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Query: UMLS:C0034186 (pyelonephritis)
 6,144 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute, uncomplicated cystitis and pyelonephritis will readily yield to promptly instituted antimicrobial therapy. First, however, you need to rule out other causes of dysuria, including urethritis and vaginitis.
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PMID:Uncomplicated UTI in young women. 1015 Mar 14

Recently the 'Kwaliteitsinstituut voor de gezondheidszorg CBO' (Dutch Institute++ for Health Care Improvement) published revised guidelines on urinary tract infections. In children less than one year old clinical signs of urinary tract infection are non-specific and the diagnosis should be ruled out by laboratory investigations: a nitrite test, followed by inspection of the urinary sediment for leucocytes and bacteria if the test is negative. If one of the investigations is positive an urinary culture is made and antimicrobial therapy is started as for pyelonephritis. The child should be referred to a paediatrician to examine the urinary tract for anatomical abnormalities with a view to possible preventive measures regarding renal function loss. Boys older than one year with urinary tract infections should be managed in the same way as younger children. In older girls examination of the urinary tract is indicated after recurrent infection. In adult women with complaints of urinary tract infection causes like vaginitis, pyelonephritis and genital herpes should be excluded. Urine is examined (nitrite test, if negative followed by urinary sediment) to confirm the diagnosis. A urine culture is not indicated. First-choice treatment for uncomplicated infection is trimethoprim or nitrofurantoin. Persistent infection may be treated blind with a second antimicrobial drug. Recurrent infection can be prevented by changing behaviour, antimicrobial prophylaxis or oestrogen cream in postmenopausal women. If a man with micturition complaints also suffers from pain in the perineum, the lower back or the lower abdomen or during ejaculation, a distinction should be made between bacterial prostatitis, non-bacterial prostatitis and prostatodynia. Uncomplicated urinary infections can be treated with trimethoprim or nitrofurantoin. Urinary catheters are a risk for infection and their use should be restricted in number and duration. Catheter care should follow the guidelines of the Workgroup Infection Prevention. Urinary cultures should only be made in the presence of signs of infection if there is an indication for antimicrobial therapy.
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PMID:['Urinary tract infections'--revised CBO guideline. Dutch Institute for Quality Assurance]. 1080 May 55

Fever, like metrorrhagia or pelvic pain, should be a danger signal alerting women with IUDs to seek medical attention without delay. If the temperature is elevated and the clinical signs suggest salpingitis or pelvic infalmmation, the patient should be hospitalized to obtain a diagnostic and therapeutic laparoscopy, intravenous polyantibiotic treatment, and bed rest. A temperature of about 38 degrees Celsius associated with metrorrhagia suggests salpingitis, regardless of other clinical findings, particularly if the patient is under 25, has had several sexual partners, is nulliparous, or is an insulin-dependent diabetic. The diagnosis should be confirmed by laparoscopy. If a virus or flu is as likely to be the cause as a gynecological infection, blood tests and assay of sedimentation rates should be obtained; over 10,000 polynuclear forms, mainly neutrophils, and a sedimentation rate elevated beyond that expected by the fever are significant in diagnosis. A sonogram can be used to rule out endometrial or tubal infection. If doubt persists, the IUD should be removed and a careful laparoscopy performed to assess the extent and nature of lesions. If the IUD is removed, effective replacement contraception should be prescribed. The physician should not ignore a fever in a patient using an IUD, and should be available for consultation immediately. Removal of the device without further treatment is insufficient in case of gynecological infection because of the danger posed to subsequent fertility. The IUD should not be removed without a short and intensive antibiotic treatment. The possibility of a partner with urethritis should not be ignored, and the fever should not be attributed to vaginitis, even if it is a severe case. The possibility of a pregnancy with the device in place should be ruled out. If the strings are not visible, a sonogram should be obtained to locate the device. In diagnosing febrile patients, the possibility of appendicitis and pyelonephritis should also be considered.
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PMID:[Dos...don'ts...in the case of unexplained high temperature in an IUD user (author's transl)]. 1233 2

Bacteriologic examination of 1589 patients showed that, aside from C. diphtheriae, 11% of acute upper respiratory tract infections were caused by other Corynebacterium species. Such bacteria can cause infections of various localizations (bronchitis, pyelonephritis, urethritis, colpitis, dermatitis, arthritis, etc.). C. pseudodiphtheriticum and C. xerosis were isolated from clinical specimens most frequently. Corynebacterium spp. have adhesive, hemolytic, hemagglutinating, and neuraminidase activity; some of them are highly pathogenic. The most virulent, were following species: C. diphtheriae, C. pseudotuberculosis, C. urealyticum, and C. ulcerans. Corynebacterium non diphtheriae were frequently isolated from clinical specimens in association with staphylococci and streptococci. In such cases, factors of pathogenicity and resistance to antibiotics were more pronounced. Strains isolated with association with other bacteria have lost susceptibility to tetracycline, oleandomycin, penicillin, and erythromycin. It is important to be vigilant about bacteria from Corynebacterium genus in clinical settings, and thoroughly study their biologic characteristics, especially in immunocompromised patients.
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PMID:[Etiologic role of Corynebacterium non diphtheriae in patients with different pathology]. 1803 38

The most common cause of acute dysuria is infection, especially cystitis. Other infectious causes include urethritis, sexually transmitted infections, and vaginitis. Noninfectious inflammatory causes include a foreign body in the urinary tract and dermatologic conditions. Noninflammatory causes of dysuria include medication use, urethral anatomic abnormalities, local trauma, and interstitial cystitis/bladder pain syndrome. An initial targeted history includes features of a local cause (e.g., vaginal or urethral irritation), risk factors for a complicated urinary tract infection (e.g., male sex, pregnancy, presence of urologic obstruction, recent procedure), and symptoms of pyelonephritis. Women with dysuria who have no complicating features can be treated for cystitis without further diagnostic evaluation. Women with vulvovaginal symptoms should be evaluated for vaginitis. Any complicating features or recurrent symptoms warrant a history, physical examination, urinalysis, and urine culture. Findings from the secondary evaluation, selected laboratory tests, and directed imaging studies enable physicians to progress through a logical evaluation and determine the cause of dysuria or make an appropriate referral.
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PMID:Dysuria: Evaluation and Differential Diagnosis in Adults. 2655 71


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