RESUMO

Urinary tract infection (UTI) is one of the most common bacterial infections among humans. Urine culture is the gold standard diagnostic method for UTI; however, the dipstick test for nitrite is a widely used method signalling the presence of urinary nitrate-reducing bacteria. Unlike the gold standard, the dipstick test is easy to perform, while it is also less time-consuming and less expensive, and produces a result in a few minutes. This study investigates the sensitivity of the dipstick test for nitrite compared with the Griess test in urine samples from UTI caused by Enterobacterales species. We used the Griess test, which is the gold standard in nitrite measurement, to determine the sensitivity of the nitrite dipstick test. Semiquantitative urine culture was performed using standard procedures, and Enterobacterales identification was performed by manual conventional biochemical tests. In the first sample selection, 3 % (8/267) of urine samples suspected of UTI, analysed from March to April 2016, were nitrite-negative by dipstick test but positive for Enterobacterales in the urine culture. In the second sample selection, 5 % (2/44) of urine samples from October to December 2022 were also nitrite-negative but showed urine Enterobacterales isolation. All nitrite-negative dipstick results were consistent with the Griess test. Escherichia coli was the most prevalent bacterium, followed by Klebsiella pneumoniae, independent of sample selection. The dipstick test is a safe alternative for investigating nitrite in urine samples. We believe that the cause of nitrite-negative results is a lack of dietary nitrate, dilution of urine and exogenous interference (e.g. ascorbic acid). These findings support the idea that standard urine culture is necessary to rule out UTI.

Assuntos

RESUMO

Streptococcus pneumonia is an important human pathogen, which causes invasive pneumococcal diseases including pneumonia, meningitis and bloodstream infections. Responsible for high rates of child morbidity and mortality, especially in developing countries. Early diagnosis is important to lead an appropriate treatment. Strip-based immunochromatographic tests, or dipstick tests are fast, cheap, have good specificity, simple interpretation and performance. Thus, they correspond to the great alternative to conventional tests, especially in developing countries. This kind of test intends to detect the presence or absence of target analytes, such as bacterial antigens. In this study, monoclonal antibodies and conjugation methods were evaluated with two colored markers: dyed colloidal microspheres with carboxyl groups on their surface and colloidal gold nanoparticles. Monoclonal antibodies chose for conjugation were anti-pneumolysin (Ply) and anti-pneumococcus surface protein A (PspA). Anti-Ply polyclonal sera and anti-whole cell pneumococcal vaccine (WCPV) were used as capture antibodies. The best results were obtained with colloidal gold nanoparticles, in which bacterial antigens were detected in bacterial 107 a 104 CFU/mL samples and culture supernatant of S. pneumoniae serotype 9V, one of the most prevalent serotypes. The results were obtained between 10-20 minutes. The assessed dipstick can be considered as a promising sensitive and fast detection tool for antigens of S. pneumoniae.

Streptococcus pneumoniae é um importante patógeno humano, causador de doenças pneumocócicas invasivas que incluem pneumonia, meningite e bacteremia. Responsável por alta taxa de morbimortalidade infantil, sobretudo em países em desenvolvimento. O diagnóstico rápido é importante para condução de tratamento adequado. Testes imunocromatográficos baseados em tira, ou testes de dipstick são rápidos, baratos, têm boa especificidade, dotados de simples interpretação e realização. Dessa forma, correspondem a ótima alternativa a testes convencionais, principalmente em países em desenvolvimento. Detectam a presença ou ausência de analitos alvos, como antígenos bacterianos. Neste estudo, foram avaliados anticorpos monoclonais e métodos de conjugação com dois marcadores coloridos: microesferas coloidais coloridas com grupos carboxila em sua superfície e nanopartículas de ouro coloidal. Os anticorpos monoclonais escolhidos para conjugação foram anti-pneumolisina (Ply) e anti-proteína A de superfície de pneumococo (PspA). Foram utilizados como anticorpos de captura soros policlonais anti-Ply e anti-vacina pneumocócica celular (WCPV). A melhor conjugação foi obtida com nanopartículas de ouro coloidal, com detecção de antígenos bacterianos presentes em amostras bacterianas 107 a 104 UFC/mL, e em sobrenadante de cultivo de S. pneumoniae sorotipo 9V, um dos sorotipos mais prevalentes. Os resultados foram obtidos em 10-20 minutos. O dipstick avaliado pode ser considerado promissora ferramenta de detecção sensível e rápida de antígenos de S. pneumoniae.

RESUMO

Introducción: Los objetivos de este trabajo son: presentar los métodos de estudio de las infecciones urinarias actualmente disponibles en el Laboratorio de Microbiología del Hospital de Clínicas y mostrar los datos de los urocultivos evaluados en forma retrospectiva. Materiales y Métodos: Para estudiar los métodos de estudio de los urocultivos disponibles en el Laboratorio hemos recurrido al archivo del Laboratorio cuyos datos fueron consecutivamente cargados en una planilla de procesamiento de datos Excel de Microsoft Office ®. Los resultados de los urocultivos fueron evaluados de enero de 2015 a agosto de 2016, en forma retrospectiva, observacional, en corte transverso, de los adultos de ambos sexos. Las muestras para urocultivo son recibidas y procesadas en el laboratorio, siguiendo pasos preestablecidos. Resultados: El microorganismo preponderante de los urocultivos fue Escherichia coli (60% de las mujeres y 32% de los varones) seguido por Klebsiella pneumoniae (19% de los varones, 14% de las mujeres). Otros microorganismos aislados fueron Candida sp., Enterococcus faecalis, Enterobacter cloacae, Pseudomona aeruginosa, Proteus mirabilis, Staphylococcus aureus, Acinetobacter baumanii. La resistencia de Escherichia Coli a nitrofurantoína fue del 6% en los varones y 1% en las mujeres. La resistencia de E.Coli a meropenen fue también escasa. En cuanto a Klebsiella pneumoniae en las mujeres, la resistencia fue del 3%. En los hombres, los antibióticos testados para Klebsiella pneumoniae mostraron una resistencia superior al 30%, con excepción del meropenem. Uropatógenos productores de betalactamas de espectro extentido (BLEE) y de carbapenemasas fueron detectados en el presente estudio. Discusión: La toma de la orina para el urocultivo se efectúa siguiendo pautas claras, emanadas del laboratorio. Con la utilización de medios actualmente disponibles en el laboratorio, es posible tipificar el género y la especie tanto de bacterias Gram negativas y positivas como de hongos. Conclusión: La estructura del Laboratorio de Microbiología ha tenido avances que permiten la identificación precisa de los gérmenes de los urocultivos, así como la prevalencia y la resistencia que presentan a ciertos antibióticos. Estos aportes son particularmente útiles para los casos de Escherichia coli y Klebsiella pneumoniae debido a su alta prevalencia. También fue factible constatar la emergencia de gérmenes productores de betalactamasas de espectro extendido (BLEE) y carbapenemasas.

Introduction: The objectives of this work are: to present the methods of study of urinary infections currently available in the Laboratory of Microbiology of the Hospital de Clínicas and to show the data of the urine cultures evaluated retrospectively. Material and method: in order to study the available methods in urine cultures in the Laboratory, we have used the laboratory file whose data were consecutively loaded in an Excel data processing form of Microsoft Office ®. The results of the urine cultures were evaluated from January 2015 to August 2016, in a retrospective, observational, cross-sectional study of adults of both sexes. Samples for urine culture are received and processed in the laboratory, following pre-established steps. Results: The predominant microorganisms were Escherichia coli in 60% of women and 32%of men, Klebsiella pneumonia 19% of men and 14% of women. Other isolated organisms were Candida sp., Enterococcus faecalis, Enterobacter cloacae, Pseudomonas aeruginosa, Proteus mirabilis, Staphylococcus aureus, and Acinetobacter baumanii. Escherichia coli resistance to nitrofurantoin was seen in 6% of men and 1% of women and meropenem resistance to E. coli was also low. As for Klebsiella pneumoniae in women, resistance to meropenem was seen in 3% of cases. In men, the antibiotics tested for Klebsiella pneumoniae showed resistance greater than 30% except for meropenem. Uropathogens producing Extended-Spectrum -lactamase (ESBL ) and Carbapenemase were found. Discussion: Urine collection for urine culture is done following clear guidelines emanating from the laboratory. With the use of media currently available in the laboratory, it is possible to typify the genus and species of both Gram negative and positive bacteria as well as fungi. Conclusion: The structure of the Laboratory of Microbiology has had advances that allow the precise identification of the germs of the urine cultures, as well as the prevalence and resistance to certain antibiotics. These contributions are particularly useful for the cases of Escherichia coli and Klebsiella pneumoniae due to their high prevalence. It was also possible to verify the emergence of spread spectrum beta-lactamases (ESBL) and carbapenemases.

RESUMO

OBJECTIVES: To compare the Multistix 10SG/visual-read with two automated methods (Multistix 10SG/Clinitek 50 and Chemstrip 10A/Urisys 1100) to detect significant proteinuria among high-risk pregnant women. STUDY DESIGN: Prospective cohort study at British Columbia Women's Hospital & Health Centre, Vancouver, Canada. MAIN OUTCOME MEASURES: Diagnostic accuracy determined by sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-). RESULTS: 303 (89.6%) of 338 women had a urine sample tested by all three dipstick methods. 196 samples (64.7%) were collected in the morning (subsequent to their first void) and from outpatients. 107 samples (35.3%) were from inpatients at various times throughout the day. A PrCr ⩾30mg/mmol was present in 46 (15.2%) samples. The sensitivity for proteinuria was higher with Multistix 10SG/Clinitek 50 (65.2%) than with Multistix 10SG/visual-read (41.3%, p<0.001) or Chemstrip 10A/Urisys 1100 (54.3%, p=0.06). Specificity was >90% for all methods studied, although it was highest for Multistix 10SG/visual-read (98.4%) compared with either Multistix 10SG/Clinitek 50 (92.6%, p<0.001) or Chemstrip 10A/Urisys 1100 (95.7%, p=0.04). For all methods, LR+ was good-excellent (>5), but LR- poor-fair (>0.20). 29 samples were discordant for proteinuria between methods. 28/29 women had negative proteinuria by Multistix 10SG/visual-read, but at least 1+ proteinuria by an automated method; 17/28 were false positives and 11/28 true positives. CONCLUSIONS: Automated dipstick methods are more sensitive than visual urinalysis for proteinuria, but test performance is still only poor-fair as a 'rule-out' test for proteinuria. Whether the enhanced sensitivity would be worth the false positives, cost, and personnel training remains to be determined for detection of low-level proteinuria in pregnancy.

Assuntos

RESUMO

Hematúria enzoótica bovina é causada principalmente pela ingestão crônica de samambaia e ainda é considerada uma importante causa de perdas econômicas em rebanhos de corte, especialmente em grandes áreas metropolitanas do Brasil que não são adequados para a agricultura (solo fraco, morros íngremes). O objetivo deste trabalho foi avaliar se há uma correlação entre o grau de hematúria e presença de lesões na bexiga urinária de vacas com hematúria enzoótica bovina (HEB). Avaliou-se a bexiga de vinte vacas Nelore com intoxicação por samambaia usando um endoscópio flexível para descrever as lesões presentes e foi realizado um teste de urina rápido por meio do uso de fitas químicas reagentes (Combur Roche ® - Suiça) para verificar o grau de hematúria; então foram correlacionados ambos os resultados com o uso do teste estatístico de Spearman. Todas as vacas apresentavam lesões na parede da bexiga e a urina estava visualmente avermelhada, também o teste com as tiras foi positivo para hematúria. As fitas reagentes apresentaram uma correlação positiva com o número de lesões da bexiga. Nos bexigas dos animais que foi realizado eutanásia, vários nódulos avermelhados difusos pela submucosa e múltiplos pontos de equimose foram vistos macroscopicamente, e em uma bexiga havia um tumor maior com um diâmetro de 3 centímetros, o qual foi determinado como hemangioma por meio da análise histopatológica. Concluiu-se que as fitas reagentes para urinálise são uma ferramentavaliosa para avaliar a gravidade das lesões da bexiga urinária nos casos de hematúria enzoótica bovina.Além disso, a cistoscopia é uma importante ferramenta diagnóstica para avaliar lesões vesicais embovinos. Mais estudos são necessários para avaliar o envolvimento de papilomavírus e ocorrência detumor de bexiga nestas vacas.(AU)

Enzootic bovine haematuria is mainly caused by the chronic ingestion of bracken fern and is still considered an important cause of economic losses in beef herds, particularly in large metropolitan areas of Brazil that are not suitable for agriculture (weak soil, steep hills).The aim of this paper was evaluate if there is a correlation between the degree of haematuria and the presence of lesions in the urinary bladder of cows with bovine enzootic haematuria (BEH).We evaluated the bladder of twenty Nelore cows with bracken fern intoxication using a flexible endoscope to describe the lesions present and we performed a rapid urine test with a chemical multiple-reagent commercial strips (Combur test Roche® Swiss) to check the degree of haematuria; then we correlated both results with the Spearman statistical test. All cows presented lesions in their bladder walls and the urine was visually reddish and positive for haematuria in the strips. Urine dipstick has shown to correlate with bladder lesion number. In the bladders of the euthanised animals, multiple sub-mucosal reddish nodules and multiple ecchymotic haemorrhages were seen macroscopically, and one bladder had a larger tumour with a 3cm diameter, which was determined to be a haemangioma by analysing the histopathology. We concluded that urine dipstick is a valuable device for bovine enzootic haematuria prognostic purposes and to evaluatethe severity of lesions from the urinary bladder. Moreover, cystoscopy is an important diagnostictool to assess bladder lesions in cattle. Further studies are necessary to evaluate the involvement ofpapillomaviruses and bladder tumour occurrence in these cows.(AU)

Assuntos

RESUMO

Hematúria enzoótica bovina é causada principalmente pela ingestão crônica de samambaia e ainda é considerada uma importante causa de perdas econômicas em rebanhos de corte, especialmente em grandes áreas metropolitanas do Brasil que não são adequados para a agricultura (solo fraco, morros íngremes). O objetivo deste trabalho foi avaliar se há uma correlação entre o grau de hematúria e presença de lesões na bexiga urinária de vacas com hematúria enzoótica bovina (HEB). Avaliou-se a bexiga de vinte vacas Nelore com intoxicação por samambaia usando um endoscópio flexível para descrever as lesões presentes e foi realizado um teste de urina rápido por meio do uso de fitas químicas reagentes (Combur Roche ® - Suiça) para verificar o grau de hematúria; então foram correlacionados ambos os resultados com o uso do teste estatístico de Spearman. Todas as vacas apresentavam lesões na parede da bexiga e a urina estava visualmente avermelhada, também o teste com as tiras foi positivo para hematúria. As fitas reagentes apresentaram uma correlação positiva com o número de lesões da bexiga. Nos bexigas dos animais que foi realizado eutanásia, vários nódulos avermelhados difusos pela submucosa e múltiplos pontos de equimose foram vistos macroscopicamente, e em uma bexiga havia um tumor maior com um diâmetro de 3 centímetros, o qual foi determinado como hemangioma por meio da análise histopatológica. Concluiu-se que as fitas reagentes para urinálise são uma ferramentavaliosa para avaliar a gravidade das lesões da bexiga urinária nos casos de hematúria enzoótica bovina.Além disso, a cistoscopia é uma importante ferramenta diagnóstica para avaliar lesões vesicais embovinos. Mais estudos são necessários para avaliar o envolvimento de papilomavírus e ocorrência detumor de bexiga nestas vacas.

Enzootic bovine haematuria is mainly caused by the chronic ingestion of bracken fern and is still considered an important cause of economic losses in beef herds, particularly in large metropolitan areas of Brazil that are not suitable for agriculture (weak soil, steep hills).The aim of this paper was evaluate if there is a correlation between the degree of haematuria and the presence of lesions in the urinary bladder of cows with bovine enzootic haematuria (BEH).We evaluated the bladder of twenty Nelore cows with bracken fern intoxication using a flexible endoscope to describe the lesions present and we performed a rapid urine test with a chemical multiple-reagent commercial strips (Combur test Roche® Swiss) to check the degree of haematuria; then we correlated both results with the Spearman statistical test. All cows presented lesions in their bladder walls and the urine was visually reddish and positive for haematuria in the strips. Urine dipstick has shown to correlate with bladder lesion number. In the bladders of the euthanised animals, multiple sub-mucosal reddish nodules and multiple ecchymotic haemorrhages were seen macroscopically, and one bladder had a larger tumour with a 3cm diameter, which was determined to be a haemangioma by analysing the histopathology. We concluded that urine dipstick is a valuable device for bovine enzootic haematuria prognostic purposes and to evaluatethe severity of lesions from the urinary bladder. Moreover, cystoscopy is an important diagnostictool to assess bladder lesions in cattle. Further studies are necessary to evaluate the involvement ofpapillomaviruses and bladder tumour occurrence in these cows.

Assuntos

RESUMO

INTRODUCTION: Diabetes knowledge among TB patients can contribute to improved TB treatment outcomes, but lack of diabetes diagnosis awareness is a limitation in developing countries. Given its low cost, the sensitivity of urine glucose dipsticks for diabetes screening in TB patients was assessed. METHODS: Glycosuria was assessed in 90 newly diagnosed TB patients (38 with diabetes) in south Texas, USA (n = 20) and northeast Mexico (n = 70) during January 2009-December 2010. RESULTS: Glycosuria was detected in 65% of the diabetic patients with chronic hyperglycemia (positive predictive value 91%, negative predictive value 84%). CONCLUSION: We propose that TB clinics with limited budgets where portable glucometers may not be available conduct universal screening for diabetes with urine dipsticks. This could be followed by blood glucose or HbA1c testing in the subset of patients requiring confirmation or higher sensitivity assessment, to improve the comanagement of TB and diabetes.

Assuntos

RESUMO

Sem infecção, nada de antibiótico. Certo? Talvez não. Três em cada quatro mulheres com disúria e polaciúria, mas sem um resultado positivo no teste rápido de nitritos e leucócitos, responderão ao tratamento antibiótico em comparação com uma em cada quatro pacientes que tomarem placebo. O resultado negativo no teste do dipstick foi compatível com a cultura em 92% dos casos. Esses resultados sugerem que algumas mulheres têm infecções microbianas que não são identificadas pelo teste rápido nem pela cultura. Ou, talvez, o antibiótico esteja fazendo algo além de matar bactérias.

Assuntos