1/22. Staghorn calculus in renal allograft presenting as acute renal failure.BACKGROUND: urolithiasis is a rare complication in renal transplant recipients. We report a case of a staghorn calculus occurring in renal allograft, presenting as anuric renal failure with Gram-negative sepsis. methods AND RESULTS: A 48-year-old Caucasian female, with end-stage renal disease due to autosomal dominant polycystic kidney disease, underwent cadaveric renal transplantation in 1986. Sixteen years after transplant, she presented with Gram-negative sepsis with proteus mirabilis and acute anuric renal failure in the allograft. After undergoing an emergency nephrostomy and treatment of sepsis, a staghorn calculus was subsequently removed by percutaneous nephrolithotomy. Based on the stone analysis and history of urinary tract infections with urease splitting bacteria, the calculus was thought to be infection-induced. CONCLUSION: Although a rare complication, urolithiasis in an allograft can be associated with significant morbidity. Immediate recognition is critical to restore renal allograft function and to treat associated serious infection in an immunocompromised patient.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
2/22. proteus mirabilis spondylodiscitis complicating a urinary tract infection.Infectious spondylodiscitis results from local or haematogenous infection by microorganisms of intervertebral disc spaces, vertebral bodies and surrounding structures. Haematogenous invasion may follow urosepsis. We report on a case of septic spondylodiscitis following urosepsis with proteus mirabilis, a frequently isolated microorganism in urinary tract infections but rarely in spondylodiscitis.- - - - - - - - - - ranking = 5keywords = tract (Clic here for more details about this article) |
3/22. endocarditis due to enteric bacilli other than Salmonellae: case reports and literature review.The clinical and pathological findings in two recent patients with non-salmonella enterobacterial endocarditis are described, and those of 42 patients in the literature are summarized. Most of the patients acquired their endocarditis secondary to urinary tract infection and had an acute clinical course characterized by high fever and chills. Thirty-two of these patients died, and all except one had a postmortem examination. The most frequent pathological finding was the occurrence of very large vegetations which caused relatively little destruction of the underlying valve. Prompt diagnosis and antibiotic therapy chosen on the basis of bactericidal as well as bacteriostatic activity against the individual bacterium may improve the prognosis in this disease. Results of tricuspid and pulmonic valvulectomies for bacteriologic failure in pseudomonas and in a few cases of enterobacterial endocarditis appear to warrant a surgical approach in patients with right-sided enterobacterial endocarditis who fail to respond to vigorous medical therapy.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
4/22. Gram-negative endocarditis following cystoscopy.patients with bacteriuria are at risk for local and distant infectious complications at the time of urologic procedures. The american heart association recommends that penicillin and streptomycin be given prophylactically to patients with rheumatic or congenital heart disease without reference to the presence or absence of bacteriuria. A patient with unrecognized calcification of the mitral annulus who underwent cystoscopy for evaluation of urinary retention is reported. Although bacteriuria was present preoperatively antibiotics were not given. Subsequently, serratia marcescens and possibly Proteus morgani mitral valve infection developed and the patient died. Calcification of the mitral valve annulus and an extensive urinary tract infection were identified at autopsy. This case suggests that calcification of the mitral annulus may be an endocarditis risk factor. The spectrum of prophylactic antibiotic coverage given at the time of urologic procedures to patients with congenital or aquired heart disease, including calcification of the mitral annulus, should include whatever organisms are present in the urine.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
5/22. Xanthogranulomatous pyelonephritis masquerading as occult malignancy.Xanthogranulomatous pyelonephritis (XGP) can present with weight loss, anemia, leukemoid reaction, and generalized debility; there may be no signs or symptoms referable to the urinary tract. confusion between XGP and renal adenocarcinoma is well recognized, but other malignancies can also be simulated. Case histories of patients with proved XGP whose clinical presentations suggested occult malignancies are recorded. Proteus urinary tract infection, calculi, and a nonvisualizing kidney on intravenous pyelogram should suggest the correct diagnosis. The pathology, bacteriology, diagnosis, and treatment are reviewed.- - - - - - - - - - ranking = 2keywords = tract (Clic here for more details about this article) |
6/22. Gram-negative septicemia caused by providencia stuartii.The role of urologic disease and manipulation of the genito-urinary tract in the pathogenesis of gram-negative bacteremia has been long recognized. Among these organisms, species of providencia genus have been increasingly reported. We describe a 17-year-old male paraplegic who developed septic shock due to providencia Stuartii following urinary tract manipulation and responding to medical therapy. This is unusual as most cases with septic shock from providencia species will succumb. It is important to review this case since providencia species appear to be increasingly common in paraplegic patients.- - - - - - - - - - ranking = 2keywords = tract (Clic here for more details about this article) |
7/22. Hyperammonemic coma due to Proteus infection.Hyperammonemic coma without liver disease or associated deficiencies in urea cycle enzymes is rare. We report a case and discuss the pathophysiological findings of hyperammonemic coma secondary to proteus mirabilis urinary tract infection.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
8/22. xanthine calculi in the patient with the lesch-nyhan syndrome associated with urinary tract infection.A Japanese boy with lesch-nyhan syndrome who passed xanthine calculi is reported. After pyelolithotomy for a left renal stone, made up of ammonium urate, associated with urinary tract infection, a high dose of allopurinol was given because of the persistence of pyuria. In the present case, the administration of a high dose of allopurinol, given for the prevention of ammonium urate stone formation in infected urine, induced xanthine calculi formation and we had difficulty in the management of this patient with lesch-nyhan syndrome associated with urinary tract infection. However, we believe it a basic necessity to cure our patient of his urinary tract infection and prevent recurrent ammonium urate stone formation because of the risk of renal deterioration.- - - - - - - - - - ranking = 7keywords = tract (Clic here for more details about this article) |
9/22. Clinical and laboratory study of tobramycin in the treatment of infections due to gram-negative organisms.tobramycin, an aminoglycoside antibiotic, was used to treat 52 infections due to gram-negative organisms in 51 patients. Complicated urinary tract infections, bacteremia and pyelonephritis accounted for 80% of the infections. The rate of immediate satisfactory response was 79%. During therapy with tobramycin, resistant organisms emerged in four patients--two pseudomonas aeruginosa and two escherichia coli strains. There were four superinfections with tobramycin-resistant providencia sp. In four seriously ill patients the serum creatinine concentration increased 1 mg/dL or more; in three the increase was transient. No auditory toxicity was noted in the 19 patients in whom serial audiograms were made. in vitro testing of isolates from these patients showed that tobramycin and gentamicin had equal activity against enterobacteriaceae. tobramycin was two to four times more active against susceptible P. aeruginosa.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
10/22. A review of providencia bacteremia in a general hospital, with a comment on patterns of antimicrobial sensitivity and use.Six cases of providencia bacteremia occurring between 1969 and 1978 were reviewed. These cases represented 3% of the gram-negative bacteremias occurring at one hospital. All six cases of providencia bacteremia were secondary to urinary tract infection with P. stuartii, and in most the infection developed only shortly before the onset of bacteremia; in three cases the bacteremia developed immediately following manipulation of the urinary tract. patients with long-standing providencia infections did not acquire bacteremia. The signs and symptoms of providencia bacteremia were typical of those of septicemia except that vascular collapse was not a prominent feature, occurring in only one patient. The mortality was 33%. All the providencia strains cultured from the bloodstream were susceptible to gentamicin, although the frequency of gentamicin resistance increased from roughly 10% to 50% during the period studied; the increase in gentamicin use over this period was more gradual. Also noted was a decrease in resistance to ampicillin that paralleled a decrease in ampicillin use. All the providencia strains were susceptible to amikacin.- - - - - - - - - - ranking = 2keywords = tract (Clic here for more details about this article) |
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