Desempenho de diferentes marcas de tiras reagentes relativo à densidade e à análise química da urina de cães e gatos / Performance of different brands of reagent strips for density and chemical analysis of dog and cat urine

Objetivou-se verificar a compatibilidade entre diferentes marcas de tiras reagentes para urinálise, tanto de uso veterinário, como de uso humano, e confrontar os parâmetros semiquantitativos desse instrumento com métodos quantitativos. Para isso, foram analisadas 77 amostras frescas de urina de cães e gatos e testados 04 modelos de tiras reagentes. Quanto à densidade urinária, houve correlação razoável entre os métodos quantitativo e semiquantitativo naquelas amostras com pH ácido, mas não naquelas com pH neutro ou alcalino. Quanto à concentração proteica, houve similaridade de 53,3% a 83,3% entre as marcas testadas e quando comparadas com a análise fotométrica houve uma correlação razoável (rs = 0,69752 a 0,75074). Em ponto de corte de 15mg/dL de proteína, a sensibilidade da tira reagente foi 82,5% e 100% para urina canina e felina, respectivamente. No tocante à hematúria, houve divergência razoável entre a sedimentoscopia e as diferentes marcas de tiras reativas. Quanto à piúria, há uma baixa sensibilidade das tiras em relação às amostras caninas com muitos resultados falso-negativos (33% a 75%), enquanto em amostras felinas a sensibilidade foi de 100%. Assim, independente da marca, as tiras reagentes devem servir apenas como teste rápido de triagem, sendo mais apropriado o uso de métodos quantitativos na avaliação clínica do paciente a partir da urinálise.

The aim was to verify the compatibility between different brands of urinary dipsticks, for both human and veterinary use, and to compare the semiquantitative parameters of this instrument with quantitative methods. For this, 77 fresh samples of urine from dogs and cats were analyzed e and 04 models of reagent strips were tested. Regarding urinary density, a reasonable correlation was observed between the quantitative and semiquantitative methods in those samples with acidic pH, which did not occur in those with neutral or alkaline pH. Regarding the protein concentration, there was similarity from 53.3% to 83.3% between the brands and in the comparative analysis between the control strip and the photometric analysis, there was a reasonable correlation (rs = 0.69752 to 0.75074). In cut-off point of 15mg/dL protein, the sensitivity of the reagent strip was 82.5% and 100% for canine and feline urine, respectively. Regarding hematuria, there was a reasonable divergence of results between sedimentation and tested dipsticks. As for pyuria, there is a low sensitivity of the strips in relation to canine samples with many false negative results (33% to 75%), while in feline samples the sensitivity was 100%. Thus, regardless of the brands, the reagent strips should serve only as a rapid screening test, while the use of quantitative methods in the clinical evaluation of the patient from urinalysis is more appropriate.

Desempenho de diferentes marcas de tiras reagentes relativo à densidade e à análise química da urina de cães e gatos / Performance of different brands of reagent strips for density and chemical analysis of dog and cat urine

Objetivou-se verificar a compatibilidade entre diferentes marcas de tiras reagentes para urinálise, tanto de uso veterinário, como de uso humano, e confrontar os parâmetros semiquantitativos desse instrumento com métodos quantitativos. Para isso, foram analisadas 77 amostras frescas de urina de cães e gatos e testados 04 modelos de tiras reagentes. Quanto à densidade urinária, houve correlação razoável entre os métodos quantitativo e semiquantitativo naquelas amostras com pH ácido, mas não naquelas com pH neutro ou alcalino. Quanto à concentração proteica, houve similaridade de 53,3% a 83,3% entre as marcas testadas e quando comparadas com a análise fotométrica houve uma correlação razoável (rs = 0,69752 a 0,75074). Em ponto de corte de 15mg/dL de proteína, a sensibilidade da tira reagente foi 82,5% e 100% para urina canina e felina, respectivamente. No tocante à hematúria, houve divergência razoável entre a sedimentoscopia e as diferentes marcas de tiras reativas. Quanto à piúria, há uma baixa sensibilidade das tiras em relação às amostras caninas com muitos resultados falso-negativos (33% a 75%), enquanto em amostras felinas a sensibilidade foi de 100%. Assim, independente da marca, as tiras reagentes devem servir apenas como teste rápido de triagem, sendo mais apropriado o uso de métodos quantitativos na avaliação clínica do paciente a partir da urinálise.

The aim was to verify the compatibility between different brands of urinary dipsticks, for both human and veterinary use, and to compare the semiquantitative parameters of this instrument with quantitative methods. For this, 77 fresh samples of urine from dogs and cats were analyzed e and 04 models of reagent strips were tested. Regarding urinary density, a reasonable correlation was observed between the quantitative and semiquantitative methods in those samples with acidic pH, which did not occur in those with neutral or alkaline pH. Regarding the protein concentration, there was similarity from 53.3% to 83.3% between the brands and in the comparative analysis between the control strip and the photometric analysis, there was a reasonable correlation (rs = 0.69752 to 0.75074). In cut-off point of 15mg/dL protein, the sensitivity of the reagent strip was 82.5% and 100% for canine and feline urine, respectively. Regarding hematuria, there was a reasonable divergence of results between sedimentation and tested dipsticks. As for pyuria, there is a low sensitivity of the strips in relation to canine samples with many false negative results (33% to 75%), while in feline samples the sensitivity was 100%. Thus, regardless of the brands, the reagent strips should serve only as a rapid screening test, while the use of quantitative methods in the clinical evaluation of the patient from urinalysis is more appropriate.

Urinary tract infection in nephrotic syndrome in pediatric age group: a hospital based cross-sectional study

Background: Nephrotic syndrome, characterized by the presence of heavy proteinuria, hypoalbuminemia, edema and hyperlipidemia, is a common renal disorder in pediatric population. Aim of this study were to find out the prevalence of Urinary Tract Infection (UTI) in nephrotic syndrome, bacterial etiologies and antibiotic sensitivity pattern.Methods: After matching the criteria, 82 cases, were taken for this prospective, single center, observational study. The diagnosis was confirmed by bacterial culture. This is an institution based cross-sectional descriptive observational study. All newly diagnosed and relapse cases of nephrotic syndrome based on inclusion exclusion criteria was included in this study. Respondent was either of the parents or caregiver of the study subjects. Analysis of all data was done by appropriate statistical software (SPSS-23).Results: Among 82 participants evaluated with nephrotic syndrome 29.3% participants had UTI, majority 66.7% were asymptomatic and 33.3% were symptomatic. Significant microscopic hematuria were found in 20.7% study subjects and significant pyuria were found in 58.54% study subjects. Majority of UTI caused by E.coli 33.3% followed by Klebsiella 25%, Proteus 16.7%, Staphylococcus aureus 12.5%, Citrobacter, Acinetobacter and mixed growth were found in 4.2% each. Mean serum cholesterol of group with UTI was 422.13±34.65 and group without UTI was 307.43±26.13. The variation amongst the two groups were found to be significant (p=0.0001).Conclusions: The children with nephrotic syndrome are frequently predisposed to UTI and in most cases it is asymptomatic, often undiagnosed. Higher serum cholesterol level may predispose the nephrotic child for UTI.

Study of prevalence of urinary tract infection in febrile children less than 5 years of age

Background: Fever is the most common reason for children under 5 years of age to visit the OPD. Unlike other foci of infection, only a little attention has been focused on the identification of UTI in febrile children. Quite often child receives antibiotics empirically without adequate evaluation of UTI. To determine the prevalence of UTI in all febrile children, from 2 months to 5years of age.Methods: The study included children admitted with bronchiolitis in between during the period of December 2018 to March 2019 at Department of Pediatrics, Raja Muthiah Medical College and Hospital. Totally 200 consecutive children from 2 months to 5 years admitted in the pediatric department Data related to age, sex, predisposing factors will be noted. Urine analysis and urine culture have to be done in all these patients. USG abdomen to be done in patients with culture positive UTI.Results: Among the 200 cases, the prevalence of UTI was higher among females (10%) than males (8%). Among the culture-positive cases UTI, an underlying focus of infection was present in 89% of cases and only 11% of cases did not have any foci. In this study, the % of cases with a duration of fever more than 5 days was 57, as compared to 43% in patients with fever less than 5 days. Among the 19 UTI cases, 5 of them presented with voiding difficulties and all the 5 cases had significant growth on culture. There was a significant association between UTI cases and voiding difficulties.Conclusions: Hence through this study, authors concluded that pyuria of >5 pus cells /HPF in the centrifuged sample should be considered as significant pyuria and hence further evaluation should be done in all these cases to promptly initiate antibiotic treatment and also to prevent morbidity and several long term sequelae.

Prevalence and Clinical Characteristics of Asymptomatic Pyuria in Chronic Kidney Disease

BACKGROUND: Pyuria seems to be common in chronic kidney disease (CKD), irrespective of urinary tract infection (UTI). It has been hypothesized that sterile pyuria occurs in CKD because of chronic renal parenchymal inflammation. However, there are limited data on whether CKD increases the rate of pyuria or how pyuria in CKD should be interpreted. We investigated the prevalence and characteristics of asymptomatic pyuria (ASP) in CKD via urinary white blood cell (WBC) analysis.METHODS: Urine examination was performed for all stable hemodialysis (HD) and non-dialysis CKD patients of the outpatient clinic (total N=298). Patients with infection symptoms or recent history of antibiotic use were excluded. Urine culture and WBC analysis were performed when urinalysis revealed pyuria.RESULTS: The prevalence of ASP was 30.5% (24.1% in non-dialysis CKD and 51.4% in HD patients). Over 70% of the pyuria cases were sterile. The majority of urinary WBCs were neutrophils, even in sterile pyuria. However, the percentage of neutrophils was significantly lower in sterile pyuria. In multivariate logistic regression analysis, the degree of pyuria, percentage of neutrophils, and presence of urinary nitrites remained independently associated with sterile pyuria.CONCLUSIONS: The prevalence of ASP was higher in CKD patients and increased according to CKD stage. Most ASP in CKD was sterile. Ascertaining the number and distribution of urinary WBCs may be helpful for interpreting ASP in CKD.

A study of sterile pyuria in dengue fever

Background: Dengue fever is an important tropical disease which is endemic in around 110 countries. It infects 50-100 million people worldwide per year. In India case fatality rate is 1-5% for severe Dengue. Between 2015-2017, 790 deaths have been recorded according to NVBDCP data. Global burden of Dengue has increased at least fourfold over last three decades and now 2.5 billion people at risk of disease. This study aims at determining sterile pyuria as a manifestation in patients presenting with Dengue fever, as patients may present with similar symptoms as that of urinary tract infection, thereby preventing unnecessary use of antibiotics.Methods: It is a Cross sectional observational study conducted on 100 consecutive patients with serologically proven Dengue fever. Patients satisfying inclusion and exclusion criteria underwent relevant investigations and in patients with urine routine showing pyuria, urine culture and sensitivity was done to rule out urinary tract infection and look for sterile pyuria.Results: Among 100 patients of dengue studied, age distribution being 18years to 70years, mean age was 33.27±13.2 years of them 78 were male and 22 were female. 41% patients showed pyuria in urine. 25 % patients were culture positive most common being E. coli and 16% patients had sterile pyuria.Conclusions: Sterile pyuria is not a well-recognized entity in Dengue fever and is often missed. This study shows that sterile pyuria is quite common manifestation in dengue fever which resembles urinary tract infection and therefore does not require any empirical antibiotic treatment.

Incidence of urinary tract infection in febrile children

Background: Urinary tract infection is diagnosed by the growth of many organisms of a single specimen in the urine with presence of many symptoms. bacteriuria is defined as growth with a colony of >105/ml of a single species in a midstream clean catch urine sample.Methods: A cross sectional study was undertaken in febrile children with urinary tract infection attending Department of Paediatrics, tertiary care hospital, Bangalore during the period January 2017 to December 2017.Results: Out of the 200 children studied, 93 children belonged to the age group of 6 year to 12 year and 57 children belong to 1 year to 6-year age group and 50 children belongs to 12 year to 18-year age group. 97 children showed significant pyuria in centrifuged urine sample of which 49 were males and 48 were females. Majority 45 children were belonging to age group of 6 year to 12 year. Out of 97 children showed significant pyuria in centrifuged urine sample of which 46 children 5-10 cells/HPF and 27 children showed > 10 cells/HPF and 24 cases showed < 5cells / HPF. Out of 200 children, in 29 cases urine culture showed E. coli growth and 51 cases showed no growth.Conclusions: Urinary tract infections are common in childhood. Nearly all UTIs are caused by bacteria that enter the opening of the urethra and move upward to the urinary bladder and sometimes the kidneys.

Clinical outcome and response of treatment in asymptomatic bacteriuria in type I and type II diabetes in women

Back Ground: Asymptomatic bacteriuria is common in neonates, preschool children, in pregnant women, in elderly people, in diabetes mellitus, in catheterized patients and in patients with abnormal urinary tracts or renal disease. Few data, however, are available about the potential complications arising from asymptomatic bacteriuria for various populations and for various medical conditions. The aim of the study: To study clinical outcome and response of treatment in asymptomatic bacteriuria in Type 1 and Type II Diabetes in women. Materials and methods: 150 Diabetes mellitus patients without any urinary complaints such as dysuria, frequency, urgency, strangury, tenesmus, nocturia, nocturnal enuresis, incontinence, urethral pain, bladder pain, renal colic, who attended Diabetology Department as outpatients and in patients in various wards of Govt. Government Mohan Kumuramanglam Medical College, Between 2015- 2016 were enrolled for this study. Results: 30% of the culture-positive cases occurred in 1 to 3 years duration group 24% of positive cases occurred in 5 to 10 years duration group. Of the 15 new cases, 5 cases were culture positive; the percentage of culture positive in new cases was 33.33%. 40% of culture-positive cases had random blood sugar value in the range of 201 mg% to 250 mg%. 24% of cases had random blood sugar value in the range of 151 mg% to 200 mg%. 15% of patients had a random blood sugar range of 251 mg% to 300 mg%. Of the 6 patients with diabetic nephropathy, 4 cases were culture positive, the positive culture percentage was 66.66%. Both cases of diabetic retinopathy are culture was positive. Both cases were grown E.coli. Of the 4 cases with ischemic heart disease, 2 cases were culture positive. S. Palanivel Rajan, I.V. Priyamvadha. Clinical outcome and response of treatment in asymptomatic bacteriuria in type I and type II diabetes in women. IAIM, 2019; 6(4): 26-30. Page 27 E.Coli was grown in culture positive cases in the study group was mostly highly sensitive to quinolones viz norfloxacin and ciprofloxacin and gentamicin. Other commonly used antibiotics like tetracycline, ampicillin, co-trimoxazole, cephalexin, nalidixic acid etc. were non-sensitive to E.coli. Klebsiella were grown in culture positive cases in the study group were 100% highly sensitive to quinolones. Conclusion: Quinolones are used widely for the treatment of E coli causing UTIs and may also be used to treat other infections caused by other members of the Enterobacteriaceae family. There has been a significant increase in quinolone-resistant uropathogenic E. coli strains isolated from patients with UTI in several countries and therapeutic failures have been reported

Clinical and laboratory features of urinary tract infections in young infants / Aspectos clínicos e laboratoriais da infecção do trato urinário em lactentes jovens

ABSTRACT Introduction: Urinary tract infection (UTI) is the most common serious bacterial infection in young infants. Signs and symptoms are often nonspecific. Objectives: To describe clinical, demographic and laboratory features of UTI in infants ≤ 3 months old. Methods: Cross-sectional study of infants ≤ 3 months old with UTI diagnosed in a pediatric emergency department, for the period 2010-2012. UTI was defined as ≥ 50,000 colony-forming units per milliliter of a single uropathogen isolated from bladder catheterization. Paired urinalysis and urine culture from group culture-positive and group culture-negative were used to determine the sensitivity and specificity of pyuria and nitrite tests in detecting UTI. Results: Of 519 urine cultures collected, UTI was diagnosed in 65 cases (prevalence: 12.5%); with male predominance (77%). The most common etiologies were Escherichia coli (56.9%), Klebsiella pneumoniae (18.5%) and Enterococcus faecalis (7.7%). Frequent clinical manifestations were fever (77.8%), irritability (41.4%) and vomiting (25.4%). The median temperature was 38.7°C. The sensitivity of the nitrite test was 30.8% (95%CI:19.9-43.4%), specificity of 100% (95%CI:99.2-100%). Pyuria ≥ 10,000/mL had a sensitivity of 87.7% (95%CI:77.2-94.5%), specificity of 74.9% (95%CI:70.6 -78.8%). The median peripheral white blood cell count was 13,150/mm3; C-reactive protein levels were normal in 30.5% of cases. Conclusions: The male: female ratio for urinary tract infection was 3.3:1. Non-Escherichia coli etiologies should be considered in empirical treatment. Fever was the main symptom. Positive nitrite is highly suggestive of UTI but has low sensitivity; whereas pyuria ≥ 10,000/mL revealed good sensitivity, but low specificity. Peripheral white blood cell count and C-reactive protein concentration have limited usefulness to suggest UTI.

RESUMO Introdução: A infecção do trato urinário (ITU) é um quadro infeccioso grave mais frequente em lactentes jovens, cujos sinais e sintomas são frequentemente inespecíficos. Objetivos: Descrever aspectos clínicos, demográficos e laboratoriais de ITU em lactentes ≤ 3 meses. Métodos: Estudo transversal de ITU diagnosticada em lactentes ≤ 3 meses, em pronto-socorro geral de pediatria, entre 01/01/2010 a 31/12/2012. Diagnóstico de ITU definida como crescimento ≥ 50.000 unidades formadoras de colônia por mililitro de uropatógeno único, colhido por cateterismo vesical. Urina tipo I e urocultura foram pareadas dos grupos cultura-positiva e cultura-negativa para determinar a sensibilidade e especificidade de piúria e teste do nitrito para o diagnóstico de ITU. Resultados: Das 519 uroculturas colhidas, confirmou-se 65 casos de ITU (prevalência: 12,5%), com predomínio em meninos (77%). As etiologias mais frequentes foram Escherichia coli (56,9%), Klebsiella pneumoniae (18,5%) e Enterococcus faecalis (7,7%). Os sintomas mais frequentes foram febre (77,8%), irritabilidade (41,4%) e vômitos (25,4%). A temperatura mediana foi de 38,7°C. A sensibilidade do nitrito positivo foi de 30,8% (IC95%:19,9-43,4%), especificidade de 100% (IC95%:99,2-100%). Piúria ≥ 10.000/mL apresentou sensibilidade de 87,7% (IC95%:77,2-94,5%), especificidade de 74,9% (IC95%:70,6-78,8%). A contagem mediana de leucócitos foi 13.150/mm3. A proteína C reativa foi normal em 30,5% dos casos. Conclusões: A proporção entre meninos e meninas para ITU foi de 3,3:1. Outros agentes além de Escherichia coli devem ser considerados no tratamento empírico. A febre foi a principal queixa. O nitrito positivo é altamente sugestivo de ITU mas tem baixa sensibilidade; enquanto que a piúria ≥ 10.000/mL revelou boa sensibilidade, porém baixa especificidade. Leucograma e proteína C reativa demonstraram pouca utilidade clínica para sugerir ITU.

Urinary Tract Infection in Diabetes / 임상당뇨병

Urinary tract infection (UTI) is common in patients with diabetes mellitus. Furthermore, UTI is more severe, more often caused by resistant pathogens, and produces worse outcomes in those with diabetes mellitus. Although some patients may have altered clinical signs, symptoms of UTI are similar in patients with or without diabetes mellitus. Treatment depends on severity of systemic symptoms, results of urine culture, and underlying diseases of patients. There are no definite indications to treat asymptomatic bacteriuria in patients with diabetes mellitus.

Clinical Features of Kawasaki Disease with Pyuria

PURPOSE: Clinical and laboratory features of two Kawasaki disease (KD) groups were evaluated; the patient with pyuria and those without pyuria. METHODS: From January 2015 to December 2016, the medical records of 140 (86 males and 54 females) inpatients with KD were retrospectively analyzed. RESULTS: Forty-eight KD patients (34.3%) presented with pyuria. KD patients with pyuria showed a higher level of C-reactive protein (CRP) and a higher proportion of elevated liver enzymes than those without pyuria. There were no differences in the proportions of unresponsiveness to intravenous immunoglobulin and coronary artery lesions between the two groups. Six KD patients (12.5%) with pyuria underwent a renal imaging study to rule out the possibility of a urinary tract infections. Thirty-two KD patients (66.7%) with pyuria received treatment with antibiotics in addition to the standard treatment for KD. CONCLUSIONS: KD patients with pyuria showed a higher level of CRP and elevated levels of liver enzymes than those without pyuria. These findings suggest that KD patients with pyuria have more severe systemic inflammation than those without pyuria.

Analysis of sterile pyuria in patients with Kawasaki disease / 临床儿科杂志

Objectives To explore the clinical features and pathogenesis of Kawasaki disease (KD) combined with sterile pyuria. Methods A total of 420 patients diagnosed of KD were recruited and divided into pyuria group ( 95 patients) and control group ( 325 patients) according to urine routine examination on admission. The clinical data between the two groups were compared. Results There was no difference in gender, age, and the incidence of atypical KD (P all?>?0 . 05 ). The levels of C-reactive protein, D-dimer concentrations, fibrinogen degradation products, alanine aminotransferase, aspartate aminotransferase, and urine retinol binding protein were higher in pyuria group than those in control group (all P>?0 . 05 ). No difference was found in the duration of fever before admission between two groups (P>?0 . 05 ). However, pyuria group had longer duration of fever after treatment with immunoglobulin (P?0.05). Conclusion The morbidity of sterile pyuria in KD patients was 22 . 6%. KD patients with sterile pyuria have more intense inlfammatory response, markedly high coagulation condition, and mild or subclinical renal damage.

Urinary Screening for Detection of Renal Abnormalities in Asymptomatic School Children, Sohag Governorate, Egypt.

Background: Dipstick urine analysis is the most common method for screening children for detecting urinary abnormalities. This study is aimed to estimate the frequency of urinary problems among children aged 6-13 years from five primary schools in different parts of the Sohag Governorate, Egypt. Study Design and Setting: Cross-sectional study carried out by the Pediatrics Department and Community Medicine Departments at Sohag University, Egypt. Study Duration: Study was conducted during the academic year of Egypt 2014-2015. Methods: Urine analysis was performed for 2850 asymptomatic school children [1800 (63%) males and 1050 (37%) females]. Out of which, 1736 (61%) children were from rural areas and 1114 (39%) children were from urban areas. Microscopic examinations were performed for the abnormal dipstick samples after two weeks. Urine culture and other investigations were done to determine the underlining urinary abnormities. Results: The initial urinary screening by dipstick revealed 53 children (1.86%) had urine abnormities. Confirmatory test by complete microscopic examination of urine after 15 days showed that only 38 children (1.33%) still had urinary abnormalities. Twenty-one children (0.74%) had hematuria, three children (0.11%) had proteinuria and 14 children (0.49%) had pyuria. Urinary tract infections (UTIs) were diagnosed in 21 children (14 children with pyuria and seven children with hematuria) in whom further evaluation revealed UTIs. The most common bacteria in positive urine culture samples were gram-negative bacilli in 42.86% children. Conclusion: Small number of asymptomatic renal abnormalities can be detected by dipstick urine screening. The common abnormalities were hematuria, UTIs and proteinuria. Hematuria and UTIs were more common in females than males. Further work is needed to determine value of early detection of renal disorders in childhood in preventing development of end-stage renal diseases.

Predicting Factors of Roseola Infantum Infected with Human Herpesvirus 6 from Urinary Tract Infection

PURPOSE: The aim of this study was to compare the clinical and laboratory features of infants with roseola infantum due to human herpesvirus 6 (HHV6) infection and those with urinary tract infection (UTI). METHODS: We retrospectively reviewed the medical records of children who were hospitalized at Cheil General Hospital and Women's Health Care Center, College of Medicine, Dankook University, and diagnosed as having HHV6 infection or UTI. RESULTS: Among the infants admitted between September 2014 and May 2016, 92 (male, 45 and female, 47) were included in the study and divided into a HHV6 infection group (n=50) and a UTI group (n=42). The relative risk of UTI compared with that of HHV6 infection increased with pyuria (P<0.001), increased with leukocytosis (mean white blood cell [WBC] count, 15,048±5,756/mm³ vs 87,916±54,056/mm³; P<0.001), increased with C-reactive protein (CRP) level (4.89±4.85 mg/dL vs 1.04±1.76 mg/dL; P<0.001), and younger age (6.3±3.2 months vs 18.3±12.6 months; P<0.001). The relative risk of HHV6 infection compared with that of UTI increased with fever duration (4.3±1.7 days vs 2.8±1.7 days; P<0.001) and decreased with platelet (PLT) count (373±94×10³/mm³ vs 229±90×10³/mm³; P<0.001). No significant differences were found between the HHV6 groups according to the presence or absence of pyuria. CONCLUSION: Pyuria, age, fever duration, WBC count, CRP level, and PLT count were the differentiating factors of HHV6 infection from UTI. However, sterile pyuria can occur in children with HHV6 infection. In the presence of pyuria, CRP level and PLT count were the strong predictors of UTI compared with HHV6.

Urinary tract infections in pediatric oncology patients with febrile neutropenia / 영남의대학술지

BACKGROUND: Neutropenic fever is one of the most common and potentially severe complications of chemotherapy in pediatric oncology patients, while urinary tract infection (UTI) is one of the most prevalent bacterial infections in these patients. Therefore, this study was conducted to investigate features of UTI with neutropenic fever in pediatric oncology patients. METHODS: We retrospectively reviewed and analyzed the medical records, laboratory results and image findings of cases of neutropenic fever in the Department of Pediatrics of Yeungnam University Medical Center, South Korea between November 2013 and May 2015. Episodes were divided into two groups, UTI vs. non-UTI group according to the results of urine culture. The results were then compared between groups. The analysis was performed using IBM SPSS 23.0. A p-value <0.05 was considered to indicate a significant difference between groups. RESULTS: Overall, 112 episodes of neutropenic fever were analyzed, among which 22 episodes (19.6%) showed organisms on urine culture and were classified as UTI. The remaining 90 episodes were classified as non-UTI. Only four episodes (18.2%) of the UTI group showed pyuria on urine analysis. In the UTI group, 76.5% were sensitive to the first line antibiotics and showed higher clinical response than the non-UTI group. Among hematologic malignancy patients, the UTI group revealed higher serum β 2-microglobulin levels than the non-UTI group (1.56±0.43 mg/L vs. 1.2±0.43 mg/L, p<0.028). CONCLUSION: UTI in pediatric neutropenic fever responds well to antibiotics. Hematologic malignancy cases with UTI reveal increased serum β2-microglobulin level. These results will be helpful to early phase diagnosis of UTI.

A Case of Incidentally Detected Asymptomatic Emphysematous Pyelonephritis / 대한내과학회지

Emphysematous pyelonephritis (EPN) is a severe gas-forming infection of the renal parenchyma and surrounding tissues. Patients with EPN commonly present with high fever, chills, and flank pain. These symptoms mimic a simple urinary tract infection, such that diagnosis is often delayed. Because of its life-threatening fulminant course, the early detection of EPN and its prompt treatment with intravenous antibiotics with or without percutaneous drainage are critical. Here we describe a case of a 63-year-old Korean female with diabetes mellitus who had no specific symptoms or signs of EPN. A chest computed tomography (CT) scan to assess a right pleural effusion incidentally detected an abnormal gas shadow in the renal parenchyma. An abdominal CT scan performed 5 days later showed increased gas within the kidney parenchyma, but the patient still had no symptoms of EPN. She was treated with intravenous antibiotics alone. A follow-up abdominal CT scan revealed the complete disappearance of the features of EPN.

Study on natural transition of pyuria and bacteriuria after transurethral resection of the prostate / 中华泌尿外科杂志

Objective To observe the incidence and transformation of pyuria and bacteriuria in different time point after TURP and supply the evidence for antibiotic application.Methods From March,2011 to May,2012,84 patients with BPH admitted in our hospital.Their ages ranged from 61 to 87 years old,mean (71.9±7.6) years.The volume of prostate in those patients ranged from 27.8 to 118 ml,mean (70.8±24.1) ml.The procedure of TURP was undergone in all of them.In one week after the operation,two urine specimens from each patient,one for urine routine examination and one for urine culture,were collected 24 h after the catheter have been withdrawn.The catheter was also cultured.During the following-up,urine routine examination and urine culture were regularly performed in 1,2,3 months after surgery.If the patient had both pyuria and bacteriuria,he should be excluded the study.Results The pyuria rate on one week,one month,two months and three months were 54.8％ (46/84),100.0％ (82/82),65.8％ (48/ 73),34.2％ (25/73),respectively.There is a significance difference among those groups (P＜0.05).It seemed that the pyuria would appear in all patients.However,the incidence would gradually decrease.It seemed that the pyuria has the tendency of self-recovery.A significant difference of prostatic resection volume after 3 months could be observed in the pyuria group (31.4±15.2 ml) and non-pyuria group (24.8±11.6 ml) (P＜0.05).The bacteriuria rate on one week,1,2,3 months were 7.1％ (6/84),11.0％ (9/82),6.8％ (5/73)and 0,respectively.There is no significance difference among the groups (P＞0.05).Conclusions Pyuria will appear after TURP and the incidence reduced gradually following the time.The pyuria alone without the bacteriuria may be explained by inflammation,that antibiotics were unnecessary.The bacteriuria alone without the pyuria may be considered as asymptomatic bacteriuria or bacterial colonization,antibiotics were unnecessary,either.

Urine storage under refrigeration preserves the sample in chemical, cellularity and bacteriuria analysis of ACS / Armazenamento da urina, sob refrigeração, preserva a amostra nas análises químicas, celularidade e bacteriuria no EAS

INTRODUCTION: The analysis of urine abnormal constituents and sediment (ACS) comprises tests of great diagnostic and prognostic value in clinical practice. When the analysis of ACS cannot be performed within two hours after collection, the sample must be preserved in order to avoid pre-analytical interferences. Refrigeration is the most applied technique due to its cost effectiveness. Moreover, it presents fewer inconveniences when compared to chemical preservation. However, changes in ACS may also occur in samples under refrigeration. OBJECTIVE: To analyze the influence of refrigeration at 2 to 8ºC on the storage of urine samples within 24 hours. MATERIAL AND METHOD: A total of 80 urine samples were selected from patients admitted at Universidade Federal de Juiz de Fora (UFJF) university hospital, which were tested for ACS at room temperature and stored under refrigeration for 6, 12 and 24 hours. RESULTS: The results showed that refrigeration proved to be effective when compared to samples kept at room temperature, inasmuch as the physical, chemical, microbial and cellularity features were preserved. Nevertheless, crystalluria was present after a 6- hour storage period. CONCLUSION: The tests revealed that cooling preserved cellularity and chemical characteristics of urine samples for up to 12 hours. Nonetheless, the precipitation of crystals was evident in this storage method. Thus, the possible consequences of storing urine samples for ACS test under these conditions should be included in the analysis report.

INTRODUÇÃO: A pesquisa de elementos anormais e sedimentoscopia na urina (EAS) compreende testes de grande valor diagnóstico e prognóstico na prática clínica. Quando a análise do EAS não puder ser realizada dentro de duas horas após a coleta da amostra, esta deve ser conservada para que interferências pré-analíticas sejam evitadas. A refrigeração é a técnica mais utilizada devido ao custo-benefício e por apresentar menos inconvenientes quando comparada com conservantes químicos. No entanto, alterações no EAS também podem ocorrer na amostra sob refrigeração. OBJETIVO: Analisar a influência da refrigeração entre 2 a 8ºC no armazenamento do EAS por um período de até 24 horas. MATERIAL E MÉTODO: Foram selecionadas 80 amostras de urina de pacientes internados no hospital da Universidade Federal de Juiz de Fora (UFJF) testadas para EAS, à temperatura ambiente, e armazenadas sob refrigeração em 6, 12 e 24 horas. RESULTADOS: Os resultados mostraram que a refrigeração foi eficaz quando comparada com amostras mantidas à temperatura ambiente, já que as características físicas, químicas, da celularidade e da microbiota da urina foram preservadas. No entanto, a cristalúria se fez presente desde as 6 horas de armazenamento. CONCLUSÃO: Os testes demonstraram que a refrigeração preservou as características químicas e a celularidade da urina por até 12 horas. No entanto, precipitações de cristais mostraram-se evidentes neste método de armazenamento. Dessa forma, a sugestão de se relatar no laudo as possíveis consequências dessa forma de armazenamento de urina para o EAS pode ser importante.

Infant with incomplete Kawasaki disease present with sterile pyuria / 临床儿科杂志

Objectives To explore the clinical features of incomplete Kawasaki disease (IKD) which presents with sterile pyuria in infant, in order to achieve early diagnosis and treatment. Methods A retrospective study of 15 infants with IKD was conducted in comparison with 29 patients who were diagnosed with KD according to the diagnostic criteria of American Heart Association 2004. Results Both KD and IKD groups had recurrent fever and poor response to antibiotic therapy. Hemoglobin level was signiifcantly lower in IKD group than in KD group at the onset or 7-d after onset (P<0.05). C-reaction protein (CRP) level was signiifcantly higher in IKD group than that in KD group at 7-d after onset (P<0.05). There were 4 patients with coronary artery abnormality, 2 patients with coronary artery dilation and 2 patients with coro-nary artery aneurysm. Conclusions For infant <1 year old who has pyuria ifrstly, continuous fever for over 5 days when treated by antibiotics and increasing serum inlfammatory markers, incomplete Kawasaki disease should be suspected and the cardiac ultrasound is recommended.

Acute Epididymitis in Children: the Role of the Urine Test

PURPOSE: Acute epididymitis is considered to have an important role in children with scrotal pain. Recent reports have shown that urinalysis is not helpful for the diagnosis and treatment of acute epididymitis owing to negative microbiological findings. Therefore, we analyzed clinical and laboratory characteristics to examine the diagnostic yield of urinalysis in children. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 139 patients who were diagnosed with acute epididymitis from 2005 to 2011. Diagnosis was based on symptoms, physical findings, and color Doppler ultrasonography (DUS). To investigate the characteristics of epididymitis in children, the patients were divided into 3 groups: group A (aged less than 18 years, 76 patients), group B (18 to 35 years old, 19 patients), and group C (older than 35 years, 44 patients). RESULTS: There were statistically significant differences in age, symptom duration, hospital stays, and lesion location in each group. White blood cell count and serum C-reactive protein levels, pyuria, and positive urine culture results were statistically higher in the older age group. The most common cause of acute epididymitis in children was idiopathic (96.1%). CONCLUSIONS: In our group of children with epididymitis, 73 cases out of 76 (96.1%) resulted in negative pyuria in urinalysis. In addition, the most common cause of epididymitis was idiopathic. Because most urinalyses do not show pyuria, we believe that routine antibiotics may be not required in pediatric patients with epididymitis. If urinalysis shows pyuria with or without positive urine culture, antibiotics should be considered.