal urethritis (NGU) in patients with and without clinical symptoms. METHODS: Patients were tested for both M genitalium and Chlamydia trachomatis if they had symptoms or microscopic signs of NGU or if they were perceived to be at high-risk of exposure to a STI (n = 8468). Urethral smears were examined for polymorphic mononuclear leucocytes. RESULTS: We found that M genitalium infection was associated with symptoms of non-chlamydial NGU (discharge and dysuria; OR 4.3; 95% CI 3.4 to 5.5). We also found that M genitalium infection was associated with signs of non-chlamydial NGU independently with or without symptoms of NGU (with symptoms: OR 4.7; 95% CI 3.2 to 6.7; without symptoms: OR 3.1; 95% CI 2.0 to 4.6). Prevalence of M genitalium was also associated with severity of urethritis as quantified by microscopic examination of urethral smears. CONCLUSIONS: These data add further evidence to the association of M genitalium infection with NGU and should allow better risk analysis of recent recommendations of not performing urethral smears in asymptomatic men attending STI clinics.