Assuntos
Abscesso/microbiologia , Antibacterianos/administração & dosagem , Dor no Flanco/diagnóstico por imagem , Doenças Musculares/microbiologia , Choque Séptico/microbiologia , Abscesso/diagnóstico por imagem , Abscesso/tratamento farmacológico , Idoso , Diabetes Mellitus Tipo 2 , Febre/microbiologia , Dor no Flanco/microbiologia , Humanos , Ílio/microbiologia , Masculino , Doenças Musculares/diagnóstico por imagem , Doenças Musculares/tratamento farmacológico , Choque Séptico/tratamento farmacológico , Choque Séptico/etiologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
An 18-year-old woman presented to our institution with fever, bilateral flank pain, headache and photophobia. She had a previous atrial septal defect (ASD) closure device inserted at the age of 9 years. Blood cultures on admission were positive for Corynebacterium diphtheriae, and transoesophageal echocardiogram (TOE) revealed an echodensity associated with the ASD closure device, most consistent with a vegetation. She was treated for infective endocarditis with 6 weeks of intravenous benzylpenicillin, and follow-up TOE showed resolution of the echodensity. To our knowledge, no cases of C. diphtheriaeendocarditis of an ASD closure device have previously been reported.
Assuntos
Antibacterianos/administração & dosagem , Corynebacterium diphtheriae/isolamento & purificação , Endocardite/diagnóstico , Comunicação Interatrial/cirurgia , Penicilina G/administração & dosagem , Infecções Relacionadas à Prótese/microbiologia , Dispositivo para Oclusão Septal/microbiologia , Adolescente , Ecocardiografia Transesofagiana , Endocardite/tratamento farmacológico , Endocardite/fisiopatologia , Feminino , Febre/microbiologia , Dor no Flanco/microbiologia , Humanos , Infusões Intravenosas , Fotofobia/microbiologia , Infecções Relacionadas à Prótese/tratamento farmacológico , Dispositivo para Oclusão Septal/efeitos adversos , Fatores de Tempo , Resultado do TratamentoAssuntos
Dor nas Costas/microbiologia , Infecções por Bartonella/diagnóstico , Febre/microbiologia , Dor no Flanco/microbiologia , Osteomielite/diagnóstico , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/microbiologia , Antibacterianos/uso terapêutico , Infecções por Bartonella/tratamento farmacológico , Criança , Quimioterapia Combinada , Humanos , Masculino , Osteomielite/complicações , Osteomielite/tratamento farmacológico , Doenças da Coluna Vertebral/tratamento farmacológicoAssuntos
Abscesso/patologia , Cetoacidose Diabética/fisiopatologia , Endoftalmite/fisiopatologia , Retina/patologia , Doenças Retinianas/fisiopatologia , Abscesso/tratamento farmacológico , Abscesso/microbiologia , Adulto , Antibacterianos/uso terapêutico , Dexametasona/uso terapêutico , Cetoacidose Diabética/complicações , Dispneia , Endoftalmite/tratamento farmacológico , Endoftalmite/etiologia , Dor no Flanco/microbiologia , Humanos , Masculino , Retina/microbiologia , Doenças Retinianas/tratamento farmacológico , Doenças Retinianas/microbiologia , Resultado do TratamentoAssuntos
Injúria Renal Aguda/microbiologia , Calcinose/microbiologia , Infecções por Corynebacterium/microbiologia , Dor no Flanco/microbiologia , Pielite/microbiologia , Infecções Urinárias/microbiologia , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/terapia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Técnicas Bacteriológicas , Calcinose/diagnóstico , Calcinose/terapia , Infecções por Corynebacterium/complicações , Infecções por Corynebacterium/diagnóstico , Infecções por Corynebacterium/terapia , Feminino , Dor no Flanco/diagnóstico , Dor no Flanco/terapia , Humanos , Soluções Isotônicas/administração & dosagem , Nefrostomia Percutânea , Pielite/diagnóstico , Pielite/terapia , Teicoplanina/uso terapêutico , Irrigação Terapêutica/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Infecções Urinárias/complicações , Infecções Urinárias/diagnóstico , Infecções Urinárias/terapiaRESUMO
OBJECTIVES: This study aimed to investigate the clinical features of renal tuberculosis and identify the age- and gender-related differences. METHODS: A total of 419 patients at the Peking University First Hospital from January 2000 to July 2015 were retrospectively reviewed. Data on demographic characteristics, clinical presentation, complications, laboratory results, radiologic imaging, surgical procedures, and pathology features were collected and compared between genders and 3 different age groups (under 40 years, 41-60, years and over 60 years). RESULTS: The most common local presentations were lower urinary tract symptoms (65.2%), flank pain (37.9%), and gross hematuria (26.3%). Constitutional symptoms were also observed in 38.9% of the patients. Gross hematuria was more common in male patients (32.2%) and older patients (45.5%). Flank pain was more common in female patients (43.6%). Patients younger than 40 years of age had lower frequencies of calcification of the urinary tract (22.2%) and kidney atrophy (4.2%) in CT. In the postoperative pathological reports, atrophy (35.9%) and fibrosis (38.5%) were found to be significantly more common in older patients. CONCLUSIONS: While gross hematuria is more prevalent in older patients and male patients, flank pain is more common in female patients. Radiological and pathological features including calcification of the urinary tract, fibrosis, and kidney atrophy are more common in older patients.
Assuntos
Hematúria/epidemiologia , Tuberculose Renal/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Atrofia , Biópsia , Criança , China/epidemiologia , Feminino , Fibrose , Dor no Flanco/epidemiologia , Dor no Flanco/microbiologia , Hematúria/diagnóstico , Hematúria/microbiologia , Hematúria/cirurgia , Hospitais Universitários , Humanos , Rim/microbiologia , Rim/patologia , Sintomas do Trato Urinário Inferior/epidemiologia , Sintomas do Trato Urinário Inferior/microbiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Distribuição por Sexo , Fatores Sexuais , Fatores de Tempo , Tomografia Computadorizada por Raios X , Tuberculose Renal/diagnóstico , Tuberculose Renal/microbiologia , Tuberculose Renal/cirurgia , Adulto JovemRESUMO
Authors present two patients suffering from renal tuberculosis, which caused differential diagnostic problems. The first patient was examined because of fever and left flank pain. Computed tomography revealed renal shrinkage on the left side. Retrograde pyelography demonstrated ureteric stricture and dilated calices. Urine culture showed Mycobacterium tuberculosis. Two months after initiation of the antituberculotic therapy nephrectomy was performed. The second patient was referred to the department because of fever after unsuccessful antibiotic treatment. Ultrasound examination showed a staghorn stone, dilated renal pelvis and perirenal abscess on the left side. Double J catheter insertion and percutaneous puncture of the abscess were performed. Culture of the pus aspirated proved Proteus morganii. Fever and complaints of the patient relieved after antibiotic treatment. Two months later double J catheter was changed because of persistent pyelonephritis. One week later the patient returned to the hospital with fever, which could not be reduced with intravenous antibiotics. Computed tomography showed purulent fluid in the left kidney, and nephrectomy was performed. Histology revealed renal tuberculosis. The authors summarize the diagnosis and treatment of renal tuberculosis on the basis of these two cases.
Assuntos
Antituberculosos/uso terapêutico , Mycobacterium tuberculosis/isolamento & purificação , Nefrectomia , Pielonefrite/microbiologia , Tuberculose Renal/diagnóstico , Tuberculose Renal/tratamento farmacológico , Abscesso/complicações , Abscesso/diagnóstico , Abscesso/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Febre/microbiologia , Dor no Flanco/microbiologia , Humanos , Pessoa de Meia-Idade , Proteus/isolamento & purificação , Tomografia Computadorizada por Raios X , Tuberculose Renal/complicações , Tuberculose Renal/cirurgia , Obstrução Ureteral/etiologia , UrografiaRESUMO
We present an interesting case of Legionnaires' disease masquerading as acute pyelonephritis, with complete absence of respiratory symptoms on admission. A 45-year-old man was diagnosed with Legionnaires' disease 2â days after presenting to hospital with dysuria and right loin pain. He became critically unwell during the hospital admission, with headache, uncontrolled fever, breathlessness, decreasing oxygen saturations and increasing oxygen requirements. A CT pulmonary angiography demonstrated right upper lobar consolidation and Legionella urinary antigen was positive. He was treated with ciprofloxacin and rifampicin and made a full recovery.
Assuntos
Doença dos Legionários/diagnóstico , Pielonefrite/diagnóstico , Antibacterianos/uso terapêutico , Antígenos de Bactérias/urina , Ciprofloxacina/uso terapêutico , Infecções Comunitárias Adquiridas/diagnóstico , Diagnóstico Diferencial , Disuria/microbiologia , Dor no Flanco/microbiologia , Humanos , Doença dos Legionários/tratamento farmacológico , Doença dos Legionários/imunologia , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico , Rifampina/uso terapêuticoAssuntos
Actinomicose/complicações , Actinomicose/diagnóstico , Pneumopatias/complicações , Pneumopatias/diagnóstico , Doenças Torácicas/complicações , Doenças Torácicas/diagnóstico , Actinomicose/tratamento farmacológico , Antibacterianos/uso terapêutico , Biópsia , Criança , Meios de Contraste , Diagnóstico Diferencial , Feminino , Dor no Flanco/tratamento farmacológico , Dor no Flanco/etiologia , Dor no Flanco/microbiologia , Humanos , Aumento da Imagem , Pulmão/microbiologia , Pulmão/patologia , Pneumopatias/tratamento farmacológico , Imageamento por Ressonância Magnética , Penicilinas/uso terapêutico , Doenças Torácicas/tratamento farmacológico , Tórax/microbiologia , Tórax/patologia , Tomografia Computadorizada por Raios XRESUMO
We present a case of iliopsoas abscess in an immunocompetent patient. She experienced three weeks of worsening right hip pain, which was initially misdiagnosed as degenerative joint disease. This led to admission to the Intensive Care Unit for severe sepsis. The patient improved with intravenous antibiotics and percutaneous abscess drainage.
Assuntos
Abscesso do Psoas/diagnóstico por imagem , Antibacterianos/uso terapêutico , Artralgia/microbiologia , Biomarcadores/metabolismo , Cefazolina/uso terapêutico , Feminino , Dor no Flanco/microbiologia , Articulação do Quadril , Humanos , Imunocompetência , Leucocitose/microbiologia , Dor Lombar/diagnóstico por imagem , Dor Lombar/microbiologia , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Abscesso do Psoas/tratamento farmacológico , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVES: Purpose of this study was to compare clinical characteristics and treatment outcomes in diabetic and non-diabetic women with community-acquired APN (CA-APN). METHODS: We prospectively collected and analyzed clinical data of women with CA-APN who attended 11 hospitals in South Korea from March 2010 to February 2012. RESULTS: Of a total of 775 patients, 246 (31.7%) were diabetic and 529 (68.3%) non-diabetic. Fewer of the diabetic patients had flank pain (27.6% vs. 37.2% P = 0.009), symptoms of lower urinary tract infection (57.3% vs. 69.6% P = 0.001) and costovertebral angle tenderness (54.9% vs. 72.2% P < 0.001). However, more of them had C-reactive protein ≥20 mg/dL (40.7% vs. 27.4% P < 0.001), azotemia (29.3% vs. 13.4% P < 0.001) and bacteremia (53.7% vs. 38.2% P < 0.001). Final clinical failure rates and deaths did not differ between the two groups: 6.9% vs. 4.5%, P = 0.169; 2.0% vs. 1.7%, P = 0.747. However, hospitalization was longer in the diabetics than the non-diabetics (median 9.0 days vs. 7.0 days, P < 0.001). In logistic regression, diabetes was independently associated with longer hospitalization (OR 1.7, CI 1.1-2.7, P = 0.011), together with nausea/vomiting, history of admission within 1 year, bacteremia, azotemia, and dementia, as well as extended-spectrum ß-lactamase (ESBL)-positivity and fluoroquinolone resistance of uropathogens. CONCLUSIONS: CA-APN patients with diabetes have more severe disease manifestations and require longer hospitalization than non-diabetic patients although their clinical findings are less clear than those of non-diabetic patients.
Assuntos
Diabetes Mellitus/microbiologia , Infecções por Enterobacteriaceae , Enterobacteriaceae/isolamento & purificação , Pielonefrite/microbiologia , Infecções Urinárias/microbiologia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/microbiologia , Proteína C-Reativa/metabolismo , Infecções Comunitárias Adquiridas/microbiologia , Infecções por Enterobacteriaceae/microbiologia , Feminino , Dor no Flanco/microbiologia , Humanos , Infecções por Klebsiella , Tempo de Internação , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções por Pseudomonas , Pielonefrite/complicações , Infecções EstafilocócicasRESUMO
BACKGROUND: Isolated renal zygomycosis is a life-threatening infection and difficult to diagnose ante mortem due to varied presentations. Most reports in the literature are case reports. We are presenting our experience of 10 patients. MATERIALS AND METHODS: Retrospective data of 10 consecutive patients with primary renal zygomycosis, including 2 post-transplant patients, in our tertiary care center was analyzed. Epidemiological characteristics, predisposing conditions, clinical presentation, diagnostic findings and treatment outcomes were recorded. Characteristic radiological findings were recorded. Localized disease was managed by supportive treatment or percutaneous drainage and extensive disease with unilateral or bilateral nephrectomy. Renal involvement was confirmed in all patients by histopathology. RESULTS: The mean age of presentation was 35 years. Five patients who had bilateral renal involvement presented with oliguric acute renal failure, hematuria and abdominal pain. Three had unilateral renal disease and presented with flank pain and fever. The two post-transplant patients presented with fever and graft dysfunction. Even after aggressive treatment 5 patients died, accounting for a mortality rate of 50%. CONCLUSION: Isolated renal zygomycosis can be diagnosed with typical radiological findings, combined with clinical, laboratory and histopathological features. This study describes the newer ante mortem radiological diagnostic criteria and prognostic predictors of the disease.