摘要
La Sociedad Argentina de Infectología y otras sociedades científicas han actualizado estas recomendaciones utilizando, además de información internacional, la de un estudio multicéntrico prospectivo sobre infecciones del tracto urinario del adulto realizado en Argentina durante 2016-2017. La bacteriuria asintomática debe ser tratada solo en embarazadas, a quienes también se las debe investigar sistemáticamente; los antibióticos de elección son nitrofurantoína, amoxicilina, amoxicilina-clavulánico, cefalexina y trimetoprima-sulfametoxazol. Ante procedimientos que impliquen lesión con sangrado del tracto urinario se recomienda solicitar urocultivo para pesquisar bacteriuria asintomática, y, si resultara positivo, administrar antimicrobianos según sensibilidad desde inmediatamente antes hasta 24 horas luego de la intervención. En mujeres, la cistitis puede ser tratada con nitrofurantoina, cefalexina, o fosfomicina y no se recomienda usar trimetoprima-sulfametoxazol o fluoroquinolonas; en pielonefritis puede emplearse ciprofloxacina, cefixima o cefalexina si el tratamiento es ambulatorio o ceftriaxona, cefazolina o amikacina si es hospitalario. En los hombres, las infecciones del tracto urinario se consideran siempre complicadas. Se recomienda tratamiento con nitrofurantoina o cefalexina por 7 días, o bien monodosis con fosfomicina. Para la pielonefritis en hombres se sugiere ciprofloxacina, ceftriaxona o cefixima si el tratamiento es ambulatorio y ceftriaxona o amikacina si es hospitalario. Se sugiere tratar las prostatitis bacterianas agudas con ceftriaxona o gentamicina. En cuanto a las prostatitis bacterianas crónicas, si bien su tratamiento de elección hasta hace poco fueron las fluoroquinolonas, la creciente resistencia y ciertas dudas sobre la seguridad de estas drogas obligan a considerar el uso de alternativas como fosfomicina.
The Argentine Society of Infectious Diseases and other scientific societies have updated these recommendations based on data on urinary tract infections in adults obtained from a prospective multicenter study conducted in Argentina during 2016-2017. Asymptomatic bacteriuria should be treated only in pregnant women, who should also be systematically investigated; the antibiotics of choice are nitrofurantoin, amoxicillin, clavulanic/amoxicillin, cephalexin and trimethoprim-sulfamethoxazole. In procedures involving injury to the urinary tract with bleeding, it is recommended to request urine culture and, in the presence of bacteriuria, antimicrobial treatment according to sensitivity should be prescribed from immediately before up to 24 hours after the intervention. In women, cystitis can be treated with nitrofurantoin, cephalexin or fosfomycin, while trimethoprim-sulfamethoxazole and fluoroquinolones are not recommended; pyelonephritis can be treated with ciprofloxacin, cefixime or cephalexin in ambulatory women or ceftriaxone, cefazolin or amikacin in those who are hospitalized. In men, urinary tract infections are always considered complicated; nitrofurantoin or cephalexin are recommended for 7 days, alternatively fosfomycin should be given in a single dose. In men, ciprofloxacin, ceftriaxone or cefixime are suggested for pyelonephritis on ambulatory treatment whereas ceftriaxone or amikacin are recommended for hospitalized patients. Acute bacterial prostatitis can be treated with ceftriaxone or gentamicin. Fluoroquinolones were the choice treatment for chronic bacterial prostatitis until recently; they are no longer recommended due to the increasing resistance and recent concerns regarding the safety of these drugs; alternative antibiotics such as fosfomycin are to be considered.
Subject(s)
Humans , Male , Female , Pregnancy , Argentina , Urinary Tract Infections/drug therapy , Consensus , Anti-Infective Agents, Urinary/therapeutic use , Prostatitis/diagnosis , Prostatitis/drug therapy , Pyelonephritis/diagnosis , Pyelonephritis/drug therapy , Urinary Tract Infections/diagnosis , Prospective Studies , Cystitis/diagnosis , Cystitis/drug therapy摘要
ABSTRACT Encrusted cystitis (EC) was first described as chronic cystitis with mucosal calcification in 1914 (1). It is a very rare chronic inflammatory disease presenting with dysuria, pelvic pain and gross hematuria. Voided urine contains mucus or calcified mucopurulent stone like particles. Urinalysis always reveals alkaline pH. It may be present in healthy individuals with no predisposing etiological factors (2-4). Etiologically, previous urological diseases, immunosuppression, urinary infection with urea splitting bacteria, or urological interventions resulting in bladder mucosa trauma may also be present (5, 6). In the present case report, we describe a novel treatment for EC with intravesical dimethyl sulfoxide.
Subject(s)
Humans , Male , Adult , Dimethyl Sulfoxide/therapeutic use , Corynebacterium/classification , Corynebacterium Infections/drug therapy , Cystitis/drug therapy , Administration, Intravesical , Chronic Disease , Treatment Outcome , Corynebacterium/isolation & purification , Corynebacterium Infections/diagnosis , Corynebacterium Infections/microbiology , Cystitis/diagnosis , Cystitis/microbiology摘要
Emphysematous cystitis is found in diabetic patients and in individuals with urinary stasis and immunosuppression. We report a 58-year-old male with hypertension, type 2 Diabetes on insulin treatment and central nervous system vasculitis on immunosuppressive therapy. He was admitted with weight loss and gait instability. A PET-CT showed a circumscribed image of air in the bladder contour without involving the upper urinary tract, suggesting emphysematous cystitis. Re-interrogated, the patient referred pneumaturia, dysuria and febrile sensation one week before admission. Urine culture showed Enterobacter aerogenes. He was treated with a urinary catheter, metabolic control and parenteral antimicrobials. The patient was discharged without symptoms 21 days after admission, with the bladder catheter.
Subject(s)
Humans , Male , Middle Aged , Cystitis/diagnosis , Emphysema/diagnosis , Enterobacter aerogenes/isolation & purification , Enterobacteriaceae Infections/drug therapy , Cystitis/complications , Dysuria/etiology , Emphysema/complications , Imipenem/therapeutic use , Treatment Outcome , Urinary Incontinence, Urge/etiology摘要
BACKGROUND/AIMS: BK virus (BKV) has been associated with late-onset hemorrhagic cystitis (HC) in recipients of hematopoietic stem cell transplantation (HSCT). Cidofovir has been used at higher doses (3 to 5 mg/kg/wk) with probenecid prophylaxis; however, cidofovir may result in nephrotoxicity or cytopenia at high doses. METHODS: Allogeneic HSCT recipients with BKV-associated HC are treated with 1 mg/kg intravenous cidofovir weekly at our institution. A microbiological response was defined as at least a one log reduction in urinary BKV viral load, and a clinical response was defined as improvement in symptoms and stability or reduction in cystitis grade. RESULTS: Eight patients received a median of 4 weekly (range, 2 to 11) doses of cidofovir. HC occurred a median 69 days (range, 16 to 311) after allogeneic HSCT. A clinical response was detected in 7/8 patients (86%), and 4/5 (80%) had a measurable microbiological response. One patient died of uncontrolled graft-versus-host disease; therefore, we could not measure the clinical response to HC treatment. One microbiological non-responder had a stable BKV viral load with clinical improvement. Only three patients showed transient grade 2 serum creatinine toxicities, which resolved after completion of concomitant calcineurin inhibitor treatment. CONCLUSIONS: Weekly intravenous low-dose cidofovir without probenecid appears to be a safe and effective treatment option for patients with BKV-associated HC.
Subject(s)
Adult , Female , Humans , Male , Administration, Intravenous , Antiviral Agents/administration & dosage , BK Virus/drug effects , Cystitis/diagnosis , Cytosine/administration & dosage , Drug Administration Schedule , Hematopoietic Stem Cell Transplantation/adverse effects , Immunocompromised Host , Organophosphonates/administration & dosage , Polyomavirus Infections/diagnosis , Retrospective Studies , Time Factors , Transplantation, Homologous , Treatment Outcome , Tumor Virus Infections/diagnosis , Viral Load摘要
We report a 53 year-old woman with type 2 diabetes mellitus and hypertension, presenting with progressive abdominal pain lasting three weeks, associated with lower abdominal swelling and fever. Clinical examination showed a large increase in abdominal volume, contraction of extracellular compartment, and signs of severe sepsis. Computed tomography showed an over-distended bladder with severe wall and luminal pneumatosis and bilateral hydronephrosis. The diagnosis was of emphysematous cystitis associated to hydronephrosis. Urine and blood cultures were positive for multi-susceptible Escherichia coli. Clinical evolution was favorable after 6 weeks of ceftriaxone and urinary catheter use. Emphysematous cystitis is a rare clinical entity, with an associated mortality of 7%. Known predisposing factors are older age, female gender and presence of diabetes. Microbiological agents most frequently involved are Escherichia coli and Klebsiella pneumoniae (80% of cases). Medical treatment is preferred and is based on urinary tract decompression with a bladder catheter, and prolonged broad spectrum antimicrobial therapy.
Subject(s)
Female , Humans , Middle Aged , Cystitis/diagnosis , Emphysema/diagnosis , Cystitis/etiology , /complications , Emphysema/etiology , Tomography, X-Ray Computed摘要
A bladder infection of Aspergillus with no evidence of dissemination is rare. We present a case of Aspergillus infection with transitional cell carcinoma of the urinary bladder without any evidence of systemic involvement. A 65-year-old male diabetic whose main complaints were intermittent painful haematuria and nocturia had undergone nephroureterectomy a year and a half back for transitional cell carcinoma of right renal pelvis. Cystoscopy revealed bladder mucosa having fixed broad tumour with encrustation and bleeding on touch at the right vesico-ureteric junction. The histopathologic diagnosis was a high-grade transitional carcinoma with Aspergillus infection. Fungal culture of urine obtained after bladder wash yielded Aspergillus fumigatus.
Subject(s)
Aged , Aspergillosis/diagnosis , Aspergillosis/microbiology , Aspergillosis/pathology , Aspergillus fumigatus/isolation & purification , Carcinoma, Transitional Cell/complications , Cystitis/diagnosis , Cystitis/microbiology , Cystitis/pathology , Cystoscopy , Histocytochemistry , Humans , Male , Urinary Bladder/microbiology , Urinary Bladder/pathology , Urinary Bladder Neoplasms/complications摘要
No abstract available.
Subject(s)
Aged , Female , Humans , Colitis, Ischemic/complications , Cystitis/diagnosis , Dehydration/etiology , Diarrhea/etiology , Fluid Therapy , Hydronephrosis/diagnosis , Oliguria/etiology , Predictive Value of Tests , Radiation Injuries/diagnosis , Tomography, X-Ray Computed摘要
Eosinophilic cystitis is a rare inflammatory pathology. It remains a poorly understood entity. To report a series of adult cases of eosinophilic cystitis mimicking a bladder tumor. Retrospective study of cases of eosinophilic cystitis collected in an urology department. Diagnosis was established on a spontaneous bladder perforation in one case and on hematuria in the eight other cases. Histopatholgy studies confirmed the diagnosis. Eight patients underwent an endoscopic resection of bladder lesions followed by medical therapy with nonsteroidal anti-inflammatory drugs and cortimoxazole. An ileal bladder enlargement was performed in one case. Regular follow-up didn't reveal any recurrence. Eosinophilic cystitis is a rare disease simulating a tumor of bladder. Its clinical presentation is not specific and final diagnosis is based on pathology. Endoscopic resection will help to pathologic diagnosis. Associated to corticoids and antihistaminic drug endoscopic resection constitute the treatment of choice
Subject(s)
Humans , Female , Male , Female , Aged , Adult , Middle Aged , Aged, 80 and over , Eosinophilia , Cystitis/diagnosis , Retrospective Studies , Cystitis/drug therapy , Cystitis/surgery摘要
Polypoid cystitis is a benign exophytic mucosal lesion of the bladder. Differentiating it from papillary transitional cell carcinoma is difficult due to their similar characteristics. Although indwelling catheter is the main well-known cause of polypoid cystitis, some case reports unrelated to catheterization have been described. However, the radiological findings of polypoid cystitis have rarely been reported. We hereby describe polypoid cystitis in a 20-year-old man without a history of catheterization along with the computed tomographic findings
Subject(s)
Humans , Male , Cystitis/diagnosis , Urinary Bladder Diseases , Urinary Catheterization , Tomography, X-Ray Computed摘要
La infección del tracto urinario (ITU), con sus múltiples presentaciones clínicas, está entre las enfermedades infecciosas más frecuentes, tanto en pacientes ambulatorios como hospitalizados. El uso del examen de orina completa y de urocultivo debe ser racional. La bacteriuria asintomática no debe ser buscada ni tratada, en parte porque esto favorece el desarrollo de bacterias resistentes a antibióticos. Distintos cuadros clínicos requieren de distintas duraciones de terapia antibiótica, y tanto el exceso de días de tratamiento como su falta deben evitarse. Se requiere investigación en la búsqueda de estrategias más efectivas para prevenir las ITU recurrentes y en el desarrollo de nuevos antibióticos orales para las ITU resistentes.
Urinary tract infection, with its multiple clinical presentations, is one of the most common infectious diseases in both ambulatory and hospitalized patients. The urinalysis and urine culture should be used when appropriate. Asymptomatic bacteriuria should not be screened or treated, in part because of a concern for the selection of antibiotic resistant bacteria. The appropriate duration of treatment of urinary tract infection should be completed. Research is needed in newstrategies for prevention of recurrent urinary tract infections and development of new oral antibiotics for drug resistant bacteria.
Subject(s)
Humans , Urinary Tract Infections/diagnosis , Urinary Tract Infections/therapy , Cystitis/diagnosis , Cystitis/therapy , Urinary Tract Infections/etiology , Urinary Tract Infections/urine , Pyelonephritis/diagnosis , Pyelonephritis/therapy , Risk Factors , Secondary Prevention摘要
Accurate differentiation between upper and lower urinary tract infection [UTI] requires invasive produces. The objective of this study was to determine the morphology of RBC that originates from kidney or bladder for differentiating between upper and lower urinary tract infection. UTI was induced by the injection of 0.5ml of normal saline containing human E coli [10[4]/cc] into the bladder of rats [n=50]. After 48 hours, the rat urine was drained from the bladder and analyzed for the morphology of RBC, culture and cell counter. For diagnosing pyelonephritis, both bilateral kidneys and bladder were biopsied for histopathology and culture. Dysmorphic RBC was detected in 33% [10/30] of the subjects with upper UTI and 13% [4/30] with lower UTI, which showed no significant difference [x[2] =0.04, P=0.63 Fisher Exact Test]. The mean and SD of percentage of dysmorphic RBC in the subjects with upper and lower UTI were 35 +/- 34% and 44 +/- 43%, respectively, which revealed no significant difference [t=0.55, P=0.25]. In this study, dysmorphic RBC showed rates of 45% sensitivity and 50% specificity for upper UTI diagnosis. Urine osmolality may influence the results of RBC morphology for differentiating between upper and lower UTI
Subject(s)
Animals, Laboratory , Erythrocytes/ultrastructure , Pyelonephritis/diagnosis , Cystitis/diagnosis , Rats摘要
Emphysematous Cystitis is a primary infection of the bladder with production of gas by bacteria. The infection is uncommon, still has obvious clinical importance due to its morbidity and mortality potential, as the following case enlightens. We report a clinical case of a patient admitted with acute myocardial infarction who developed an acute emphysematous cystitis, a further complication in his long and complex period of hospitalization.
Subject(s)
Aged, 80 and over , Humans , Male , Cystitis/diagnosis , Emphysema/diagnosis , Cystitis/complications , Emphysema/complications , Fatal Outcome , Length of Stay , Myocardial Infarction/complications , Tomography, X-Ray Computed摘要
Amyloidosis is a heterogeneous group of disorders affecting a single-or multiple-organ system and presents as generalized or localized disease. Both generalized amyloidosis and localized amyloidosis can be primary or secondary. Localized amyloidosis affects organs like urinary bladder, lung, larynx, skin, tongue and the region around the eye, producing detectable nodular masses which are clinically suspected as malignancy. We present six cases of localized urinary bladder amyloidosis that were clinically and cystoscopically suspected as bladder tumor or cystitis, which occurred over a period of last 10 years. Histology in all cases revealed diagnosis of primary amyloidosis. None of them had any stigmata of secondary disease. The cases were treated by simple transurethral resection of bladder. Two out of the six cases recurred after 3 to 5 years of initial presentation and were asymptomatic thereafter. Amyloidosis of the bladder is a rare condition which often mimics bladder neoplasm clinically and cystoscopically and histological examination is a must for definite diagnosis and proper management.
Subject(s)
Adult , Amyloidosis/diagnosis , Cystitis/diagnosis , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Recurrence , Urinary Bladder Diseases/diagnosis , Urinary Bladder Neoplasms/diagnosis摘要
La infección urinaria es una patología común en el geronte. Esta población presenta diversos factores de riesgo, tales como la edad, la insuficiencia renal crónica y otras comorbilidades, el uso frcuente de sondas vesicales, que favorecen la incidencia de dichas infecciones. Se describe una actualización acerca de la etiología, las manifestaciones clínicas, el diagnóstico y tratamiento de las infecciones urinarias en grupos epidemiológicos seleccionados.
Subject(s)
Humans , Aged, 80 and over , Aged , Bacteriuria/diagnosis , Bacteriuria/pathology , Cystitis/diagnosis , Urinary Tract Infections/diagnosis , Urinary Tract Infections/etiology , Urinary Tract Infections/pathology , Urinary Tract Infections/therapy , Renal Insufficiency, Chronic/diagnosis摘要
A cistite xantogranulomatosa (CX) é uma rara doença inflamatória crônica e benigna de etiologia desconhecida. É apresentado um caso de cistite xantogranulomatosa em um paciente masculino de 53 anos. A evolução do paciente incluiu estudos clínicos, radiológicos e histológicos. Não houve recorrência em 32 meses de seguimento após o tratamento. Este caso é provavelmente o 21o a ser relatado no mundo, e o primeiro caso na literaturabrasileira
Xanthogranulomatous cystitis (XC) is a rare benign chronic inflammatory disease of unknown etiology. A case of Xanthogranulomatous cystitis in a 53 year-old male is presented. Patient evolution included clinical, radiological, and histological studies. He had no recurrence of XC 32 months after treatment. The present case is probably the 21st to be reported in the world, and the first case in the Brazilian literature
Subject(s)
Humans , Male , Middle Aged , Xanthomatosis/diagnosis , Cystitis/diagnosis , Granuloma/diagnosis , Xanthomatosis/surgery , Xanthomatosis/pathology , Cystectomy , Cystitis/surgery , Cystitis/pathology , Granuloma/surgery , Granuloma/pathologySubject(s)
Humans , Male , Adult , Cystitis/diagnosis , Urinary Bladder Neoplasms/diagnosis , BCG Vaccine/therapeutic use , Cystitis/drug therapy摘要
Emphysematous cystitis is a rare form of acute infection of the bladder is which most cases are seen in diabetic patients. Most infections are due to E.coli and Klebsiella species. Predisposing factors are diabetes mellitus, recurrent urinary tract infections, bladder outlet obstruction and neurogenic bladder. CT-scan is the most sensitive method of diagnosis that detects air whithin intramular of bladder that is pathogonomonic of the disease. In this case report we reported two cases of emphysematous cystitis. The first case was a 73 years old diabetic woman who was admitted due to acute renal failure after cholecystectomy. During hospitalization, after remission of renal function, she developed fever, abdominal pain, hematuria and progressive abdominal distention. In physical examination she had generalized abdominal tenderness with dominance in the lower abdomen without rebound tenderness which with observation of air in intramural bladder by CT-scan, diagnosis of emphysematous cystitis was confirmed and the patient was treated and improved. The second case was a 37 years old diabetic woman. She was refered to the hospital because of nausea, recurrent vomiting and abdominal pain. In physical examination she had severe hypotention, generalized abdominal tenderness that was dominant in the lower abdomen and abdominal mass in suprapubic area. Suspicious to emphysematous cystitis, pelvic CT-scan was ordered. By observation of air in intramural bladder, emphysematous cystitis was confirmed. Patient was treated with antibiotic, insertion of fouly catheter and was improved. Undiagnosing or delaying in initiating appropriate treatment can lead to peritonitis secondary to intraperitoneal perforation of the bladder, septisemia and ultimately death of the patient. Timely diagnosis and aggressive therapy are important for the survival of these patients