Local immune response in experimental pyelonephritis in the rabbit. I. Morphological and functional features of the lymphocytic infiltrate.
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The cellular activity of circulating lymphocytes and lymphocytes isolated from the infected kidney of animals with experimental haematogenous pyelonephritis was evaluated. The incorporation of [3H-methyl]thymidine into DNA by lymphocytes was studied with mitogens such as phytohaemagglutinin (PHA), pokeweek mitogen (PWM) and goat anti-rabbit IgG (GARIG). Lymphocytes from infected kidney had a high baseline DNA synthesis compared to circulating lymphocytes from days 5 to 27 of infection. Infected kidney lymphocytes failed to respond to PHA, PWM, or GARIG, whereas circulating lymphocytes did respond to these mitogens. Uropod-bearing lymphocytes, which were shown to be T lymphocytes, were present from days 5 to 77 of infection. B lymphocytes, as determined by surface immunofluorescent technique, were present by day 12, coincident with the onset of local synthesis of antibody. These studies reveal that in pyelonephritis, the cellular response goes through sequential changes and indicate a dynamic interrelationship between T and B lymphocytes at an infected site. (+info)
Quantitation of immunoglobulin-bearing lymphocytes and the lymphocyte response to PHA in experimental pyelonephritis.
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In these experiments the effect of experimental pyelonephritis on the distri-ution of B lymphocytes in the peripheral blood and lymphoid sites in the rat has been determined and the functional capacity of T cells during the course of infection has been investigated. The studies have shown that renal infection affects the distribution of lymphocytes and has a marked effect on the functional capacity of splenic T lymphocytes early in infection. Most of the lymphocytes forming the round cell infiltrate in the kidney have been identified as thymus-derived lymphocytes on their surface labelling characteristics. Evidence is presented to demonstrate the inability of T lymphocytes to function normally in the environment of the kdiney. It is suggested that ablation of cell-mediated immunity may be a factor contributing to the persistence of renal infection. (+info)
Predominance of class II papG allele of Escherichia coli in pyelonephritis in infants with normal urinary tract anatomy.
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P-fimbrial genotypes of Escherichia coli strains and their possible association with urinary tract abnormalities were studied in infants with pyelonephritis. A total of 153 urinary E. coli strains were analyzed by polymerase chain reaction for class I, II, and III alleles of the pyelonephritis-associated adhesin gene papG. Strains with any class II papG alleles were found significantly more often in infants with normal anatomy and function or in infants with clinically insignificant abnormalities than they were in infants with significant abnormalities (90 of 119 vs. 14 of 34 infants; P<. 001). On the other hand, strains without any papG alleles were found significantly more often in infants with major urinary tract abnormalities (11 of 34 vs. 17 of 119 infants; P=.016). Our genotypic findings indicate that, especially in infants with a normal urinary tract, infection is caused by more-virulent E. coli than is present in infants without a normal urinary tract. This virulence could be due to expression of pyelonephritogenic P fimbriae by an infecting E. coli strain. (+info)
Comparative efficacy of gemifloxacin in experimental models of pyelonephritis and wound infection.
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Gemifloxacin (SB-265805) is a potent, novel fluoroquinolone with broad-spectrum antimicrobial activity. In this study, the efficacy of gemifloxacin was studied in experimental models of Gram-negative pyelonephritis (caused by Escherichia coli or Proteus mirabilis) and Gram-positive wound infection resulting from Streptococcus pyogenes, Staphylococcus epidermidis or Staphylococcus aureus. Gemifloxacin activity against these pathogens was compared with those of amoxycillin-clavulanate, ciprofloxacin, cefuroxime, azithromycin, trovafloxacin, grepafloxacin, levofloxacin and tosufloxacin. Oral treatment was initiated 1 h after infection and continued once or twice daily for 3 days. Around 17 h after the end of treatment, animals were killed and the infected kidneys or the skin around the wound site were excised for the enumeration of viable bacteria. In the pyelonephritis model (either microorganism), gemifloxacin reduced bacterial numbers significantly (P < 0.01) compared with no treatment. No comparator agent had a greater effect than gemifloxacin. Notably, grepafloxacin and azithromycin were significantly less effective (P < 0.01) than gemifloxacin against E. coli pyelonephritis, and amoxycillin-clavulanate, azithromycin and trovafloxacin were inferior (P < 0.01) against P. mirabilis infection. In the S. pyogenes wound infection model, gemifloxacin, amoxycillin-clavulanate, cefuroxime and azithromycin reduced bacterial numbers significantly compared with controls (P < 0.01). Results for the comparator quinolones were not significantly different from untreated controls (P > 0.05). Gemifloxacin was also effective against staphylococcal infection, as were grepafloxacin and levofloxacin, while ciprofloxacin, trovafloxacin and tosufloxacin were significantly less effective against these pathogens than gemifloxacin (P < 0.01). No comparator agent had greater activity than gemifloxacin against S. pyogenes or S. aureus infections. These data demonstrate the potential benefit of gemifloxacin in the treatment of Gram-negative urinary tract infection and Gram-positive skin and soft tissue infection. (+info)
Emphysematous pyelonephritis: a rare presentation.
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Emphysematous pyelonephritis is a rare life threatening infection in diabetes characterised by suppurative infection of renal parenchyma and perirenal tissues. It usually presents with fever, nausea, vomiting, abdominal pain, shock, lethargy, and confusion. Diabetic ketoacidosis is an uncommon presentation. In the present case, an elderly female presented with abdominal pain, fever, vomiting, and altered sensorium. She was diagnosed to have diabetic ketoacidosis with metabolic encephalopathy with right emphysematous pyelonephritis. She had an excellent response to medical treatment alone and was later discharged on oral hypoglycaemic agents. (+info)
How accurate is dimercaptosuccinic acid scintigraphy for the diagnosis of acute pyelonephritis? A meta-analysis of experimental studies.
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The purpose of this study was to evaluate the performance of dimercaptosuccinic acid (DMSA) scintigraphy in the diagnosis of acute pyelonephritis and to compare the test performance of the standard technique, planar DMSA, with the newly introduced technique, SPECT DMSA. METHODS: All published animal studies in which DMSA scintigraphy was compared with histopathology, the reference standard for acute pyelonephritis, were identified using a comprehensive search strategy with the MEDLINE and EMBASE databases. Test performances of all DMSA methods and SPECT versus planar DMSA were analyzed using summary receiver operating characteristic (sROC) curves. RESULTS: Seven studies were identified, including 2 of SPECT DMSA. Problems in study design or reporting were common, with numerical errors in 4 studies. Overall, at a sensitivity of 86%, specificity was estimated to be 91%. Detection of acute pyelonephritis was at a lower threshold for SPECT than for planar DMSA (sensitivity/specificity values of 97%0/66% compared with 82%/ 97%), and the overall test performance of SPECT was not demonstrably better than that of planar DMSA. When applied to a group of children with a prevalence of renal damage of 40%, this means that 98% of children with abnormal planar DMSA scans will have renal damage, whereas only 65% of those with abnormal SPECT scans will have renal damage. Planar and SPECT DMSA will miss 11% and 3% of children with renal damage, respectively. Out of 100 children in the hypothetical group with 40% experiencing renal damage, SPECT will identify 6 extra true cases of renal damage at the expense of 19 extra false positives, when compared with planar DMSA. CONCLUSION: Published studies of DMSA test performance are few in number and have significant methodologic problems that should be avoided in future studies. DMSA, particularly the planar technique, performs well for the diagnosis of acute pyelonephritis. Using test performance criteria, SPECT DMSA alone has not been shown to be preferable to the established planar method and will result in a small number of true-positives at the expense of a larger number of false-positives. (+info)
Diseases causing end-stage renal failure in New South Wales.
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The nature of the original renal disease was determined in 403 consecutive cases of end-stage renal failure, in 317 of which the clinical diagnosis was corroborated by histological examination of the kidney. Five diseases accounted for 20 or more cases--glomerulonephritis (31% of the total), analgesic nephropathy (29%), primary vesicoureteral reflux (8%), essential hypertension (6%), and polycystic kidneys (5%). In only four cases did renal failure result from chronic pyelonephritis without a demonstrable primary cause. Greater use of micturating cystography and cystoscopy and routine urine testing for salicylate are advocated for earlier diagnosis of the major causes of "pyelonephritis". The incidence of end-stage renal failure in people aged 15-55 in New South Wales was estimated to be at least 34 new cases per million of total population each year. (+info)
Experimental Escherichia coli O6 pyelonephritis in rabbits. Effect on O6 antibody quantity and avidity of prior immunization with E. coli O2 bacteria.
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Haematogenous pyelonephritis was induced in rabbits using Escherichia coli 06:K13:H1 bacteria and the amounts and avidities of antibodies to the 06 antigen were analysed by the ammonium sulphate precipitation technique of Farr. In a group of six animals preimmunized with E. coli 02:K2ab:H1, five developed pyelonephritis and one pyelitis, as determined by histological examination. All aminals showed a considerable antibody response to E. coli 06 antigen during the infection. The animal with pyelitis gave a slightly smaller response than the others. The antibody avidity showed a pronounced variation. In a second group of six rabbits not preimmunized, five animals developed pyelonephritis. The titres of antibodies against E. coli 06 antigen increased during the infection inall of the six animals. However, the increase was significantly smaller than for the animals preimmunized with E. coli 02:K2ab:H1 (P smaller than 0.01). The pattern of the antibody avidities in this group was also heterogenous. The results are consistent with previous findings that exposure to serologically heterologous E. coli bacteria can enhance the development of the homologous antibody titres. This could be of relevance for serological diagnostic work as well as in the determination of the protective capacity of the antibody. (+info)