Pyuria: Difference between revisions
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:::: Note: Treat patient’s sex partner if trichomoniasis is diagnosed in patient. | :::: Note: Treat patient’s sex partner if trichomoniasis is diagnosed in patient. | ||
::* '''Fungal infections'''<ref name="pmid8824962">{{cite journal| author=Jacobs LG, Skidmore EA, Freeman K, Lipschultz D, Fox N| title=Oral fluconazole compared with bladder irrigation with amphotericin B for treatment of fungal urinary tract infections in elderly patients. | journal=Clin Infect Dis | year= 1996 | volume= 22 | issue= 1 | pages= 30-5 | pmid=8824962 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8824962 }} </ref> | ::* '''Fungal infections'''<ref name="pmid8824962">{{cite journal| author=Jacobs LG, Skidmore EA, Freeman K, Lipschultz D, Fox N| title=Oral fluconazole compared with bladder irrigation with amphotericin B for treatment of fungal urinary tract infections in elderly patients. | journal=Clin Infect Dis | year= 1996 | volume= 22 | issue= 1 | pages= 30-5 | pmid=8824962 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8824962 }} </ref> | ||
:::* Preferred regimen, ''Candida albicans'': [[Fluconazole]] 100 mg PO for 2-5 days | :::* Preferred regimen, ''Candida albicans'': [[Fluconazole]] 100 mg PO qd for 2-5 days | ||
:::*Preferred regimen, non-''albicans Candida'': [[Amphotericin B]] 0.1 mg/kg/day IV for 2-5 days {{or}} [[Amphotericin B]] bladder irrigation 5-50 mg/L of sterile water qd for 2-5 days | :::*Preferred regimen, non-''albicans Candida'': [[Amphotericin B]] 0.1 mg/kg/day IV for 2-5 days {{or}} [[Amphotericin B]] bladder irrigation 5-50 mg/L of sterile water qd for 2-5 days | ||
::* '''Schistosomiasis''' | ::* '''Schistosomiasis''' | ||
Revision as of 15:26, 6 October 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
To view a comprehensive algorithm of common findings of urine composition and urine output, click here
Overview
Pyuria refers to urine which contains pus. Defined as the presence of 10 or more neutrophils per high power field of unspun, voided mid-stream urine. It can be a sign of a bacterial urinary tract infection. Pyuria may be present in the septic patient, or in an older patient with pneumonia. Sterile pyuria is urine which contains white blood cells (pus) while appearing sterile by standard culture techniques. Sterile pyuria is listed as a side-effect from some medications such as paracetamol (acetaminophen).
Definition
Pyuria is defined as the presence of 10 or more white cells per cubic millimeter in a urine specimen, 3 or more white cells per high-power field of unspun urine, a positive result on Gram’s stain of an unspun urine specimen, or a urinary dipstick test that is positive for leukocyte esterase[1]
Classification
Pyuria may be classified based on the presence/absence of detectable infection as shown below:
- Sterile pyuria: the persistent finding of white cells in the urine in the absence of bacteria, as determined by means of aerobic laboratory techniques (on a 5% sheep-blood agar plate and MacConkey agar plate)[2]
- Bacteriuria: bacterial colony counts of more than 1000 colony-forming units (CFU) per milliliter in urine[3]== Causes==
In Alphabetical Order[4][5]
- Colpitis
- Cystitis
- Epididymitis
- Genitourinary tuberculosis
- Interstitial Nephritis
- Neoplasm
- Prostitis
- Pyelonephritis
- Renal Carcinoma
- Renal papillary necrosis
- Urethritis
- Vaginitis
- Vulvitis
Causes by Organ System
| Cardiovascular | No underlying causes |
| Chemical/Poisoning | No underlying causes |
| Dental | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | Thalidomide |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | No underlying causes |
| Hematologic | No underlying causes |
| Iatrogenic | No underlying causes |
| Infectious Disease | No underlying causes |
| Musculoskeletal/Orthopedic | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional/Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | No underlying causes |
| Ophthalmologic | No underlying causes |
| Overdose/Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal/Electrolyte | No underlying causes |
| Rheumatology/Immunology/Allergy | No underlying causes |
| Sexual | No underlying causes |
| Trauma | No underlying causes |
| Urologic | No underlying causes |
| Miscellaneous | No underlying causes |
Sterile Pyuria
Definition
- Sterile pyuria is defined as the persistent finding of white cells in the urine in the absence of detectable bacteria, as determined by means of aerobic laboratory techniques (on a 5% sheep-blood agar plate and MacConkey agar plate)[6]
- Note that sterile pyuria may still be caused by an infectious agent, but the inability to detect the agent on regular urine gram-stain and culture is diagnostic of sterile pyuria.
Causes
Pyuria may have either an infectious or a non-infectious etiology:[7]
- Infectious etiologies
- Gynecologic infection
- Urethritis due to chlamydia, Neisseria gonorrhoeae, mycoplasma, or ureaplasma
- Prostatitis
- Balanitis
- Appendicitis
- Viral infection of the lower genitourinary tract
- Genitourinary tuberculosis
- Fungal infection
- Parasitic disease such as trichomoniasis or schistosomiasis
- Non-infectious etiologies
- Current use of antibiotics
- Recently treated urinary tract infection (within past 2 weeks)
- Presence or recent use of a urinary catheter
- Recent cystoscopy or urologic endoscopy
- Urinary tract stones
- Foreign body such as surgical mesh in the urethra or a retained stent
- Urinary tract neoplasm
- Pelvic irradiation
- Urinary fistula
- Polycystic kidney
- Rejection of a renal transplant
- Renal-vein thrombosis
- Interstitial nephritis or analgesic nephropathy
- Papillary necrosis
- Interstitial cystitis
- Inflammatory disease such as systemic lupus erythematosus or Kawasaki’s disease===Antimicrobial regimen===
Treatment
- Sterile pyuria
- . Pathogen-directed antimicrobial therapy[8]
- Renal Tuberculosis
- Preferred regimen: (Isoniazid 300 mg PO qd for 2 months AND Rifampicin 450-600 mg qd for 2 months AND Ethambutol 15-25 mg/kg PO qd for 2 months AND Pyrazinamide 1500 mg for 2 months) THEN (Isoniazid 300 mg PO qd for 4-6 months AND Rifampicin 450-600 mg qd for 4-6 months)
- Gonorrhea
- Preferred regimen: Ceftriaxone 250 mg IM in a single dose THEN (Azithromycin 1 g PO in a single dose OR Doxycycline 100 mg PO bid for 7 days)
- Chlamydia
- Preferred regimen: Azithromycin 1 g PO in single dose OR Doxycycline 100 mg PO bid for 7 days
- Alternative regimen: Erythromycin base 500 mg PO qid for 7 days
- Mycoplasma and Ureaplasma
- Preferred regimen: Azithromycin OR Levofloxacin OR Moxifloxacin
- Genital herpes
- Preferred regimen: Acyclovir 400 mg PO tid for 7–10 days or Acyclovir 200 mg PO five times a day for 7–10 days OR Famciclovir 250 mg PO tid for 7–10 days OR Valacyclovir 1 g PO bid for 7 days
- Trichomoniasis
- Preferred regimen: Metronidazole 2 g PO in a single dose OR Tinidazole 2 g PO in a single dose
- Note: Treat patient’s sex partner if trichomoniasis is diagnosed in patient.
- Fungal infections[9]
- Preferred regimen, Candida albicans: Fluconazole 100 mg PO qd for 2-5 days
- Preferred regimen, non-albicans Candida: Amphotericin B 0.1 mg/kg/day IV for 2-5 days OR Amphotericin B bladder irrigation 5-50 mg/L of sterile water qd for 2-5 days
- Schistosomiasis
- Preferred regimen: Praziquantel 20 mg/kg PO bid for 1–2 days
References
- ↑ Horan, Teresa C.; Andrus, Mary; Dudeck, Margaret A. (2008-06). "CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting". American Journal of Infection Control. 36 (5): 309–332. doi:10.1016/j.ajic.2008.03.002. ISSN 1527-3296. PMID 18538699. Check date values in:
|date=(help) - ↑ Wise, Gilbert J.; Schlegel, Peter N. (2015-03-12). "Sterile pyuria". The New England Journal of Medicine. 372 (11): 1048–1054. doi:10.1056/NEJMra1410052. ISSN 1533-4406. PMID 25760357.
- ↑ Kwon, Jennie H.; Fausone, Maureen K.; Du, Hongyan; Robicsek, Ari; Peterson, Lance R. (2012-05). "Impact of laboratory-reported urine culture colony counts on the diagnosis and treatment of urinary tract infection for hospitalized patients". American Journal of Clinical Pathology. 137 (5): 778–784. doi:10.1309/AJCP4KVGQZEG1YDM. ISSN 1943-7722. PMID 22523217. Check date values in:
|date=(help) - ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
- ↑ Wise, Gilbert J.; Schlegel, Peter N. (2015-03-12). "Sterile pyuria". The New England Journal of Medicine. 372 (11): 1048–1054. doi:10.1056/NEJMra1410052. ISSN 1533-4406. PMID 25760357.
- ↑ Dieter, R. S. (2000). "Sterile pyuria: a differential diagnosis". Comprehensive Therapy. 26 (3): 150–152. ISSN 0098-8243. PMID 10984817.
- ↑ Wise, Gilbert J.; Schlegel, Peter N. (2015-03-12). "Sterile pyuria". The New England Journal of Medicine. 372 (11): 1048–1054. doi:10.1056/NEJMra1410052. ISSN 1533-4406. PMID 25760357.
- ↑ Jacobs LG, Skidmore EA, Freeman K, Lipschultz D, Fox N (1996). "Oral fluconazole compared with bladder irrigation with amphotericin B for treatment of fungal urinary tract infections in elderly patients". Clin Infect Dis. 22 (1): 30–5. PMID 8824962.