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 imagenAsunto(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)
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/etiologíaRESUMEN
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 farmacológicoRESUMEN
A 64-year-old male patient diagnosed with amyotrophic lateral sclerosis 2 years ago was admitted with fever and chills. The patient had complex medical history and several indwelling catheters/tubes in his body. To identify the infection focus, 67Ga whole-body scintigraphy and SPECT/CT were obtained. 67Ga whole-body scintigraphy demonstrated focal 67Ga uptake in the lower pelvic cavity and the right kidney. Additional Ga SPECT/CT images were obtained, and it enabled characterization of these uptakes as infection of bladder stones that result in pyelitis.
Asunto(s)
Pielitis/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos X , Cálculos de la Vejiga Urinaria/diagnóstico por imagen , Radioisótopos de Galio , Humanos , Masculino , Persona de Mediana Edad , Imagen Multimodal , Radiofármacos , Imagen de Cuerpo EnteroAsunto(s)
Enfisema/diagnóstico por imagen , Infecciones por Escherichia coli/diagnóstico por imagen , Escherichia coli/aislamiento & purificación , Riñón/patología , Pielitis/diagnóstico por imagen , Antibacterianos/uso terapéutico , Ceftriaxona/uso terapéutico , Preescolar , Enfisema/tratamiento farmacológico , Enfisema/microbiología , Infecciones por Escherichia coli/tratamiento farmacológico , Infecciones por Escherichia coli/microbiología , Femenino , Humanos , Riñón/diagnóstico por imagen , Nefrectomía/métodos , Pielitis/tratamiento farmacológico , Pielitis/microbiología , Tomografía Computarizada por Rayos XAsunto(s)
Infecciones por Corynebacterium/diagnóstico por imagen , Cistitis/diagnóstico por imagen , Pielitis/diagnóstico por imagen , Anciano de 80 o más Años , Infecciones por Corynebacterium/complicaciones , Cistitis/complicaciones , Humanos , Masculino , Pielitis/complicaciones , Tomografía Computarizada por Rayos XAsunto(s)
Infecciones por Corynebacterium/diagnóstico por imagen , Pelvis Renal/diagnóstico por imagen , Trasplante de Riñón , Pielitis/diagnóstico por imagen , Enfermedad Crónica , Infecciones por Corynebacterium/diagnóstico , Infecciones por Corynebacterium/tratamiento farmacológico , Humanos , Fallo Renal Crónico/microbiología , Fallo Renal Crónico/terapia , Trasplante de Riñón/efectos adversos , Masculino , Persona de Mediana Edad , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/diagnóstico por imagen , Infecciones Oportunistas/tratamiento farmacológico , Pielitis/diagnóstico , Pielitis/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Uréter/diagnóstico por imagenRESUMEN
Renal emphysema is a rare, fulminant, suppurative infection of pelvicaliceal system, renal parenchyma, perinephric tissues, and retroperitoneum. It is characterized by formation of gas. Invariably this condition is associated with diabetes mellitus and carries high mortality (40-90%). Renal emphysema can be classified into two distinct clinical entities: emphysematous pyelitis and emphysematous pyelonephritis. This classification has important prognostic and therapeutic implications. Herein we describe the computed tomographic findings in five unilateral cases of renal emphysema (two cases of emphysematous pyelitis and three cases of emphysematous pyelonephritis) in five insulin-dependent diabetic patients.
Asunto(s)
Nefropatías Diabéticas/diagnóstico por imagen , Enfisema/diagnóstico por imagen , Pielitis/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Nefropatías Diabéticas/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nefrectomía , Pielitis/cirugía , Tomografía Computarizada por Rayos X/métodosAsunto(s)
Calcinosis/diagnóstico por imagen , Infecciones por Corynebacterium/diagnóstico por imagen , Pielitis/diagnóstico por imagen , Enfermedades Ureterales/diagnóstico por imagen , Corynebacterium/metabolismo , Hematuria/etiología , Humanos , Riñón/diagnóstico por imagen , Cálculos Renales/diagnóstico por imagen , Cálculos Renales/microbiología , Pielitis/microbiología , Radiografía , Uréter/diagnóstico por imagen , Enfermedades Ureterales/microbiología , UrinálisisRESUMEN
OBJECTIVES: To report our experience with the management of encrusted cystitis and pyelitis (EC and EP) in the pediatric population. EC and EP are well-known entities in adults but are rarely identified in children. They consist of mucosal encrustations and are due to specific microorganisms. METHODS: Between 1996 and 2001, 4 children with a mean age of 9 years (range 4 to 13) were treated for EC (n = 2), EP (n = 1), and EC and EP (n = 1). The latter was a kidney transplant recipient. We retrospectively evaluated the clinical characteristics of the patients and the results of conservative management. RESULTS: The delay between the beginning of the symptoms and the diagnosis was longer than 1 month in all cases. The diagnosis of EC was not evoked and was made during cystoscopy in all cases. EP was diagnosed during pyelotomy in 1 patient because it was evoked and confirmed by computed tomography scan in the kidney transplant recipient. Corynebacterium urealyticum was identified in the urine of all patients. EC was treated by antibiotics and endoscopic debulking, and EP was treated by antibiotics and local acidification. The duration of antibiotic therapy was between 1 and 6 months. The tolerance to local acidification of the kidneys was poor. Cure was achieved in 3 cases, but the treatment of EP failed in the kidney transplant recipient and graft removal was decided after 6 months of failed management because intractable febrile urinary tract infections became life threatening for the patient. CONCLUSIONS: EC and EP are uncommon in children; however, these diseases must be considered. They must be diagnosed rapidly and require, if possible, conservative management. Nevertheless, kidney loss can occur in transplant recipients with EP.
Asunto(s)
Infecciones por Corynebacterium/epidemiología , Corynebacterium/aislamiento & purificación , Cistitis/terapia , Compuestos de Magnesio/análisis , Fosfatos/análisis , Pielitis/terapia , Adolescente , Antibacterianos/uso terapéutico , Niño , Preescolar , Terapia Combinada , Corynebacterium/metabolismo , Infecciones por Corynebacterium/diagnóstico por imagen , Infecciones por Corynebacterium/tratamiento farmacológico , Infecciones por Corynebacterium/microbiología , Infecciones por Corynebacterium/patología , Infecciones por Corynebacterium/cirugía , Cistitis/diagnóstico por imagen , Cistitis/tratamiento farmacológico , Cistitis/microbiología , Cistitis/patología , Cistitis/cirugía , Susceptibilidad a Enfermedades , Quimioterapia Combinada/uso terapéutico , Endoscopía , Femenino , Estudios de Seguimiento , Glicopéptidos , Humanos , Concentración de Iones de Hidrógeno , Soluciones Isotónicas/uso terapéutico , Trasplante de Riñón , Masculino , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/microbiología , Complicaciones Posoperatorias/cirugía , Pielitis/diagnóstico por imagen , Pielitis/tratamiento farmacológico , Pielitis/microbiología , Pielitis/patología , Pielitis/cirugía , Estudios Retrospectivos , Estruvita , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Urea/metabolismo , Orina/microbiologíaRESUMEN
PURPOSE: Its described three cases of Corynebacterium urealyticum (CU) infection in patients with renal transplantation and one of its most serious consequences: encrusted pyelitis and cystitis. It is explained the principal keys for its diagnosis, based in the appearance of alkaline pH in in urine analysis (alkaline urine), positives urinary cultures for CU, and the CT and US studies revealed the characteristic images of calcifications in the wall of renal pelvis and bladder. PATIENTS: Three male patients with renal transplantation and CU infection that caused encrusted pyelitis in two of the cases and encrusted cystitis in one case. RESULTS: Calcifications of the urinary tract were noticed in CT in all the patients. In two cases bladder stones were linear, and in the third case they were fundamentally coarse and placed in pelvis. The diagnosis suspicion showed by the images was confirmed by the use of prolonged urine cultures, necessary for detecting CU. All the patients were treated with vancomycin, with success in two of the cases and, finally needing surgery, and after loss of the graft, in the other case. CONCLUSION: Encrusted pyelitis and cystitis are cronic and severe infections of the urinary tract. Calcic struvite incrustations in the urothelium are characteristics of this infection. CT is a choice technique for the diagnosis and followup of the calcifications after treatment.
Asunto(s)
Infecciones por Corynebacterium/diagnóstico por imagen , Corynebacterium/aislamiento & purificación , Cistitis/diagnóstico por imagen , Trasplante de Riñón/efectos adversos , Pielitis/diagnóstico por imagen , Adulto , Antibacterianos/uso terapéutico , Infecciones por Corynebacterium/tratamiento farmacológico , Cistitis/tratamiento farmacológico , Humanos , Riñón/patología , Riñón/cirugía , Trasplante de Riñón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Pielitis/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ultrasonografía , Vancomicina/uso terapéuticoRESUMEN
OBJECTIVE: The aim of this study was to determine whether renal pelvic wall thickening in active childhood urinary tract infections (UTIs), as demonstrated using ultrasound, is caused by acute pyelitis or by vesicoureteral reflux (VUR)-related chronic changes. MATERIAL AND METHODS: A total of 41 children with at least unilateral renal pelvic wall thickening as demonstrated using ultrasound during the acute stage of UTI, and confirmed using voiding cystourethrography (VCUG), were analyzed. All cases underwent ultrasound studies at 6 months follow-up. RESULTS: Using ultrasound, 50 halves of the pelvis showed renal pelvic wall thickening. In 27 (54%), ipsilateral VUR could be demonstrated using VCUG. The sensitivity, specificity and positive predictive value of renal pelvic wall thickening for predicting ipsilateral VUR were 79.4%, 52.1% and 54%, respectively. Only 2 (7%) cases presented with wall thickening at 6 months follow-up. Most of the thickening recovered after clinical improvement, although VUR became persistent in half the cases. CONCLUSIONS: Renal pelvic wall thickening is an abnormal finding in the acute stage of childhood UTI and predominantly indicates acute pyelitis rather than VUR-related chronic changes. Renal pelvic wall thickening is not sufficiently predictive of VUR in acute UTI, although it does provide evidence of upper UTI.
Asunto(s)
Pelvis Renal/diagnóstico por imagen , Pielitis/diagnóstico por imagen , Pielitis/etiología , Infecciones Urinarias/complicaciones , Infecciones Urinarias/diagnóstico por imagen , Reflujo Vesicoureteral/diagnóstico por imagen , Reflujo Vesicoureteral/etiología , Enfermedad Aguda , Factores de Edad , Niño , Preescolar , Enfermedad Crónica , Femenino , Humanos , Lactante , Masculino , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Ultrasonografía , UrografíaRESUMEN
This is the first report of death due to gross encrustations of the entire upper urinary tract and bladder by Corynebacterium group D2 in a man with no history of renal transplantation or prolonged catheterizations. This case demonstrates that debilitated patients with a prior endoscopic procedure are at risk for this disease process. Prolonged treatment with appropriate antibiotics, acidification of the urine, and removal of crusts is essential for proper management.