Chronic asymptomatic pyuria precedes overt urinary tract infection and deterioration of renal function in autosomal dominant polycystic kidney disease.
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Detection of urinary tract infections by rapid methods.
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A review of rapid urine screens for detection of bacteriuria and pyuria demonstrates a number of available alternatives to the culture method. Selection of one or more of these systems for routine use is dependent upon the laboratory and the patient population being tested. The laboratory approach to the diagnosis of urinary tract infection should consider the clinical diagnosis of the patient whenever possible. Keeping in mind that quantitative urine cultures alone cannot be used to detect infection in some patient populations unless lower colony counts are considered, a rapid screen may be a more practical approach. It has become accepted that 10(5) CFU/ml can no longer be used as the standard for all patient groups, that pyuria often is important in making the diagnosis of a urinary tract infection, and that most of the rapid screens are more sensitive than the culture method at 10(5) CFU/ml. Presently, no one approach can be recommended for all laboratories and all patient groups. However, each diagnostic laboratory should select one approach which is best for its situation. It is not practical, efficient, or cost effective to define a protocol for each possible clinical condition; however, all should be considered when developing a protocol. This protocol should be compatible with the patient population and communicated to the physicians. Use of a rapid screen should be beneficial to the patient, the physician, and the laboratory. (+info)
Inability of the Chemstrip LN compared with quantitative urine culture to predict significant bacteriuria.
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The Chemstrip LN (Boehringer Mannheim Biochemicals, Indianapolis, Ind.), designed to detect pyuria and bacteriuria, was compared with culture of 1,020 unselected, consecutive midstream urine specimens and evaluated on its ability to predict colony counts at three levels. At the level of greater than or equal to 10(5) CFU/ml, the combined test (detection of leukocyte esterase and nitrite) had sensitivity of 82.3%, specificity of 67.9%, positive predictive value of 41.3%, and negative predictive value of 93.3% at prevalence rate of 21.6%. The test would have rejected 9.4% of the specimens with significant bacteriuria if the Chemstrip alone had been used. (+info)
Aetiology of urinary symptoms in sexually active women.
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Two hundred and fifty six unselected women, 50 of whom had urinary symptoms (frequency of urination or dysuria, or both), and who were attending a department of genitourinary medicine, were investigated. The urinary symptoms were associated both with pyuria and the isolation of undoubted pathogens from midstream urine (MSU) specimens. No associations were found between urinary symptoms and the isolation of Neisseria gonorrhoeae or Chlamydia trachomatis from the urethra or cervix; the recovery of Mycoplasma hominis from the urethra, cervix, or MSU; the recovery of Trichomonas vaginalis or Candida albicans from the vagina; or the presence of bacterial vaginosis. Urethral leucocytosis was associated with the isolation of T vaginalis but not with the recovery of N gonorrhoeae, C trachomatis, C albicans, or urinary pathogens. Pyuria was associated with the isolation of urinary pathogens and with the presence of trichomoniasis; it was not associated with the recovery of C trachomatis or M hominis. (+info)
Tubo-ovarian abscess: pathogenesis and management.
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That a female patient with abdominal pain is often considered to have pelvic inflammatory disease until proven otherwise is ubiquitous in the medical literature. This view is dangerous and should be challenged because it has resulted in episodes of ruptured appendix, death from ruptured ectopic pregnancies, and serious morbidity from delayed diagnoses of such entities as diverticulitis and endometriosis. Proper diagnostic steps should be taken for all patients with abdominal pain of unclear etiology.This article reviews the pathogenesis of tubo-ovarian abscesses so as to separate and clearly identify fact from fiction. Diagnostic steps and management guidelines are discussed. (+info)
Leucocyte esterase determination as a secondary procedure for urine screening.
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The use of a dipstick to detect leucocyte esteraseuria (Chemstrip L) was compared with the visualisation of leucocytes in a Gram stained smear for the detection of pyuria. The sensitivity and specificity of the two systems using the predictive value theory were similar. The use of a dual screening procedure (automation plus dipstick) allowed reliable 4 h screening of urine specimens for the detection of urinary tract infections. (+info)