ABSTRACT
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.
ABSTRACT
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.
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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.
ABSTRACT
PURPOSE: Kawasaki disease (KD) is a systemic vasculitis and affects many organ systems. It often presents sterile pyuria, microscopic hematuria, and proteinuria due to renal involvement. The aims of this study were to define clinical characteristics of acute KD patients with pyuria and to analyze meaning of pyuria in KD. METHODS: The medical records and laboratory findings including serum and urine test of 133 patients with KD admitted to Yeungnam University Hospital from March 2006 to December 2010 were reviewed retrospectively. RESULTS: Forty patients had sterile pyuria and their clinical characteristics including age, gender and body weight were not significantly different with those who did not have pyuria. Fever duration after treatment was significantly longer in KD patients with pyuria. Erythrocyte sedimentation rate, C-reactive protein and serum concentration of alanine aminotransferase were significantly higher in patients with pyuria. Hyponatremia and coronary artery lesion were seen more often in patients with pyuria but there was no significant difference. Also serum blood urea nitrogen was significantly higher in KD patients with pyuria. Urine beta2-microglobulin was elevated in both patients groups and showed no difference between two groups. CONCLUSION: We found more severe inflammatory reaction in KD patients with pyuria. We also found elevation of some useful parameters like beta2-microglobulin that indicate renal involvement of KD through the urine test. Careful management and follow up will need for KD patients with pyuria and it is necessary in the future to study the specific parameters for renal involvement of KD.