RESUMEN
OBJECTIVE: Chronic trigonitis (CT) is usually diagnosed through cystoscopy which is invasive and expensive. Thus, an accurate non-invasive diagnostic method is necessary. The objective of this study is to determine the efficacy of transvaginal bladder ultrasound (TBU) for CT diagnosis. METHODS: Between 2012 and 2021, 114 women (17-76 years old) with recurrent urinary tract infection (RUTI) and history of antibiotic resistance were evaluated with TBU by a single ultrasonographer. As a control group, TBU was performed in 25 age-matched women with no previous history of UTI, urological or gynecological conditions. All patients with RUTI had undergone a cystoscopy with biopsy for diagnostic confirmation at the time of trigone cauterization. RESULTS: Thickening of trigone mucosa (>3 mm) was detected in all patients with RUTI and represented the most relevant criteria for trigonitis diagnosis on TBU. Other TBU findings in CT are: irregular and interrupted mucosa lining (96.4%), free debris in the urine (85.9%), increased blood flow at doppler (81.5%), mucosa shedding and tissue flaps. Biopsy showed CT with erosive pattern (58%) or non-keratinizing metaplasia (42%). Diagnostic agreement index between TBU and cystoscopy was 100%. In the control group, normal trigone mucosa is ultrasonographically regular, continuous, with thickness ≤3 mm and there is no debris in the urine. CONCLUSIONS: TBU proved to be an efficient, inexpensive and minimally invasive method to diagnose CT. To our knowledge, this is the first article that reports the use of transvaginal ultrasound as an alternative method for diagnosing trigonitis.
Asunto(s)
Cistitis , Infecciones Urinarias , Humanos , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Vejiga Urinaria/patología , Infecciones Urinarias/patología , Cistoscopía , UltrasonografíaRESUMEN
BACKGROUND: Uropathogenic Escherichia coli (UPEC) are frequent pathogens worldwide, impacting on the morbidity and economic costs associated with antimicrobial treatment. OBJECTIVES: We report two novel mutations associated with polymyxin-B resistance in an UPEC isolate collected in 2019. METHODS: Isolate was submitted to antimicrobial susceptibility testing including broth microdilution for polymyxin B. Whole genome was sequenced and analyzed. RESULTS: Polymyxin-B total inhibition occurred at 16 mg/L (resistant). UPEC isolate was assigned to the phylogroup D, serotype O117:H4, and Sequence Type 69. mcr genes were not detected, but two novel mutations in the pmrA/basS (A80S) and pmrB/basR (D149N) genes were identified. CONCLUSIONS: The occurrence of non-mcr polymyxin resistance in E. coli from extraintestinal infections underscores the need of a continuous surveillance of this evolving pathogen.
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Proteínas Bacterianas/genética , Farmacorresistencia Bacteriana Múltiple/genética , Factores de Transcripción/genética , Escherichia coli Uropatógena/genética , Antibacterianos/farmacología , Humanos , Mutación , Filogenia , Polimixina B/farmacología , Infecciones Urinarias/microbiología , Infecciones Urinarias/patología , Escherichia coli Uropatógena/clasificación , Escherichia coli Uropatógena/efectos de los fármacos , Escherichia coli Uropatógena/aislamiento & purificaciónRESUMEN
Urinary tract infection (UTI) is one of the most frequent bacterial infection in pediatrics. However, its diagnosis and management can be complicated due to the nonspecific clinical presentation, the difficulty of exams interpretation, especially in younger children, and an uncertain prognosis regar ding renal damage. In recent years, significant worldwide change has come in treatment, diagnosis, and images studies, we have decided to update the current recommendations on UTI management published by the Pediatric Nephrology branch of Chilean Pediatrics Society in previous years. The purpose of these recommendations is to reduce the variability of clinical practice in management of UTI in our pediatric population, favoring diagnostic and therapeutic interventions in the most ap propriate way, improving detection and management of structural pathology and other risk factors of renal damage, avoiding unnecessary actions in children with low risk. This first part includes diag nosis and treatment recommendations of urinary tract infection in pediatric age. In the second part the study, prevention and monitoring of urinary tract in pediatric age is detailed.
Asunto(s)
Infecciones Urinarias/diagnóstico , Infecciones Urinarias/terapia , Adolescente , Antibacterianos/uso terapéutico , Niño , Preescolar , Chile , Hospitalización , Humanos , Lactante , Recién Nacido , Nefrología , Pediatría , Sociedades Médicas , Infecciones Urinarias/patología , Infecciones Urinarias/fisiopatologíaRESUMEN
Resumen: La infección del tracto urinario (ITU) es una de las infecciones bacterianas mas frecuentes en la edad pediátrica, pero su diagnóstico y manejo se pueden ver complicados por lo inespecífico de sus sín tomas y signos de presentación, la dificultad en la interpretación de los exámenes, especialmente en niños mas pequeños, y por un pronóstico respecto a daño renal muchas veces incierto. En los últimos años, se ha evidenciado una modificación significativa en el enfoque diagnostico y terapéutico de esta patología, surgiendo la necesidad de actualizar las recomendaciones previas. El propósito de esta re vision es contribuir a reducir la variabilidad de la práctica clínica en el manejo de ITU en la población pediátrica, mejorando la detección y manejo de la patología estructural y otros factores de riesgo de daño renal, evitando acciones innecesarias en aquellos niños con bajo riesgo. En esta primera parte, se presentan las recomendaciones en cuanto a diagnóstico y manejo de la ITU en pediatría. En la segunda parte se detalla su estudio, prevención y seguimiento.
Abstract: Urinary tract infection (UTI) is one of the most frequent bacterial infection in pediatrics. However, its diagnosis and management can be complicated due to the nonspecific clinical presentation, the difficulty of exams interpretation, especially in younger children, and an uncertain prognosis regar ding renal damage. In recent years, significant worldwide change has come in treatment, diagnosis, and images studies, we have decided to update the current recommendations on UTI management published by the Pediatric Nephrology branch of Chilean Pediatrics Society in previous years. The purpose of these recommendations is to reduce the variability of clinical practice in management of UTI in our pediatric population, favoring diagnostic and therapeutic interventions in the most ap propriate way, improving detection and management of structural pathology and other risk factors of renal damage, avoiding unnecessary actions in children with low risk. This first part includes diag nosis and treatment recommendations of urinary tract infection in pediatric age. In the second part the study, prevention and monitoring of urinary tract in pediatric age is detailed.
Asunto(s)
Humanos , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/terapia , Pediatría , Sociedades Médicas , Infecciones Urinarias/fisiopatología , Infecciones Urinarias/patología , Chile , Hospitalización , Antibacterianos/uso terapéutico , NefrologíaRESUMEN
A 65-year-old male with a history of urinary tract trauma requiring cystotomy and chronic bladder catheterization, presenting with chronic and uninvestigated changes in the color of the urine bag system, with no urine color change, and positive urine culture for Proteus mirabilis . These characteristics refer to the purple urine bag syndrome, a not weel-known condition, with a benign course in most cases, and associated with urinary tract infection in patients with chronic bladder catheterization. Although it is characterized by marked changes, it is underdiagnosed by healthcare professionals.
Asunto(s)
Infecciones Relacionadas con Catéteres/microbiología , Reservorios Urinarios Continentes/efectos adversos , Infecciones Urinarias/microbiología , Anciano , Infecciones Relacionadas con Catéteres/patología , Humanos , Masculino , Proteus mirabilis/aislamiento & purificación , Factores de Riesgo , Síndrome , Infecciones Urinarias/patología , Orina/microbiologíaRESUMEN
ABSTRACT A 65-year-old male with a history of urinary tract trauma requiring cystotomy and chronic bladder catheterization, presenting with chronic and uninvestigated changes in the color of the urine bag system, with no urine color change, and positive urine culture for Proteus mirabilis . These characteristics refer to the purple urine bag syndrome, a not weel-known condition, with a benign course in most cases, and associated with urinary tract infection in patients with chronic bladder catheterization. Although it is characterized by marked changes, it is underdiagnosed by healthcare professionals.
RESUMO Homem de 65 anos com história de trauma do sistema urinário, sendo necessário cistotomia e sondagem vesical crônica, apresentando alterações crônicas e não investigadas da cor do sistema coletor de urina, sem alteração da cor da urina, e urocultura positiva para Proteus mirabilis . Tais características remetem à síndrome do saco coletor de urina roxo, uma entidade pouco conhecida, de curso benigno na maioria da vezes, associada à infecção urinária em paciente com cateterismo vesical de demora. Embora seja caracterizada por alterações marcantes, é subdiagnosticada pelos profissionais de saúde.
Asunto(s)
Humanos , Masculino , Anciano , Infecciones Urinarias/microbiología , Reservorios Urinarios Continentes/efectos adversos , Infecciones Relacionadas con Catéteres/microbiología , Proteus mirabilis/aislamiento & purificación , Síndrome , Infecciones Urinarias/patología , Orina/microbiología , Factores de Riesgo , Infecciones Relacionadas con Catéteres/patologíaRESUMEN
INTRODUCTION: Streptococcus agalactiae (group B streptococcus, GBS) is a recognized urinary pathogen both in males and pregnant or non-pregnant women. Data regarding GBS serotypes recovered from urinary tract infections (UTIs) are scarce. The aim of this study was to describe the clinical and microbiological characteristics of UTIs caused by GBS in adult patients in Argentina. METHODOLOGY: A prospective multicenter study involving 86 centers was conducted in Argentina between July 1st, 2014 and June 30th, 2015. Antimicrobial susceptibility and serotype distribution of GBS isolated from the urinary tract of adult patients were determined. Susceptibility tests were performed by the disk diffusion and/or agar dilution methods. Epidemiological and clinical characteristics of the patients were considered to identify associated comorbilities. RESULTS: Seven hundred and one GBS were sent to the reference laboratory in the above mentioned period, however, only 211 fulfilled our selection criteria (demographic data availability, underlying diseases reported, colony counts greater than 105 CFU/mL, single organism isolated from the urine sample). No penicillin-resistant GBS was found but fluoroquinolone resistance was high (12.8%), especially among GBS isolated from men and non-pregnant women. UTIs due to GBS were associated to underlying diseases in men and non-pregnant women, particularly diabetes mellitus. Most of the isolates showed serotypes Ia and III. CONCLUSIONS: GBS are still susceptible to penicillin but fluoroquinolone resistance is a growing concern, at least in Argentina. There are underlying conditions that could be associated to urinary infections caused by GBS.
Asunto(s)
Infecciones Estreptocócicas/epidemiología , Streptococcus agalactiae/aislamiento & purificación , Infecciones Urinarias/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Argentina/epidemiología , Farmacorresistencia Bacteriana , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Estudios Prospectivos , Serotipificación , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/patología , Infecciones Urinarias/microbiología , Infecciones Urinarias/patología , Adulto JovenRESUMEN
Extraintestinal pathogenic Escherichia coli (ExPEC) is responsible for various infections outside the gastrointestinal tract in humans and other animals. ExPEC strain MT78 is invasive to various nonphagocytic cells and highly virulent in vivo To identify genes required for invasion of nonphagocytic cells by this strain, we applied signature-tagged mutagenesis to generate a library of mutants and tested them for invasion of avian fibroblasts. Mutants showing reduced cellular invasion included those with insertions in the fim operon, encoding type 1 fimbriae. Another attenuated mutant showed a disruption in the treA gene, which encodes a periplasmic trehalase. The substrate of TreA, trehalose, can be metabolized and used as a carbon source or can serve as an osmoprotectant under conditions of osmotic stress in E. coli K-12. We generated and characterized mutant MT78ΔtreA In contrast to the wild type, MT78ΔtreA was able to grow under osmotic stress caused by 0.6 M urea but not in minimal M9 medium with trehalose as the only carbon source. It presented decreased association and invasion of avian fibroblasts, decreased yeast agglutination titer, and impaired type 1 fimbria production. In a murine model of urinary tract infection, MT78ΔtreA was less able to colonize the bladder. All phenotypes were rescued in the complemented mutant. Our results show that the treA gene is needed for optimal production of type 1 fimbriae in ExPEC strain MT78 and that loss of treA significantly reduces its cell invasion capacity and colonization of the bladder in a murine model of urinary tract infection.
Asunto(s)
Infecciones por Escherichia coli/patología , Escherichia coli Patógena Extraintestinal/enzimología , Escherichia coli Patógena Extraintestinal/patogenicidad , Fimbrias Bacterianas/metabolismo , Proteínas Periplasmáticas/metabolismo , Trehalasa/metabolismo , Factores de Virulencia/metabolismo , Animales , Aves , Células Cultivadas , Medios de Cultivo/química , Modelos Animales de Enfermedad , Endocitosis , Infecciones por Escherichia coli/microbiología , Escherichia coli Patógena Extraintestinal/genética , Escherichia coli Patógena Extraintestinal/crecimiento & desarrollo , Fibroblastos/microbiología , Fimbrias Bacterianas/genética , Eliminación de Gen , Prueba de Complementación Genética , Ratones Endogámicos CBA , Mutagénesis , Proteínas Periplasmáticas/genética , Trehalasa/genética , Vejiga Urinaria/microbiología , Infecciones Urinarias/microbiología , Infecciones Urinarias/patología , Virulencia , Factores de Virulencia/genéticaRESUMEN
To evaluate the pathophysiology of catheter-associated candiduria, the bladders of female mice were infected with Candida tropicalis. One group was implanted with a catheter fragment with preformed biofilm by cystotomy technique, while another group received, in separate, a sterile catheter fragment and a correspondent yeast suspension. The bladder tissues were examined by histopathology and the quantity of colony forming units was evaluated. All the animals presented inflammation and the presence of C. tropicalis was observed in the tissue within 72â¯h of the introduction of biofilm, while 75% of the mice remained infected after 144â¯h. However, only 50% of animals from the group infected with C. tropicalis in suspension (planktonic yeasts), exhibited such signs of infection over time. The cystotomy technique is therefore viable in mice, and is an effective model for evaluating the pathogenesis of candiduria from catheter biofilms. The model revealed the potential of C. tropicalis infectivity and demonstrated more effective evasion of the host response in biofilm form than the planktonic yeast.
Asunto(s)
Biopelículas/crecimiento & desarrollo , Candida tropicalis/patogenicidad , Candidiasis/microbiología , Modelos Animales de Enfermedad , Infecciones Urinarias/microbiología , Animales , Candidiasis/inmunología , Candidiasis/patología , Recuento de Colonia Microbiana , Cistotomía/métodos , Femenino , Interacciones Huésped-Patógeno/inmunología , Evasión Inmune , Inflamación/microbiología , Inflamación/patología , Ratones , Ratones Endogámicos BALB C , Factores de Tiempo , Vejiga Urinaria/microbiología , Vejiga Urinaria/patología , Catéteres Urinarios/microbiología , Infecciones Urinarias/inmunología , Infecciones Urinarias/patologíaRESUMEN
OBJECTIVE: This is a random blinded placebo controlled murine experimental model to study the effects of Cantharis 6 CH, a homeopathic medicine, on E coli-induced cystitis. METHODS: 24 adult susceptible female BALB/c mice were inoculated with E coli - UPEC O4:K-:H5 by a transurethral catheter. Cantharis 6cH or vehicle (placebo) was offered to mice by free access into the drinking water (1:100), during 24 h after infection. Spleen, bladder and kidneys were processed for quantitative histopathology after immunohistochemistry, using anti-CD3, CD79, MIF, NK and VEGF antibodies; the cytokines present in the bladder washing fluid were measured using a LUMINEX-Magpix KIT. Mann-Whitney and Fisher exact test were used as statistical analysis. RESULTS: Cantharis 6 CH increased IL12p40, IFN-γ and decreased IL10 concentrations in the bladder fluid (p⩽0.05); in the bladder mucosa, it increased the ratio between B and T lymphocytes (31%) and between B lymphocytes and MIF+ macrophages (57%, p⩽0.05). In the pelvis, instead, it decreased the B/T cells ratio (41%, p⩽0.05) and increased the M1/M2 macrophage ratio (42%, p⩽0.05). No differences were seen in the kidney and spleen analysis. CONCLUSION: The inverted balance of inflammatory cells and cytokines in bladder and pelvis mucosa shows specific local immune modulation induced by Cantharis 6cH.
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Cistitis/tratamiento farmacológico , Infecciones por Escherichia coli/tratamiento farmacológico , Materia Medica/farmacología , Infecciones Urinarias/tratamiento farmacológico , Escherichia coli Uropatógena/inmunología , Animales , Cistitis/inmunología , Cistitis/microbiología , Cistitis/patología , Citocinas/inmunología , Infecciones por Escherichia coli/inmunología , Infecciones por Escherichia coli/patología , Femenino , Ratones , Ratones Endogámicos BALB C , Infecciones Urinarias/inmunología , Infecciones Urinarias/patologíaRESUMEN
A 71-year-old woman in a nursing home, with indwelling urinary catheter, bedridden, presented with a purple urine collector bag. The purple urine bag syndrome is a rare condition associated with the metabolism of tryptophan by overgrowth of intestinal bacteria. The purple color is formed by a combination of indigo and indirubin produced as a result of phosphatase and sulfatase enzymatic activity of bacteria on indoxyl sulfate, under alkaline pH of the urine. We present the second case of this syndrome reported in Colombia detailing the management of this rare syndrome associated with urinary tract infection. Several conditions should be considered in the differential diagnose of diseases that cause discoloration of the urine.
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Infecciones Bacterianas/diagnóstico , Infecciones Relacionadas con Catéteres/diagnóstico , Fenómenos Químicos , Pigmentos Biológicos/análisis , Infecciones Urinarias/diagnóstico , Orina/química , Anciano , Antibacterianos/uso terapéutico , Infecciones Bacterianas/patología , Infecciones Relacionadas con Catéteres/patología , Ciprofloxacina/uso terapéutico , Colombia , Color , Diagnóstico Diferencial , Enterococcus faecalis/aislamiento & purificación , Escherichia coli/aislamiento & purificación , Femenino , Humanos , Concentración de Iones de Hidrógeno , Proteus mirabilis/aislamiento & purificación , Resultado del Tratamiento , Infecciones Urinarias/patologíaAsunto(s)
Humanos , Masculino , Femenino , Niño , Pediatría , Infecciones Urinarias/etiología , Infecciones Urinarias/patología , Uruguay , Epidemiología DescriptivaRESUMEN
New Delhi metallo-ß-lactamase 1 (NDM-1) was first identified in Brazil in Enterobacter hormaechei and Providencia rettgeri in 2013. Here, we describe the first case of NDM-1-producing Acinetobacter baumannii sequence type 25 isolated from the urinary tract of a 71-year-old man who died of multiple complications, including A. baumannii infection. The NDM-1 gene was detected by quantitative PCR, and its sequence confirmed its presence in an â¼ 100-kb plasmid.
Asunto(s)
Acinetobacter baumannii/genética , Plásmidos/química , Resistencia betalactámica/genética , beta-Lactamasas/genética , Infecciones por Acinetobacter/tratamiento farmacológico , Infecciones por Acinetobacter/microbiología , Infecciones por Acinetobacter/patología , Acinetobacter baumannii/efectos de los fármacos , Acinetobacter baumannii/enzimología , Acinetobacter baumannii/aislamiento & purificación , Anciano , Antibacterianos/farmacología , Técnicas de Tipificación Bacteriana , Brasil , Resultado Fatal , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Plásmidos/metabolismo , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiología , Infecciones Urinarias/patología , beta-Lactamasas/metabolismoRESUMEN
OBJECTIVE: To check whether subtle voiding dysfunction is related to recurrent urinary tract infection (rUTI). METHODS: 254 consecutive patients with at least four episodes of urinary tract infection (UTI) were studied. At least three repeat urodynamic evaluations with an additional ice water test to maximize the detection of involuntary detrusor contraction (IDC) were used. Stress urinary incontinence cases were used as controls. Nonparametric univariate and multivariate analyses were used for statistics. RESULTS: IDC was detected in 83.6% of patients in the rUTI group and in 31.7% in the control group. IDC was <15 cm H2O in 54.7% whereas high-amplitude (>50 cm H2O) IDC was observed in 6.8% in the rUTI group. Female urinary tract obstruction was diagnosed in 16.8% of patients in the rUTI group and in 7.9% in the control group. Residual volume, PdetQmax and Qmax were not predictive of UTI recurrence. Symptoms were similar in both groups. CONCLUSIONS: Patients with rUTI present with covert bladder dysfunctions represented by detrusor overactivity.
Asunto(s)
Vejiga Urinaria Hiperactiva/patología , Vejiga Urinaria/patología , Infecciones Urinarias/patología , Adulto , Femenino , Humanos , Persona de Mediana Edad , Análisis Multivariante , Contracción Muscular , Músculo Liso/fisiopatología , Estudios Prospectivos , Recurrencia , Encuestas y Cuestionarios , Incontinencia Urinaria de Esfuerzo/fisiopatología , Trastornos Urinarios/fisiopatología , Urodinámica , AguaRESUMEN
Las litiasis vesicales de gran tamaño son infrecuentes. Se manifiestan clínicamente por sepsis urinaria a repetición, polaquiuria y estranguria. Se presenta un nuevo caso de litiasis vesical gigante, así como aspectos de su diagnóstico y tratamiento. La paciente de 64 años de edad, asistió a la consulta y refirió padecer de infecciones urinarias reiteradas, incontinencia por urgencia miccional y dolor posmiccional en hipogastrio y uretra. Tenía el antecedente de haber sido operada, siete meses atrás, de un prolapso uterino total por vía vaginal. En el cultivo de orina se aisló Escherichia coli y, en el ultrasonido abdominal, se detectó una litiasis vesical de gran tamaño, la cual se confirmó en la radiografía simple de la pelvis. Se le realizó la cistolitotomía retropúbica, extrayéndose una litiasis de 9 x 6 x 5 cm de tamaño y 186 g de peso. La paciente evolucionó favorablemente con la desaparición total de los síntomas. La litiasis vesical gigante es rara, pero se debe sospechar en pacientes con síntomas urinarios sépticos e irritativos bajos persistentes. El ultrasonido del tracto urinario y la radiografía simple de la pelvis, son suficientes para establecer el diagnóstico de certeza. La cistolitotomía continúa siendo el tratamiento de elección de esta afección(AU)
Giant bladder calculi are uncommon. Their clinical manifestations are recurrent urinary sepsis, polachiuria and strangury. A new case is presented of giant bladder calculus, as well as aspects of its diagnosis and treatment. A 64-year-old female patient attended consultation and stated that she suffered from recurrent urinary infection, urinary urgency incontinence and hypogastric and urethral post-miction pain. Seven months before she had undergone surgery for total uterine prolapse via the vagina. Escherichia coli was isolated from the urine culture, and abdominal ultrasonography revealed a large bladder calculus, which was confirmed by simple pelvic radiography. Retropubic cystolithotomy resulted in the removal of a 9 x 6 x 5 cm, 186 g calculus. The patient evolved favorably with total disappearance of all symptoms. Giant bladder calculus is a rare condition which should be suspected in patients with persistent irritative symptoms of lower urinary sepsis. Urinary-tract ultrasonography and simple pelvic radiography are sufficient to establish the certainty diagnosis. Cystolithotomy continues to be the treatment of choice for this condition(AU)
Asunto(s)
Humanos , Femenino , Anciano , Cálculos de la Vejiga Urinaria/diagnóstico , Cálculos de la Vejiga Urinaria/terapia , Cálculos de la Vejiga Urinaria/cirugía , Infecciones Urinarias/patología , Infecciones Urinarias , UltrasonografíaRESUMEN
Diseases caused by extraintestinal pathogenic Escherichia coli (ExPEC) in wild felids are rarely reported. Although urinary tract infections are infrequently reported in domestic cats, such infections when present are commonly caused by ExPEC. The present work characterized ExPEC strains isolated from 2 adult felines, a snow leopard (Panthera uncia) and a black leopard (Panthera pardus melas), that died from secondary bacteremia associated with urinary tract infections. Isolates from both animals were classified into the B2 phylogenetic group and expressed virulence genotypes that allowed them to cause severe disease. In addition, strains from the black leopard showed multidrug resistance.
Asunto(s)
Bacteriemia/veterinaria , Infecciones por Escherichia coli/veterinaria , Felidae , Infecciones Urinarias/veterinaria , Animales , Animales de Zoológico , Antibacterianos/uso terapéutico , Bacteriemia/microbiología , Enrofloxacina , Infecciones por Escherichia coli/microbiología , Resultado Fatal , Femenino , Fluoroquinolonas/uso terapéutico , Masculino , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiología , Infecciones Urinarias/patologíaRESUMEN
OBJECTIVES: To evaluate lower urinary tract dysfunction (LUTD) based on questionnaire symptom scoring and ultrasound assessment of bladder wall thickness (BWT) in children with cerebral palsy (CP). METHODS: A total of 97 children with CP were enrolled in the study. The patients were either symptomatic or asymptomatic with respect to lower urinary tract symptoms. All children underwent a urinary questionnaire and renal ultrasonography. Ultrasound assessment of BWT was completed in 72 cases. RESULTS: A total of 47 patients were female and 50 were male. The mean age was 8 years 8 months (SD 3 years 1 month), with a range of 5-18 years. Urinary incontinence was present in 43 patients (44.3%). Based on the questionnaire, LUTD was found in 59 patients (60.8%). The mean BWT was 2.30 mm. There was no statistically significant difference between continent and incontinent children (2.46 vs 2.19 mm) or between children with and without LUTD (2.43 vs 2.12 mm). CONCLUSIONS: LUTD is common in children with CP and occurred in 60.8% of the patients assessed. BWT did not correlate with the presence of bladder dysfunction or incontinence. Ultrasound assessment of BWT was not relevant for diagnosis of lower urinary tract dysfunction.
Asunto(s)
Parálisis Cerebral/complicaciones , Vejiga Urinaria/diagnóstico por imagen , Trastornos Urinarios/etiología , Adolescente , Parálisis Cerebral/patología , Niño , Preescolar , Estreñimiento/etiología , Estreñimiento/patología , Femenino , Humanos , Riñón/diagnóstico por imagen , Masculino , Paraplejía/etiología , Cuadriplejía/etiología , Índice de Severidad de la Enfermedad , Ultrasonografía , Infecciones Urinarias/diagnóstico por imagen , Infecciones Urinarias/etiología , Infecciones Urinarias/patología , Trastornos Urinarios/diagnóstico por imagen , Trastornos Urinarios/patologíaRESUMEN
OBJECTIVE: To examine acute lobar nephronia (ALN) in the spectrum of upper urinary tract infections between acute pyelonephritis (APN) and renal abscess. STUDY DESIGN: Medical records of 115 patients diagnosed with APN, ALN, or renal abscess with computed tomography (CT) were reviewed retrospectively. CT lesions and patterns of ALN were checked, and the volume of CT lesions was estimated in every patient. Then the correlation between clinical presentation and CT lesions was examined. RESULTS: The study included 21 patients with APN, 85 with ALN (63 simple ALN, 22 complicated ALN), and 9 with renal abscesses. The volume fraction of CT lesions correlated well with duration of fever before and after treatment in patients with APN or simple ALN, and only the correlation between fever duration after treatment and CT lesions was significant in patients with complicated ALN or renal abscess. CONCLUSIONS: We suggest that simple ALN be regarded clinically as the progression of APN. By contrast, complicated ALN is a distinct, more severe disease entity, and it may relate to or progress to renal abscess. ALN is probably not the midpoint in the traditional dynamic spectrum of upper urinary tract infections between APN and renal abscess.