Introduction of a complementary screening system for the detection of sexually transmitted infections in patients with sterile pyuria

Objective. The aim of the study was to evaluate a complementary screening system for the detection of sexually transmitted infections in patients with sterile pyuria. Material and methods. A prospective study was conducted using Real-time multiplex qPCR in 300 consecutive urine samples with data on sterile pyuria. STI prevalence and patient epidemiological data were analyzed. Results. A total of 29 positive cases (9.67%) were found: 16 Chlamydia trachomatis, 5 Mycoplasma genitalium, 5 Trichomonas vaginalis and 3 co-infections. The group with sexually transmitted infections was mainly composed of women (65.5%), of which one third was pregnant. Conclusion. This study presents an effective screening system for the detection of sexually transmitted infections that can be integrated into the laboratories’ work routine.

The Differential Diagnosis of Sterile Pyuria in Pediatric Patients: A Review

Sterile pyuria is a common finding in pediatric patients. Literature describing the diagnoses as well as clinical characteristics of children with sterile pyuria is lacking. This review was performed to establish an evidence-based approach to the differential diagnosis by way of an extensive literature search. The definition of pyuria is inconsistent. The various causes of pediatric sterile pyuria identified were classified as either Infectious or Non-Infectious. Sub-categories of Infectious causes include: Viral Infection, Bacterial Infection, Other Infections (tuberculosis, fungal, parasitic), Sexually Transmitted Infections, Recent Antibiotic Therapy. Non-Infectious causes include: Systemic Disease, Renal Disease, Drug Related, Inflammation adjacent to Genitourinary Tract. Clinicians that encounter pediatric patients with sterile pyuria and persistent symptoms should consider the substantial differential diagnosis described in this study.

Long – term effect of nephrocalcinosis on renal function and body growth index in children

Aims: To evaluate effect of NC on growth index, kidney function and its etiology of children at National Children’s Hospital. Methods: A case series prospective study,34 patients from 1/07/2013 to 30/06/2019. Results: 58,8% cases were males. The most common symptoms were failure to develop heightand weight for 64,7% and 73,5%, respectively. Ultrasound examinations reveal a higher degree, stage 2b and 3 were the most frequent according to Hoyer’s grading. Mean GFR was 101,2 ± 27,5 ml/min/1,73 m2 in presentation.There were 35,3% patients with hypercalciuria and 38,2% cases had sterile pyuria. During a median follow – up of 30 months in 24 patients, growth index improved more than -2SD in 60%,mean GFR 105,2 ± 22 ml/min/1,73 m2 in follow - up. The most common leading cause to NC was renal tubular acidosis in 50% followed by primary hypercalciuria and the cause of NC remained unknown (14,7%). Other causes included vitamin D excess, bartter syndrome, nephrocalcinosis - hypercalciuria -hypomagiemia, hypophosphomia ricket. Conclusions:nephrocalcinosis is a rare disease, and clinical signs are atypical.Growth retardation was the most common clinical manifestation andthe most popular cause of this condition in our study is renal tubular acidosis. There was significant increase in height and weight from the first to last observation. GFR remained stable within a long - term.

P0325FREQUENCY AND PREDICTORS OF NON URINARY INFECTIONS AMONG THE ADULT PATIENTS WITH STERILE PYURIA ATTENDED IN NEPHROLOGY DEPARTMENT OF BSMMU, BANGLADESH

Background and Aims Urinalysis is a test commonly ordered, especially when the patient has a febrile illness. In most cases it provides useful information, but it can sometimes be misleading. A significant proportion of patients with acute febrile illness have transient pyuria without bacteuria. Identification and management of such cases could be improved by better predictive models.To determine predictors of non urinary infections in adult patients with sterile pyuria and to develop a preliminary predictive model. Method This cross sectional study was done in the department of Nephrology, BSMMU, during the period of September 2016 to August 2017. All adult patients with sterile pyuria were included in the study. A total number of 233 cases who had urinary WBCs >5 per high power field (HPF) with a negative culture were selected as sample by convenient sampling technique. We performed detailed clinical and laboratory investigations to identify potential causes of the sterile pyuria. Patients were then divided into two groups, those with causative factors within the urinary tract and those with causative factors outside of the urinary tract. Logistic regression was used to create a model to predict causative group. Results Most 196(84.1%) patients were found to have disorders related to urinary tract (Group A) and 37(15.9%) patients had infections outside of the urinary tract (Group B). Significant proteinuria and urinary casts were more common in Group A, while urinary WBCs>20/hpf and microscopic hematuria were more common in Group(B). All of these differences were statistically significant (p<0.05). In the logistic regression model patients with sterile pyuria with fever (OR 32.9) and/or pyuria with urinary WBC>20/HPF (OR 2.14) were more likely to involvement outside of the urinary tract. Those with urinary tract symptoms (OR 0.28) and/or proteinuria (OR 0.20) were more likely to have renal and urinary tract involvement. Conclusion In patients attended to the nephrology department, sterile pyuria was more likely to have its origin in the urinary tract if there were urinary tract symptoms and/or proteinuria and less likely if there was fever or urinary WBCs >20/hpf. Figure: Diagnosis of the study population (n=233) Figure : Bar diagram shows renal status of the study population P=0.047 P value reached from chi square test Multivariable logistic regression analysis for infections outside the urinary tract

Assessment of Asymptomatic Bacteriuria and Sterile Pyuria among Antenatal Attendants in hospitals in Northern Ghana

Background Asymptomatic bacteriuria (ASB) and sterile pyuria (SP) are complexities of UTI whose prevalence are not known in the northern sector of Ghana. Our aim was to determine the occurrence of sterile pyuria and asymptomatic bacteriuria among pregnant women accessing antenatal care at a secondary and tertiary care hospitals in Tamale, northern Ghana.Methods A cross sectional study was conducted by screening 530 pregnant women with no signs of acute urinary tract infection attending antenatal clinic for a period of 6 months. Midstream urine was collected for microscopy, quantitative urine culture and antibiotic susceptibility testing. Data analysis was carried out using the Statistical Package for Social Sciences version 20.Results Of the 390 and 90 women screened for ASB, prevalence was 20% and 35.5% respectively at Tamale Central and Tamale Teaching Hospital. Sterile pyuria was found among 66% of the 50 women presenting at Tamale Central Hospital. More than 64% of isolates recovered from ASB patients were S. aureus and coagulase negative Staph. ( CoNS ). Escherichia coli was the dominant species among members of the enterobacteriaceae isolated. Highest susceptibility was recorded against gentamicin and amikacin while most resistance was to Ampicillin, cotrimoxazole, chloramphenicol and nitrofurantoin. Resistance to imipenem and vancomycin were 28.8% and 52%, with strains showing multiple drug resistance of between 81-92%.Conclusion The prevalence of asymptomac bacteriuria is appreciably higher (20-35.5%) than documented rates in the southern sector of the country. The presence of sterile pyuria which may be an indication of asymptomatic renal impairment and most often overlooked in antenatal management is 66%. Empirical treatment of UTIs at the Tamale Central and Teaching Hospital without confirmation of susceptibility may result in treatment failure. It is necessary to screen and treat pregnant women for ASB and SP due to the complications associated with these conditions.

Assessment of Asymptomatic Bacteriuria and Sterile Pyuria among Antenatal Attendants in hospitals in Northern Ghana

Background Asymptomatic bacteriuria (ASB) and sterile pyuria (SP) are complexities of UTI whose prevalence are not known in the northern sector of Ghana. Our aim was to determine the occurrence of sterile pyuria and asymptomatic bacteriuria among pregnant women accessing antenatal care at a secondary and tertiary care hospitals in Tamale, northern Ghana.Methods A cross sectional study was conducted by screening 530 pregnant women with no signs of acute urinary tract infection attending antenatal clinic for a period of 6 months. Midstream urine was collected for microscopy, quantitative urine culture and antibiotic susceptibility testing. Data analysis was carried out using the Statistical Package for Social Sciences version 20.Results Of the 390 and 90 women screened for ASB, prevalence was 20% and 35.5% respectively at Tamale Central and Tamale Teaching Hospital. Sterile pyuria was found among 66% of the 50 women presenting at Tamale Central Hospital. More than 64% of isolates recovered from ASB patients were S. aureus and coagulase negative Staph. ( CoNS ). Escherichia coli was the dominant species among members of the enterobacteriaceae isolated. Highest susceptibility was recorded against gentamicin and amikacin while most resistance was to Ampicillin, cotrimoxazole, chloramphenicol and nitrofurantoin. Resistance to imipenem and vancomycin were 28.8% and 52%, with strains showing multiple drug resistance of between 81-92%.Conclusion The prevalence of asymptomac bacteriuria is appreciably higher (20-35.5%) than documented rates in the southern sector of the country. The presence of sterile pyuria which may be an indication of asymptomatic renal impairment and most often overlooked in antenatal management is 66%. Empirical treatment of UTIs at the Tamale Central and Teaching Hospital without confirmation of susceptibility may result in treatment failure. It is necessary to screen and treat pregnant women for ASB and SP due to the complications associated with these conditions.