Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034186 (pyelonephritis)
 6,144 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Emergence, during therapy, of fungi resistant to amphotericin B is purportedly rare, as fungi with altered cell membrane ergosterol content are considered too fragile to survive normal host defenses. Progressive amphotericin B resistance arose in a strain of Candida tropicalis isolated repeatedly from the urine of a patient with pyelonephritis. The most resistant isolate (R-2) lacked cell membrane ergosterol, the usual attachment site for amphotericin B, and was not inhibited by greater than 500 micrograms/ml of the drug. R-2 infected and killed embryonated eggs, but was unable to produce progressive renal infection in steroid-treated mice because of a reduced capacity to produce pseudomycelia. Persistent infection of the patient by this altered fungus was attributed to defective leukocyte candidacidal activity, especially marked in autologous serum, and to defective Candida-related cell-mediated immunity. A literature review suggests that amphotericin B resistance may not be as rare as many authorities have indicated. It is apparent that few laboratories routinely monitor fungi for amphotericin B susceptibility. In patients with defective antimicrobial defenses, amphotericin B-resistant fungi may survive, produce progressive infection, and require alternative chemotherapy for eradication.
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PMID:Development of amphotericin B-resistant Candida tropicalis in a patient with defective leukocyte function. 72 19

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