RESUMEN
Psoas muscle abscesses associated with emphysematous urinary tract infections are rare. There are not many case reports about urinary tract infections such as emphysematous pyelitis and emphysematous cystitis complicating psoas muscle abscesses. Here, we report a case of an ipsilateral psoas muscle abscess following emphysematous cystitis and emphysematous pyelitis in an 81-year-old diabetic man. He was treated with prolonged antibiotic therapy and other supportive care.
Asunto(s)
Cistitis , Enfisema , Pielitis , Infecciones Urinarias , Masculino , Humanos , Anciano de 80 o más Años , Absceso , Cistitis/diagnóstico , Cistitis/diagnóstico por imagen , Pielitis/diagnóstico , Pielitis/diagnóstico por imagen , Infecciones Urinarias/complicaciones , Infecciones Urinarias/tratamiento farmacológico , Enfisema/complicaciones , Enfisema/diagnóstico por imagenRESUMEN
OBJECTIVE: Encrusted pyelitis in an infection caused by Corynebacterium Urealyticum. The incidence has increased, specially in immunosuppressed patients and patients with indwelling urinary catheters. METHODS: We are presenting a case of a 72 years old male with Bricker urinary derivation with an ureteral catheter. During the follow up, catheteral calcification and encrusted pyelitis were found in TC images and cultures were positive for Corynebacteirum Urealitycum. This condition was managed with endoscopic and medical treatment; that consisted in antibiotics and acidification of urine through nephrostomy tube using an acidifying irrigation solution and Lit-Control pH Down orally, in order to avoid new infections. RESULTS: Treatment was effective, no new reinfections were shown with the use of Lit-Control pH Down for the maintenance. CONCLUSIONS: The suspected diagnosis and the early treatment of encrusted pyelitis avoid complications. Antibiotics and urine acidification are key in the treatment of this disease.
OBJETIVO: La pielitis incrustante es una infección causada por Corynebacterium Urealyticum cuya incidencia está aumentando, sobre todo en pacientes inmunodeprimidos, y en portadores de catéteres permanentes.MÉTODOS: Se presenta el caso de un varón de 72 años con derivación urinaria tipo Bricker y portador de catéter JJ. Posteriormente se objetiva calcificación del mismo con imágenes en la TAC sugestivas de pielitis incrustante y urocultivos positivos para Corynebacterium Urealyticum. Se realiza tratamiento combinado endoscópico y médico con antibioterapia y acidificación de la orina, a través de nefrostomía con solución acidificante de irrigación y por vía oral con Lit-Control pH Down, para evitar nuevas infecciones. RESULTADOS: El tratamiento fue efectivo, con ausencia de reinfecciones gracias al tratamiento de mantenimiento con Lit-Control pH Down. CONCLUSIONES: La sospecha diagnóstica y tratamiento precoz de la pielitis incrustante evitan las complicaciones asociadas. La antibioterapia asociada a acidificación de la orina son los pilares básicos de tratamiento.
Asunto(s)
Infecciones por Corynebacterium , Pielitis , Anciano , Corynebacterium , Humanos , Masculino , Catéteres UrinariosRESUMEN
With increased use of sodium-glucose co-transporter 2 (SGLT2) inhibitors as antidiabetic agents, the risk of serious fungal urinary tract infection (UTI) may be increased. We present the case of a 67-year-old Caucasian female who was admitted for emphysematous pyelitis and found to have a fungal ball in the renal pelvis. Candida glabrata was cultured and the patient was managed with percutaneous nephrostomy tube placement and antifungal treatment. The fungal ball persisted and required surgical removal with ureteroscopy and basket extraction. Fungal balls can be a difficult sequelae of UTIs requiring a combination of antifungal and surgical intervention for definitive management.
Asunto(s)
Compuestos de Bencidrilo/efectos adversos , Candida glabrata/aislamiento & purificación , Glucósidos/efectos adversos , Micosis/inducido químicamente , Pielitis/inducido químicamente , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos , Anciano , Femenino , Humanos , Micosis/cirugía , Pielitis/microbiología , UreteroscopíaAsunto(s)
Catéteres de Permanencia , Cistitis/diagnóstico por imagen , Cistostomía , Enfisema/diagnóstico por imagen , Infecciones por Enterobacteriaceae/diagnóstico , Pielitis/diagnóstico por imagen , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Citrobacter , Cistitis/tratamiento farmacológico , Enterobacter cloacae , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Humanos , Masculino , Hiperplasia Prostática/complicaciones , Pielitis/tratamiento farmacológico , Estrechez Uretral/complicaciones , Obstrucción del Cuello de la Vejiga Urinaria/etiología , Obstrucción del Cuello de la Vejiga Urinaria/terapia , Infecciones UrinariasRESUMEN
OBJECTIVE. The purpose of this article is to review the spectrum, etiopathogenesis, clinical presentation, imaging features, differential diagnoses, and management of emphysematous infections of the abdomen and pelvis. CONCLUSION. Emphysematous infections are associated with high morbidity and mortality and thus need urgent medical and surgical interventions. CT is the most sensitive modality to detect gas; CT provides definitive diagnosis in most cases and can depict the extent of involvement.
Asunto(s)
Enfisema/diagnóstico por imagen , Gases , Tomografía Computarizada por Rayos X , Pared Abdominal/diagnóstico por imagen , Pared Abdominal/microbiología , Absceso/diagnóstico por imagen , Absceso/microbiología , Aortitis/diagnóstico por imagen , Aortitis/microbiología , Cistitis/diagnóstico por imagen , Cistitis/microbiología , Enfisema/microbiología , Colecistitis Enfisematosa/diagnóstico por imagen , Colecistitis Enfisematosa/microbiología , Femenino , Gangrena de Fournier/diagnóstico por imagen , Gangrena de Fournier/microbiología , Gangrena Gaseosa/diagnóstico por imagen , Gangrena Gaseosa/microbiología , Gastritis/diagnóstico por imagen , Gastritis/microbiología , Hepatitis/diagnóstico por imagen , Hepatitis/microbiología , Humanos , Masculino , Pancreatitis/diagnóstico por imagen , Pancreatitis/microbiología , Enfermedades de la Próstata/diagnóstico por imagen , Enfermedades de la Próstata/microbiología , Absceso del Psoas/diagnóstico por imagen , Absceso del Psoas/microbiología , Pielitis/diagnóstico por imagen , Pielitis/microbiología , Pielonefritis/diagnóstico por imagen , Pielonefritis/microbiología , Enfermedades Uterinas/diagnóstico por imagen , Enfermedades Uterinas/microbiologíaRESUMEN
A 62-year-old asymptomatic woman with diabetes was referred to the urology department from nephrology due to deterioration in renal function with accompanied right-sided hydronephrosis on ultrasound. CT imaging subsequently revealed a right-sided staghorn calculus and a significant volume of gas in the right collecting system from the kidney to the distal ureter, in keeping with emphysematous pyelitis. She was admitted and managed with antibiotics and insertion of right nephrostomy in the first instance, followed by percutaneous nephrolithotomy to definitively manage the stone. The patient remained asymptomatic throughout the process.
Asunto(s)
Enfisema/diagnóstico por imagen , Pielitis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Enfermedades Asintomáticas , Femenino , Humanos , Persona de Mediana EdadAsunto(s)
Lesión Renal Aguda , Infecciones por Corynebacterium , Pielitis , Piuria , Lesión Renal Aguda/diagnóstico , HumanosAsunto(s)
Cistitis/complicaciones , Enfisema/complicaciones , Pielitis/complicaciones , Anciano , Cistitis/diagnóstico por imagen , Enfisema/diagnóstico por imagen , Resultado Fatal , Humanos , Klebsiella pneumoniae/aislamiento & purificación , Masculino , Pielitis/diagnóstico por imagen , Choque Séptico/etiologíaAsunto(s)
Calcinosis/diagnóstico , Trasplante de Riñón/efectos adversos , Riñón Poliquístico Autosómico Dominante/cirugía , Pielitis/diagnóstico , Aloinjertos/diagnóstico por imagen , Aloinjertos/microbiología , Aloinjertos/patología , Aloinjertos/cirugía , Antibacterianos/administración & dosificación , Calcinosis/microbiología , Calcinosis/patología , Calcinosis/terapia , Carbonato de Calcio/administración & dosificación , Citratos/administración & dosificación , Corynebacterium/aislamiento & purificación , Progresión de la Enfermedad , Combinación de Medicamentos , Femenino , Humanos , Pelvis Renal/diagnóstico por imagen , Pelvis Renal/microbiología , Pelvis Renal/patología , Pelvis Renal/cirugía , Óxido de Magnesio/administración & dosificación , Persona de Mediana Edad , Nefrostomía Percutánea , Pielitis/microbiología , Pielitis/patología , Pielitis/terapia , Tomografía Computarizada por Rayos X , Uréter/microbiología , Uréter/patología , Uréter/cirugía , Vancomicina/administración & dosificaciónRESUMEN
Diabetes mellitus (DM) is a common disease in Oman as in rest of Gulf Cooperation Council where metabolic syndrome is of high prevalence. DM is a foremost risk factor for urinary tract infections (UTIs). It is also linked to more complicated infections such as emphysematous pyelonephritis (EPN), emphysematous pyelitis (EP), renal/perirenal abscess, emphysematous cystitis, xanthogranulomatous pyelonephritis, and renal papillary necrosis. The diagnosis of these cases is frequently delayed because the clinical manifestations are generic and not different from the typical triad of upper UTI, which include fever, flank pain, and pyuria. A middle-aged female with DM and chronic kidney disease stage IV was admitted with recurrent UTI with extended-spectrum beta-lactamase-producing Escherichia coli. At presentation, she was afebrile, clinically stable, had no flank pain and there was no leukocytosis. Laboratory test for C- reactive protein done twice and was only mildly elevated at 7 and 11 mg/dL. A computed tomography scan of kidney-ureter-bladder (CT-KUB) was recommended and reported as "no KUB stone but small atrophic left kidney with dilatation of the pelvicalycial system and ureter and the presence of air in the collecting system suggestive of EP." Thus, commonly associated with DM, especially in females, debilitated immune-deficient individuals, and patients harboring obstructed urinary system with infective nidus. Air in the kidney is not always due to EPN. UTI with a gas-producing organism can ascend to the kidney in the presence of vesicoureteral reflux.
Asunto(s)
Complicaciones de la Diabetes/mortalidad , Enfisema/microbiología , Infecciones por Escherichia coli/microbiología , Pielitis/microbiología , Infecciones Urinarias/microbiología , Reflujo Vesicoureteral/complicaciones , Enfermedades Asintomáticas , Complicaciones de la Diabetes/diagnóstico , Enfisema/diagnóstico por imagen , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/diagnóstico , Femenino , Humanos , Persona de Mediana Edad , Pielitis/diagnóstico por imagen , Recurrencia , Factores de Riesgo , Infecciones Urinarias/complicaciones , Infecciones Urinarias/diagnóstico , Reflujo Vesicoureteral/diagnósticoRESUMEN
Encrusted pyelitis is a chronic urinary tract infection associated with mucosal encrustation induced by urea splitting bacteria. More than 40 bacteria have been implicated but the most frequent is Corynebacterium group D2. Predisposing factors are debilitating chronic diseases and preexisting urological procedures. Immunosoppression is an important cofactor. For these reasons the disease is almost always nosocomially acquired and renal transplant recipients are at particular risk. The symptoms are not specific and long lasting: dysuria, flank pain and gross haematuria are the most frequent; fever is present in two-thirds. The demonstration of urine splitting bacteria in constantly alkaline urines and radiological evidence of extensive calcification of pelvicalyceal system, ureter and bladder at US or CT scan in a clinical context of predisposing factors are the mainstay of diagnosis. Treatment is based on adapted antibiotic therapy, acidification of urine and excision of plaques of calcified encrustation. The prognosis relies on timing of diagnosis; delay can be detrimental and result in patient's death and graft loss. We describe a unique case of 69-year-old man with two contemporary diseases: autoimmune thrombotic thrombocytopenic purpura and encrusted pyelitis with a fatal evolution.
Asunto(s)
Infecciones por Enterobacteriaceae/etiología , Morganella morganii/aislamiento & purificación , Nefrocalcinosis/etiología , Púrpura Trombocitopénica Trombótica/complicaciones , Pielitis/etiología , Infecciones Estafilocócicas/etiología , Anciano , Antibacterianos/uso terapéutico , Coinfección/tratamiento farmacológico , Terapia Combinada , Susceptibilidad a Enfermedades , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Resultado Fatal , Hematuria/etiología , Humanos , Hidronefrosis/diagnóstico por imagen , Hidronefrosis/etiología , Masculino , Nefrocalcinosis/diagnóstico por imagen , Nefrotomía , Intercambio Plasmático , Púrpura Trombocitopénica Trombótica/tratamiento farmacológico , Púrpura Trombocitopénica Trombótica/terapia , Pielitis/diagnóstico por imagen , Pielitis/tratamiento farmacológico , Rituximab/uso terapéutico , Infecciones Estafilocócicas/tratamiento farmacológicoAsunto(s)
Lesión Renal Aguda/microbiología , Calcinosis/microbiología , Infecciones por Corynebacterium/microbiología , Dolor en el Flanco/microbiología , Pielitis/microbiología , Infecciones Urinarias/microbiología , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/terapia , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Técnicas Bacteriológicas , Calcinosis/diagnóstico , Calcinosis/terapia , Infecciones por Corynebacterium/complicaciones , Infecciones por Corynebacterium/diagnóstico , Infecciones por Corynebacterium/terapia , Femenino , Dolor en el Flanco/diagnóstico , Dolor en el Flanco/terapia , Humanos , Soluciones Isotónicas/administración & dosificación , Nefrostomía Percutánea , Pielitis/diagnóstico , Pielitis/terapia , Teicoplanina/uso terapéutico , Irrigación Terapéutica/métodos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Infecciones Urinarias/complicaciones , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/terapiaAsunto(s)
Enfisema/diagnóstico , Pielitis/diagnóstico , Pielonefritis/diagnóstico , Diagnóstico Diferencial , Escherichia coli , Humanos , Riñón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Nefrostomía Percutánea , Factores de Riesgo , Tomografía Computarizada por Rayos X , Uréter/diagnóstico por imagen , Vejiga Urinaria/diagnóstico por imagen , Orina/microbiologíaRESUMEN
We report a case of pseudotuberculous granulomatous pyelitis in an elderly female patient with hydronephrotic right kidney secondary to obstructing urinary stone. Pseudotuberculous granulomatous pyelitis is a rarely reported entity, characterized by severe granulomatous inflammation limited predominantly to the renal pelvis. It is associated with urinary (pelvicalyceal) obstruction, urolithiasis well as non- Mycobacterial urinary tract infection.
Asunto(s)
Granuloma/patología , Pielitis/patología , Femenino , Humanos , Persona de Mediana EdadAsunto(s)
Cistitis/diagnóstico , Enfisema/diagnóstico , Pielitis/diagnóstico , Enfermedades Ureterales/diagnóstico , Dolor Abdominal/etiología , Anciano , Cistitis/patología , Diabetes Mellitus Tipo 2/fisiopatología , Enfisema/patología , Humanos , Masculino , Pielitis/patología , Tomografía Computarizada por Rayos X , Enfermedades Ureterales/patologíaRESUMEN
A 43 years-old man presented to our stone clinic complaining of back pain for the last 3 months. He had significant past medical history for nephrolithiasis: he had undergone unsuccessful SWL for left renal calculi five years ago and also presented with several episodes of pyelonephritis in the last months, requiring hospitalization for intravenous antibiotics. Initial laboratory work-up revealed normal serum creatinine (0.92 mg/dL) and hemoglobin levels (15.3 g/dL); urine culture was negative. Abdominal computed tomography (CT) revealed a 140 mm2 stone in the left renal pelvis with 1500 Hounsfield Units (Figure-1a); thickening of the urothelium surrounding the stone was suspected after contrast infusion (Figure-1b) and confirmed in the excretory phase (Figure-1c).
Asunto(s)
Cálculos Renales/cirugía , Litotricia/métodos , Nefrostomía Percutánea/métodos , Pielitis/complicaciones , Fístula Urinaria/etiología , Adulto , Humanos , Cálculos Renales/diagnóstico por imagen , Litotricia/efectos adversos , Masculino , Nefrostomía Percutánea/efectos adversos , Factores de Riesgo , Tomografía Computarizada por Rayos X , Fístula Urinaria/diagnóstico por imagenRESUMEN
OBJECTIVE: In the present study various tissues of pigs were investigated for the presence of histopathologic lesions after an experimental infection with Haemophilus (H.) parasuis serovar 5. MATERIAL AND METHODS: Conventional pigs (n = 36) were divided into a control group B (n = 9) and a challenge group A (n = 27), which was infected intratracheally. Pigs that did not die prior to study termination were euthanized on day 14 post inoculation. Postmortem samples of the lung, heart, liver, kidney, spleen, left tarsal joint capsule and brain were collected. RESULTS: All but one pig with detectable histopathologic lesions (n = 11) showed typical macroscopic changes. Histopathologic examination of all tissue samples identified pyelitis (n = 10), synovitis (n = 7) and meningitis (n = 7) and all those animals were euthanized prior to study termination. No histopathologic lesions were found in pigs of the control group. The correlations between pyelitis and meningitis, pyelitis and synovitis and synovitis and meningitis were significant (p < 0.001). No significant correlation could be observed between the histopathologic and the clinical examination of the joints. The investigation of samples from the joints by PCR was not significantly correlated with the observed synovitis. The clinical observation of neurologic signs was significantly correlated with meningitis (p = 0.03). A significant correlation (p < 0.001) could be detected between meningitis and the detection of H. parasuis by PCR in brain samples. CONCLUSIONS: H. parasuis constantly causes clinical signs and pathologic lesions as soon as it infects the brain while it can infect the joints without causing histopathologic lesions. Pigs with histopathologic lesions do not always show typical clinical signs. Only few studies described the finding of kidney lesions in pigs with Glässer's disease and this is the first study to describe a pyelitis in pigs experimentally infected with H. parasuis. The observed pyelitis mainly occurred in acute cases.