Classical Presentation of Acute Pyelonephritis in a Case of Brucellosis

Although Brucella species is known to affect almost all organs in humans, renal involvement presenting as acute pyelonephritis remains a rare entity in brucellosis. We report the case of a female patient who presented with symptoms of fever with chills, right loin pain and dysuria in the emergency room. Blood cultures drawn at the time of admission grew Brucella spp., but no organisms were isolated from urine culture although urinalysis data was indicative of urinary tract infection. Empiric therapy with piperacillin/tazobactam plus gentamicin relieved her symptoms. However, the treatment was switched to doxycycline plus rifampicin once the blood culture result was obtained.

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1484. Microbial Etiology of Community-acquired Pneumonia in Immunocompromised Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1665 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S743-S744

Author(s):

Abhishek Deshpande ◽

Pei-Chun Yu ◽

Michael Rothberg

Keyword(s):

Panel Member ◽

Positive Culture ◽

Empiric Therapy ◽

Community Acquired Pneumonia ◽

Immunocompromised Patients ◽

Viral Pathogens ◽

Chest X Ray ◽

Microbial Etiology ◽

Almost All ◽

Immunocompetent Patients

Abstract Background Community-acquired pneumonia (CAP) is a leading cause of infection related mortality. Few studies have specifically evaluated the microbial etiology of CAP in immunocompromised patients. Using a large national inpatient database, we compared the microbial etiology of CAP in immunocompromised patients compared to immunocompetent patients. Methods We included adult patients admitted with pneumonia from 2010-2015 to 176 US hospitals participating in Premier. Patients were identified as having CAP if they had a chest X-ray and were on antimicrobials on the first day. Immunocompromised was defined by the receipt of immunosuppressive medications or ICD-9 codes for neutropenia/ hematological malignancy/ organ transplantation or comorbidities with AIDS. For microbial etiology, patients were included if they had a positive culture or test collected by hospital day 0 through 3. Patients with identical bacteria in blood and urine were excluded. Results A total of 168,159 patients had a diagnosis of CAP with a culture/test performed on first 3 days. A pathogen was detected in 18.8% of patients. Among pathogen positive patients, 4,851 patients were identified as immunocompromised and 26,752 as immunocompetent. Almost all patients (99%) had at least one culture, blood (96%) and respiratory (51%). Among patients who were immunocompromised, the most common bacterial pathogens (compared to immunocompetent patients) were, S. pneumoniae (17.7% vs 19.0%), MRSA (13.1% vs 14.4%), MSSA (12.0% vs 11.8%), P. aeruginosa (12.0% vs 9.9%), E. coli (7.4% vs 6.4%), K. pneumoniae (5.8% vs 4.9%), H. influenzae (5.5% vs 5.5%), M. pneumoniae (3.0% vs 3.0%) and L. pneumophila (0.93% vs 1.2%). Among viral pathogens, while the most common were influenza virus (12.9% vs 14.1%) followed by rhinovirus (1.5% vs 0.89%), immunocompromised patients has a higher prevalence of noninfluennza viruses (3.42% vs 2.43%). Conclusion In a large US inpatient sample, the causative organisms in immunocompromised patients did not differ much from those in immunocompetent patients. CAP pathogens in immunocompromised patients were more likely to involve gram-negative bacilli such as P.aeruginosa and E.coli, than gram-positive cocci. These findings may have implications when deciding on empiric therapy in these patients. Disclosures Abhishek Deshpande, MD, PhD, Ferring Pharmaceuticals (Advisor or Review Panel member)Merck (Consultant)

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Adrenal pheochromocytoma with involvement of aorta and left renal artery: salvaged with adrenalectomy and nephrectomy

BMJ Case Reports ◽

10.1136/bcr-2021-244297 ◽

2021 ◽

Vol 14 (9) ◽

pp. e244297

Author(s):

Shekhar Sathaye ◽

Kalpesh Mahesh Parmar ◽

Santosh Kumar ◽

Pulkit Rastogi

Keyword(s):

Renal Artery ◽

Renal Involvement ◽

Renal Tissue ◽

Preoperative Imaging ◽

Beta Blockade ◽

Left Renal Artery ◽

Rare Entity ◽

Rare Presentation ◽

Adrenal Pheochromocytoma

Large adrenal pheochromocytomas encasing the renal artery are a rare entity. The management of such challenging cases is surgical resection. The involvement of renal tissue and renal artery may necessitate meticulous dissection and concomitant nephrectomy. Here, we present a case of 41-year-old man diagnosed with left adrenal pheochromocytoma with complete encasement of left renal artery and partial encasement of aorta. Open left adrenalectomy and nephrectomy was performed after adequate preoperative optimisation. The patient is doing well at 6-month follow-up. Large adrenal pheochromocytoma with renal involvement is a rare presentation and requires optimal preoperative imaging, adequate preoperative alpha and beta blockade and meticulous surgical technique.

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Allergy and Urinary Infections: Is There an Association?

PEDIATRICS ◽

10.1542/peds.48.1.166 ◽

1971 ◽

Vol 48 (1) ◽

pp. 166-166

Author(s):

Anne Harrison

Keyword(s):

Abdominal Pain ◽

Acute Pyelonephritis ◽

Urine Culture ◽

Hay Fever ◽

Laboratory Work ◽

Low Grade ◽

Chronic Infections ◽

Urinary Infections

Noting in my small general pediatric practide that the same families kept returning for urine checks following infections as well as for allergy shots, I decided to review all of the current charts to determine the incidence of both problems. "Allergy" includes hay fever, asthma, allergic cough, eczema, bee and other stings, and reaction to foods or drugs severe enough to warrant avoidance, medication, or allergic workup. "G-U infection" includes typical symptoms of bladder irritation with or without pyuria and bacteriuria, acute pyelonephritis diagnosed by the usual symptomatology and laboratory work, and subacute or chronic infections with the children presenting often with more subtle symptoms (tired, cranky, low-grade fever, and off-and-on abdominal pain being the most common complaints) and with a "clean-catch" urine culture of at least 20,000 colonies of one organism.

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Incidence of Acute Pyelonephritis in Hospitalized Children under 5 Years Old with Positive Urine Culture

Universitas Médica ◽

10.11144/javeriana.umed59-4.piel ◽

2018 ◽

Vol 59 (4) ◽

pp. 1-5

Author(s):

Alexandra Castaño González ◽

Juan Gabriel Ruiz Peláez

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Acute Pyelonephritis ◽

Urine Culture ◽

Renal Scintigraphy ◽

Hospitalized Children ◽

Positive Urine Culture ◽

Positive Urine ◽

Urinary Culture

Introduction: Urinary tract infection is a major cause of child morbidity. The diagnosis of acute pyelonephritis is important to decide the treatment. Methods: Retrospective observational study. We collected information of urinalysis, urine Gram and urine culture of hospitalized children between 3 months and 5 years old, with suspected urinary tract infection between January 2008 and December 2010. In patients with positive urine culture, the results of renal scintigraphy (Gamma scan) were evaluated to estimate the incidence of acute pyelonephritis. Results: We identified 1,463 medical records. Urinary culture was obtained in 237 patients, of whom 54.4% were positive. Renal scintigraphy was obtained in 93 of these patients and 59.1% were positive. Conclusions: The incidence of acute pyelonephritis in patients with confirmed urinary tract infection was 59.1%.

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Clinical Outcomes of Carbapenem-Resistant Acinetobacter baumannii Bloodstream Infections: Study of a 2-State Monoclonal Outbreak

Infection Control and Hospital Epidemiology ◽

10.1086/656247 ◽

2010 ◽

Vol 31 (10) ◽

pp. 1057-1062 ◽

Cited By ~ 45

Author(s):

L. Silvia Munoz-Price ◽

Teresa Zembower ◽

Sudhir Penugonda ◽

Paul Schreckenberger ◽

Mary Alice Lavin ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Culture ◽

Acinetobacter Baumannii ◽

Bloodstream Infection ◽

Positive Blood Culture ◽

Culture Result ◽

Blood Culture Result ◽

Carbapenem Resistant ◽

Single Positive

Objective.To characterize the clinical outcomes of patients with bloodstream infection caused by carbapenem-resistant Acinetobacter baumannii during a 2-state monoclonal outbreak.Design.Multicenter observational study.Setting.Four tertiary care hospitals and 1 long-term acute care hospital.Methods.A retrospective medical chart review was conducted for all consecutive patients during the period January 1, 2005, through April 30, 2006, for whom 1 or more blood cultures yielded carbapenem-resistant A. baumannii.Results.We identified 86 patients from the 16-month study period. Their mortality rate was 41%; of the 35 patients who died, one-third (13) had positive blood culture results for carbapenem-resistant A. baumannii at the time of death. Risk factors associated with mortality were intensive care unit stay, malignancy, and presence of fever and/or hypotension at the time blood sample for culture was obtained. Only 5 patients received adequate empirical antibiotic treatment, but the choice of treatment did not affect mortality.Fifty-seven patients (66.2%) had a single positive blood culture result for carbapenem-resistant A. baumannii; the only factor associated with a single positive blood culture result was the presence of decubitus ulcers. Interestingly, during the study period, a transition from single to multiple positive blood culture results was observed. Four patients, 3 of whom were in a burn intensive care unit, were bacteremic for more than 30 days (range, 36–86 days).Conclusions.To our knowledge, this is the first time a study has described 2 patterns of bloodstream infection with A. baumannii: single versus multiple positive blood culture results, as well as a subset of patients with prolonged bacteremia.

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Isolated IgG4-related Disease of Sphenoid Sinus Manifesting as Blindness

Otorhinolaryngology Clinics - An International Journal ◽

10.5005/aijoc-6-3-19 ◽

2014 ◽

Vol 6 (3) ◽

pp. 19-22

Author(s):

Vivek Mathew ◽

Gaurav Ashish ◽

Amit Kumar Tyagi ◽

Anand Kamalam Job ◽

Ramanathan Chandrasekharan

Keyword(s):

Differential Diagnosis ◽

Optic Neuritis ◽

Paranasal Sinuses ◽

Sphenoid Sinus ◽

The Body ◽

Rare Entity ◽

Pulse Methylprednisolone ◽

Related Disease ◽

Igg4 Related Disease ◽

Almost All

ABSTRACT Introduction IgG4 related disease is a rare entity which can affect almost all parts of the body. The available literature of this entity related to paranasal sinuses is very limited. Presentation of case We present a case of isolated sphenoid sinus affliction by IgG4 related sclerosing disease manifesting as blindness, which recovered fully with pulsed steroid therapy. Discussion We present this case in view of developing insights toward diagnosis and management of IgG4 related sclerosing disease in paranasal sinuses, specifically the sphenoid sinus. Conclusion IgG4 disease involving paranasal sinuses (PNS) is rare entity and is managed with pulse methylprednisolone and immunomodulator drugs. Considering the limit of understanding of etiopathogenesis of this disease, surgeon needs to keep this differential diagnosis in mind. It may present atypically like isolated sinus involvement and optic neuritis.

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Invasive Pneumococcal Disease: Still Lots to Learn and a Need for Standardized Data Collection Instruments

Canadian Respiratory Journal ◽

10.1155/2017/2397429 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 5

Author(s):

T. J. Marrie ◽

G. J. Tyrrell ◽

Sumit R. Majumdar ◽

Dean T. Eurich

Keyword(s):

Pulmonary Embolism ◽

Invasive Pneumococcal Disease ◽

Pneumococcal Disease ◽

Functional Limitations ◽

Clinical Information ◽

Population Based ◽

Homeless Persons ◽

Preventative Measures ◽

Almost All ◽

Time Of Admission

Background.Large studies of invasive pneumococcal disease (IPD) are frequently lacking detailed clinical information.Methods.A population-based 15-year study of IPD in Northern Alberta.Results.2435 patients with a mean age of 54.2 years formed the study group. Males outnumbered females and Aboriginal and homeless persons were overrepresented. High rates of smoking, excessive alcohol use, and illicit drug use were seen. Almost all (87%) had a major comorbidity and 15% had functional limitations prior to admission. Bacteremia, pneumonia, and meningitis were the most common major manifestations of IPD. Almost half of the patients had alteration of mental status at the time of admission and 22% required mechanical ventilation. Myocardial infarction, pulmonary embolism, and new onset stroke occurred in 1.7, 1.3, and 1.1% of the patients, respectively; of those who had echocardiograms, 35% had impaired ventricular function. The overall in-hospital mortality was 15.6%.Conclusions.IPD remains a serious infection in adults. In addition to immunization, preventative measures need to consider the sociodemographic features more carefully. A standard set of data need to be collected so that comparisons can be made from study to study. Future investigations should target cardiac function and pulmonary embolism prevention in this population.

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Multiple Renal Abscesses due to ESBL Extended-Spectrum Beta-Lactamase-Producing Escherichia coli Causing Acute Pyelonephritis and Bacteremia: A Case Report with a Good Outcome (No Drainage Required)

Case Reports in Infectious Diseases ◽

10.1155/2016/9076813 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Abdalla Khalil ◽

Musaad Qurash ◽

Asem Saleh ◽

Rasha Ali ◽

Mohamed Elwakil

Keyword(s):

Ct Scan ◽

Acute Pyelonephritis ◽

Urine Culture ◽

Flank Pain ◽

Beta Lactamase ◽

Extended Spectrum Beta Lactamase ◽

Left Flank ◽

Extended Spectrum ◽

Abdomen Ct ◽

Left Flank Pain

Extended-spectrum beta-lactamase-producing Enterobacteriaceae urinary tract infections are challenging infections with increased mortality, morbidity, and failure of therapy. A 44-year-old Saudi male diabetic patient was seen at the ER of IMC Hospital with features of acute pyelonephritis: fever, burning urine, and left flank pain for three days. He was treated for cystitis at the Endocrine Clinic two weeks prior to his ER visit with nitrofurantoin and levofloxacin orally according to urine culture and sensitivity result. The patient was admitted, received IV meropenem, and continued to be febrile for three days. His urine and blood culture at ER grew the same ESBL-producing E. coli as in his urine culture from the Endocrine Clinic. His abdomen CT scan showed two left renal abscesses at the upper and middle poles. His temperature resolved on the fourth day of IV therapy. Intravenous meropenem was continued for 4 weeks after inserting PICC line and the patient was followed up by home healthcare. He was feeling better with occasional left flank pain and repeated abdomen CT scan showed complete resolution of both renal abscesses.

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Tubulointerstitial Nephritis and Uveitis Syndrome: Case Series and Literature Review

Case Reports in Ophthalmological Medicine ◽

10.1155/2021/1812271 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Beatriz Oliveira Lopes ◽

Margarida Sena Brízido ◽

Ana Cortesão Costa ◽

Mário Raimundo ◽

Margarida Maria Miranda ◽

...

Keyword(s):

Tubulointerstitial Nephritis ◽

Renal Involvement ◽

Time Lag ◽

Young Patients ◽

Case Series ◽

Posterior Uveitis ◽

Rare Entity ◽

Ocular Manifestations ◽

Systemic Corticosteroids ◽

Autoimmune Etiology

Tubulointerstitial nephritis and uveitis syndrome (TINU) is a rare oculorenal inflammatory entity with a probable autoimmune etiology. Interstitial nephritis may be asymptomatic and usually has a benign course with spontaneous resolution. Uveitis, instead, is classically anterior, bilateral, and nongranulomatous, but it can be unilateral and presents as posterior uveitis or panuveitis, sometimes with a chronic or recurrent evolution. The frequent time lag of ocular and renal manifestations makes this diagnosis particularly challenging. The authors describe four cases of this rare entity, two with tubulointerstitial nephritis preceding ocular manifestations and the remaining, instead, with uveitis preceding renal involvement. The therapeutic approach included systemic corticosteroids in all cases. The addition of immunosuppressive therapy was required in three patients to achieve uveitis control. TINU is probably an underrecognized entity and should always be considered in the differential diagnosis of a chronic or recurrent idiopathic uveitis, especially in young patients who may have mild and asymptomatic renal disease.

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Case Report: Acute pyelonephritis and hearing loss in scrub typhus

F1000Research ◽

10.12688/f1000research.18129.2 ◽

2019 ◽

Vol 8 ◽

pp. 312

Author(s):

Sivaranjini Venketesan ◽

Dheeraj Jain ◽

Stalin Viswanathan ◽

Murugesan Sivagurunathan Gayathri

Keyword(s):

Acute Pyelonephritis ◽

Hepatic Dysfunction ◽

Scrub Typhus ◽

Renal Manifestation ◽

Intravenous Antibiotics ◽

Patients With Diabetes ◽

English Medical Literature ◽

Loin Pain ◽

Systemic Infections ◽

Symptoms And Signs

Acute pyelonephritis is a common renal manifestation in patients with diabetes. A 52-year-old diabetic lady presented with loin pain, dysuria, and fever and urinary incontinence that had begun seven and three days prior to presentation respectively. She was treated with escalating spectra of intravenous antibiotics without improvement. Urine and blood cultures were sterile, while radiological investigations were suggestive of pyelonephritis. Mild hepatic dysfunction prompted consideration of scrub typhus and she improved with empirical doxycycline. Scrub IgM was later confirmed to be positive. In conclusion, local prevalence of systemic infections such as rickettsioses should always be considered in diabetics with fever, even if symptoms and signs otherwise suggest typical diabetes-related infections. We, therefore report a case of acute pyelonephritis caused by scrub typhus which has not been previously described in English medical literature.

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