Relationship of vaginal microflora to PROM, pPROM and the risk of early-onset neonatal sepsis

BACKGROUND

Infections are among the most frequent causes of premature delivery and premature discharges of amniotic fluid. The vaginal ecosystem significantly contributes to the development of these conditions. Premature rupture of membranes (PROM) and preterm premature rupture of membranes (pPROM) are associated with an increased risk of intra-amniotic infection. The intra-amniotic infection negatively affects perinatal morbidity and mortality of newborns.

OBJECTIVES

Finding of relationship of vaginal microflora to PROM, pPROM and the risk of early-onset neonatal sepsis.

METHODS

A prospective study was implemented in 152 women with singleton gestations with PROM (n=52) and pPROM (n=47); the control group included 53 women with physiologic pregnancy and delivery at normal term without PROM. In all the women, aerobic cultivations from the vagina and cervix for Chlamydia trachomatis were provided before initiation of antibiotic treatment, the microbial picture of vagina was examined, and the cultivation examination of urine was carried out. The placenta was subjected to histopathologic examination. For the diagnosis of early-onset sepsis, we used concentrations of cytokines IL-6, IL-8, TNF-alpha, and the adhesion molecule, ICAM-1, from the venous umbilical blood taken immediately after delivery and cutting of the umbilical cord. Demonstrated early neonatal sepsis served as a further criterion.

RESULTS

The most frequent bacteriologic findings throughout the group were coagulase-negative Staphylococci, Ureaplasma, Candida albicans, and Streptococcus viridans. Women with a diagnosis of urinary tract infection or diabetes mellitus were excluded from the study. We found no statistically significant relationship between a specific bacterial strain and PROM and pPROM. We found a statistically significant association between the risk for intra-amniotic infection and the finding of S. viridans (p<0.001). There was also a statistically significant relationship between the microbiologic picture of the vagina VI and infection risk (p<0.002).

CONCLUSIONS

Based on results of the present study, it is clear that the use of cultivation and microscopic findings in the vagina and cervix for the timely diagnosis of the risk of early-onset neonatal sepsis is restricted.

[Clinical characteristics in patients with purple urine bag syndrome]

Purple urine bag syndrome (PUBS) occurs predominantly in chronically catheterized and constipated patients. This syndrome is associated with bacterial urinary tract infections that produce sulfatase or phosphatase. Tryptophan is converted to indole and indigo-producing bacteria have indoxyl phosphatase or sulfatase that can produce indigo (blue) and/or indirubin (red) in patients with urinary tract infection. To further explore the metabolism of these amino acids, we evaluated the serum levels of amino acids in patients with PUBS. A total of 15 patients were enrolled in this case-control study (PUBS-positive case group: 5 patients, PUBS-negative control group: 10 patients). Data from urine tests (pH, sugar, protein, leukocyte counts), renal functions (BUN, creatinine), serum levels of amino acids, and performance status were compared between the two groups. No significant differences were seen between the two groups in urine sugar, protein, leukocyte counts, renal functions, and performance status. The mean urine pH was significantly higher in PUBS patients than in control patients (8.5+/-0.0 vs. 7.3+/-1.16, respectively, p=0.0321), and serum levels of alpha-aminobutyric acid were significantly higher in PUBS patients than in control patients (16.2+/-3.08 vs. 12.4+/-3.20, respectively, p=0.0275). These data suggest that strong alkaline urine acts as an important factor in PUBS, in combination with other facilitating factors.

Serum levels of soluble HLA and IL-2R molecules in patients with urogenital chlamydia infection

Cellular immunity plays a central role in immune response to chlamydial infection, and soluble forms of immune cell membrane antigens take part in the regulation of immune response. Using an immunoenzymatic method, we determined serum levels of soluble HLA molecules (sHLA-I and sHLA-DR) and soluble CD25 molecules (sCD25) in patients with genital chlamydial infection. Specimens from patients with nonspecific inflammation of the urogenital tract were studied and healthy volunteers served as controls. We revealed that serum levels of sHLA-DR and sCD25 increased 3.5- and 2.3-fold, respectively, during chlamydial infection, while the levels of sHLA-I were not changed. Nonspecific inflammation of the urogenital tract was characterized by a 1.5-fold increase in sHLA-I, a 1.6-fold decrease in sCD25, and no changes of sHLA-DR levels in comparison with healthy volunteers. We concluded that Th1 immune responses might dominate during genital chlamydial infection contrary to the state of nonspecific inflammation of urogenital tract.

The classical complement pathway plays a critical role in the opsonisation of uropathogenic Escherichia coli

Urinary tract infection due to uropathogenic Escherichia coli is a common clinical problem. The innate immune system and the uroepithelium are critical in defence against infection. The complement system is both part of the innate immune system and influences the interaction between epithelium and pathogen. We have therefore investigated the mechanism by which uropathogenic E. coli activate complement and the potential for this to occur during clinical infection. The classical pathway is responsible for bacterial opsonisation when complement proteins are present at low concentrations. At higher concentrations the alternative pathway predominates but still requires the classical pathway for its initiation. In contrast the mannose binding lectin pathway is not involved. Early classical pathway components are present in the urine during infection and actively contribute to bacterial opsonisation. The classical pathway could be initiated by anti-E. coli antibodies of IgG or IgM subclasses that are present in urine during infection. Additionally immunoglobulin-independent mechanisms, such as direct C1q binding to bacteria, may be involved. In conclusion, uropathogenic E. coli are readily opsonised by complement in a classical pathway dependent manner. This can occur within the urinary tract during the development of clinical infection.

Adjuvant effect of vitamin A on recurrent lower urinary tract infections

BACKGROUND

The purpose of the present paper was to investigate the effects of vitamin A supplementation on recurrent lower urinary tract infections (RUTI).

METHODS

Twenty-four patients with non-complicated RUTI were included in a placebo-controlled, double-blinded study. Twelve patients received a single dose of 200,000 IU vitamin A in addition to antimicrobial therapy. Patient and control groups (each containing 12 patients) were followed for up to 1 year and were evaluated for eradication and frequency of lower urinary tract infections (UTI). Serum levels of vitamin A and beta-carotene were determined periodically.

RESULTS

During the first 6 months follow-up period the infection rate of the vitamin A-supplemented group reduced from 3.58 to 0.75 per 6 months, and in the subsequent 6 months the infection rate was 1.75 per 6 months. These values were calculated as 2.75, 2.83 and 2.66, respectively, in the placebo group.

CONCLUSION

Vitamin A supplementation may have an adjuvant effect on the treatment of RUTI.

Primary urinary tract infection in infants: prophylaxis for uncomplicated pyelonephritis

BACKGROUND

Urinary tract infection (UTI) is one of the most common causes of unexplained fever in infants with a reported prevalence range of 5-11%. The clinical and laboratory findings were reviewed, and diagnosis and treatment for 95 infants with primary UTI were evaluated in this study.

METHODS

All patients underwent renal ultrasonography, voiding cystourethrogram and 99mTc dimercaptosuccinic acid (DMSA) scan during hospitalization before treatment, with treatment consisting of 2- or 4-week appropriated antibiotic therapy for the patients associated upper UTI, followed by a second DMSA scan 6 months after therapy.

RESULTS

In the present study the main symptom of UTI in infants was fever. High white blood cell count was not necessarily present, and urinalysis was also an imperfect diagnostic tool for discriminating UTI. In addition, colony count from urine culture and kidney ultrasonography was not efficacious in terms of predicting the occurrence of pyelonephritis. Intravenous antibiotic for 1 week followed by 3 weeks of the same oral antibiotic provided good prophylaxis for uncomplicated pyelonephritis.

CONCLUSION

Four weeks of antibiotic treatment resulted in good recovery from pyelonephritis in the present sample of infant primary UTI cases. voiding cystourethrogram, DMSA and ultrasonography scanning should be performed in primary infant UTI.

Platelet aggregation and aspirin non-responsiveness increase when an acute coronary syndrome is complicated by an infection

BACKGROUND

Epidemiologic studies have shown that there is an association between acute respiratory infection and acute coronary syndrome. The aim of this study was to analyze the thrombotic risk, assessed by platelet aggregation and aspirin non-responsiveness, in patients with an acute coronary syndrome complicated by an infection.

METHODS

Patients with an acute coronary syndrome who were admitted to the intensive care unit and hospitalized for at least 3 days in 2002 and 2003 were eligible for the study. Three hundred and fifty-eight patients were included, of whom 66 had an infection during their hospital stay. Platelet aggregation was analyzed by an aggregometer using laser light (PA-200, laser light scattering). Aspirin non-responsiveness was defined as a closure time of

RESULTS

Platelet aggregation was more pronounced during an infectious complication (P < 0.001). The subgroups of patients with persistent fever, urinary tract infection, and pneumonia all had a higher level of aggregates than the group of patients without an infection (P = 0.007, P = 0.04, and P = 0.01, respectively). Aspirin non-responsiveness was more frequent in the group of subjects with pneumonia compared with those without an infection, 90% vs. 46% (P = 0.006). The CRP levels were independently associated with platelet aggregation and aspirin non-responsiveness (P < 0.001, P < 0.001, respectively).

CONCLUSION

An infectious complication during the course of an acute coronary syndrome leads to more pronounced platelet aggregation. Aspirin non-responsiveness is more frequent in severe infections, such as pneumonia. CRP is an independent predictor of platelet aggregation and aspirin non-responsiveness in the setting of an acute coronary syndrome.

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Key Words Collapse

MESH Headings

• Acute Disease
• Aged
• Aged, 80 and over
• Aspirin/pharmacology
• Aspirin/therapeutic use
• Biomarkers/blood
• C-Reactive Protein/metabolism
• Drug Resistance
• Female
• Humans
• Linear Models
• Male
• Middle Aged
• Myocardial Ischemia/blood
• Myocardial Ischemia/complications
• Myocardial Ischemia/drug therapy
• Platelet Aggregation/drug effects
• Platelet Aggregation Inhibitors/pharmacology
• Platelet Aggregation Inhibitors/therapeutic use
• Platelet Function Tests
• Pneumonia/blood
• Pneumonia/complications
• Predictive Value of Tests
• Prognosis
• Risk Assessment
• Severity of Illness Index
• Syndrome
• Thrombosis/blood
• Thrombosis/etiology
• Thrombosis/prevention & control
• Treatment Failure
• Urinary Tract Infections/blood
• Urinary Tract Infections/complications

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Procalcitonin and pyelonephritis in children

PURPOSE OF REVIEW

In the past few years, procalcitonin has been proposed as a sensitive and specific inflammatory marker in various fields of medicine, especially in infectivology, where it has been used to discriminate between bacterial infections, viral infections and inflammation processes. Recently, different studies have emerged in the literature on the use of this marker to identify renal involvement in febrile urinary tract infections.

RECENT FINDINGS

Procalcitonin seems to be a valid biological marker, with an acceptable sensitivity and specificity, which predicts a renal involvement of the infection (pyelonephritis), in comparison with the low specificity of C-reactive protein. Procalcitonin also seems to be correlated with the degree of the involvement at the moment of diagnosis of febrile urinary tract infections and with scarring.

SUMMARY

Renal involvement has always been the main diagnostic objective in children with febrile urinary tract infections. If more studies confirm the correlation between procalcitonin, renal involvement during urinary infections and scar formation, we will finally have a noninvasive tool that can identify children at risk of complications and in need of a close follow-up as early as their first episode of febrile urinary tract infection.

The effect of ABO-Rh blood group determinants on urinary tract infections

BACKGROUND

Blood group antigens are a group of carbohydrate determinants found on erythrocytes, phagocytes, lymphocytes and certain epithelial tissues including urothelium. There are several publications that defines enhanced bacterial adhesions due to genetic markers such as blood group types.

METHODS

The ABO-Rh blood group distribution of patients with UTI and Escherichia coli(+) urine culture were compared with ABO-Rh blood group distribution of our country.

RESULTS

The distribution of blood groups was as follows; 36.6% A Rh+, 4.9% A Rh-, 12.2% B Rh+, 2.4% B Rh-, 31.7% O Rh+, 2.4% O Rh-, 4.9% AB Rh+, respectively; and none with AB Rh- blood group. There was a significant correlation between our study group and ABO-Rh phenotypes distribution of Turkish population.

CONCLUSIONS

The concordance of UTI with blood group ARh+ may be due to the most seen of ARh+ phenotype in the investigated population. We suggest that before defining the relationships on genetical markers, it would be more reliable to correlate them with their local distributions in the population.

Procalcitonin to reduce the number of unnecessary cystographies in children with a urinary tract infection: a European validation study

OBJECTIVE

To validate high serum procalcitonin (PCT) as a predictor of vesicoureteral reflux (VUR) in children with a first febrile urinary tract infection (UTI).

STUDY DESIGN

This secondary analysis of prospective hospital-based cohort studies included children ages 1 month to 4 years with a first febrile UTI.

RESULTS

Of the 398 patients included in 8 centers in 7 European countries, 25% had VUR. The median PCT concentration was significantly higher in children with VUR than in those without: 1.6 versus 0.7 ng/mL (P = 10(-4)). High PCT (> or =0.5 ng/mL) was associated with VUR (OR: 2.3; 95% CI, 1.3 to 3.9; P = 10(-3)). After adjustment for all cofactors, the association remained significant (OR: 2.5; 95% CI, 1.4 to 4.4; P = 10(-3)). The strength of the relation increased with the grade of reflux (P = 10(-5)). The sensitivity of procalcitonin was 75% (95% CI, 66 to 83) for all-grade VUR and 100% (95% CI, 81 to 100) for grade > or =4 VUR, both with 43% specificity (95% CI, 37 to 48).

CONCLUSIONS

High PCT is a strong, independent and now validated predictor of VUR that can be used to identify low-risk patients and thus avoid one third of the unnecessary cystourethrographies in children with a first febrile UTI.

Incidence of nosocomial urinary tract infections on a surgical intensive care unit and implications for management

The incidence of nosocomial infections (NIs) in our surgical intensive care unit was evaluated with special consideration of nosocomial urinary tract infections (NUTIs). The trial was a prospective, single-centre, 6-month cohort study. Infections according to CDC criteria, pathogens, devices, APACHE II scores, infection parameters and urinalysis were noted. In total, 420 patients (1543 patient days) were evaluated. Of these, 25% had 160 infections of which 110 were NIs. Mean APACHE II score in all infected patients was 16 versus 12 in non-infected patients (P<0.0001). Of the NIs, 25% were not ICU acquired and 75% were ICU acquired. UTIs accounted for 28% of the NIs, lower respiratory tract infections for 21%, pneumonia for 12% and bloodstream infections for 11%. The rates of urinary-catheter-associated UTIs varied between 4.2 (symptomatic UTI) and 14.0 (asymptomatic UTI). Although asymptomatic NUTI usually deserves no therapy, it needs to be considered carefully in terms of its environmental impact on the emergence of bacterial resistance.

Expression of interleukin-8 receptors (CXCR1 and CXCR2) in premenopausal women with recurrent urinary tract infections

The migration of neutrophils through infected tissues is mediated by the CXC chemokines and its receptors (CXCR1 and CXCR2). It has been proposed that a CXCR1 deficiency could confer susceptibility to acute pyelonephritis in children. The objective of the study is to assess the surface expression of CXCR1 and CXCR2 and the existence of polymorphisms in the CXCR1 gene in premenopausal women with recurrent urinary tract infections. The study included 20 premenopausal women with recurrent urinary infections, with normal urinary tracts, and without diseases potentially associated with relapsing urinary infections and 30 controls without previous urinary infections. The levels of CXCR1 and CXCR2 expression on neutrophils were measured and analyzed by flow cytometry by measuring the mean fluorescence intensity (MFI) channel. The promoter and coding regions of the CXCR1 gene were analyzed for the presence of polymorphisms by a sequence-based typing method. Patients with recurrent urinary tract infections exhibited median levels of CXCR1 expression, determined from MFI values, similar to those of the controls. The analysis of CXCR2 showed that patients with recurrent urinary infections had lower median levels of expression, determined from the MFI values, than the controls (P = 0.002, Mann-Whitney U test). No polymorphisms were detected at the promoter or at the exon 1 region of the CXCR1 gene either in the patients or in the controls. Polymorphisms were detected at the exon 2 of CXCR1, but their frequencies did not differ between patients and controls. We have found a low level of CXCR2 expression in patients with recurrent urinary tract infections. These results suggest that a low level of CXCR2 expression may increase the susceptibilities of premenopausal women to urinary tract infections.

Clearance of Linezolid via Continuous Venovenous Hemodiafiltration

BACKGROUND

Linezolid is being used increasingly for life-threatening vancomycin-resistant infections in critically ill patients. Limited data suggest that linezolid is cleared by intermittent hemodialysis. However, information on clearance of linezolid by continuous renal replacement therapy is limited. A patient undergoing continuous venovenous hemodiafiltration (CVVHDF) was evaluated to determine linezolid clearance through CVVHDF.

METHODS

A 33-year-old man with necrotizing fasciitis and acute-on-chronic renal failure requiring CVVHDF was treated with linezolid, 600 mg every 12 hours, for a vancomycin-resistant urinary tract infection. The study was performed on day 4 of therapy after a 1-hour infusion of linezolid. A series of blood samples and all urine and diafiltrate were collected during a 12-hour period. Linezolid concentrations were determined by using high-performance liquid chromatography assay. Linezolid clearance through CVVHDF was determined by using 2 methods. Method 1 evaluated the amount of drug recovered in diafiltrate. Method 2 evaluated plasma drug concentrations in prefilter and postfilter (PAN-10 Hemofilter; Asahi Medical Co, Tokyo, Japan) samples.

RESULTS

Clearance of linezolid through CVVHDF was 15.6 mL/min by method 1 and 21.6 mL/min by method 2. Total-body clearance was 189 mL/min. The amount of linezolid recovered in diafiltrate was 50 mg (8.3% of the dose).

CONCLUSION

Clearance of linezolid through CVVHDF in this patient was marginal. It does not appear that supplemental dosing of linezolid is necessary in patients undergoing CVVHDF.

Clinical significance of serum procalcitonin levels in patients with acute or chronic liver disease

OBJECTIVE

To evaluate the diagnostic value of serum procalcitonin levels in patients with acute or chronic liver disease, with or without bacterial infections and to correlate the results with the clinical outcome and the laboratory findings for these patients.

METHODS

One hundred and six consecutive hospitalized patients with liver disease were evaluated for procalcitonin levels on admission. Fifteen of them (14.2%) had acute alcoholic hepatitis on cirrhotic background (group A), 20 (18.9%) had alcoholic cirrhosis without hepatitis and/or bacterial infection (group B), 16 (15.1%) had decompensated cirrhosis with proved bacterial infection (group C), 42 (39.6%) had uncomplicated viral hepatitis-related cirrhosis (group D) and 13 (12.3%) had acute icteric viral hepatitis (group E). Serum procalcitonin levels were measured using an immunoluminometric assay. Statistical analysis was based on Student's t-test and the non-parametric Kruskall-Wallis test (P<0.05).

RESULTS

Serum procalcitonin levels were significantly higher in cirrhotic patients with bacterial infection (9.80+/-16.80 ng/ml) than in those without bacterial infection (0.21+/-0.13 ng/ml, P=0.001), whereas they were within normal range (<0.5 ng/ml) in all patients with uncomplicated cirrhosis, irrespective of the cause of cirrhosis. Seven of 15 group A patients (46.2%) and 4/13 group E patients (30.8%), all of them cirrhotics, had procalcitonin levels higher than 0.5 ng/ml on admission, without established bacterial infection.

CONCLUSION

Serum procalcitonin levels remain below the threshold of 0.5 ng/ml in all patients with uncomplicated cirrhosis, irrespective of the cause of the disease, while they are significantly elevated when bacterial infection complicates the course of the disease. A significant proportion of patients with acute alcoholic hepatitis on a cirrhotic background as well as of patients with acute on chronic viral hepatitis, without bacterial infection, exhibit serum procalcitonin levels above 0.5 ng/ml, suggesting that this cut-off value is probably not enough to discriminate between patients with or without bacterial infection within these subgroups of patients with liver disease.

Impact of tight glycemic control in severely burned children

BACKGROUND

Control of hyperglycemia has been shown to decrease mortality in critically ill adults, but the benefits of strict glucose control have not been established in children. Since January 2002, our pediatric burn center has adopted a policy of 'intensive' insulin therapy to achieve blood glucose levels 90 to 120 mg/dL. The purpose of this study was to examine the impact of this practice on patient outcomes.

METHODS

We reviewed the records of children with > or =30% total body surface area (TBSA) burn injury admitted to our regional pediatric burn center from July 1, 2000 to June 31, 2003. Patients were grouped into 'conventional insulin therapy' for the 2000 to 2001 period (n = 31) and into 'intensive insulin therapy' for the 2002 to 2003 period (n = 33). The efficacy of glucose control, infection rates, and patient survival were compared for the two therapies.

RESULTS

The demographic characteristics and injury severity were similar between the conventional and intensive insulin therapy groups. Children receiving intensive insulin therapy had glucose levels of 90 to 120 mg/dL more consistently than those in the conventional insulin therapy group. There was a significant decrease in urinary tract infections among intensive insulin therapy patients. TBSA burn, percent full-thickness burn, and Pediatric Risk of Mortality scores were negatively related to survival; intensive insulin therapy was positively associated with survival.

CONCLUSION

Intensive insulin therapy to maintain normoglycemia in severely burned children can be safely and effectively implemented in the burn unit. This therapy seems to lower infection rates and improve survival. Intensive insulin therapy should be considered for children with severe burn injuries.

Uroperitoneum in 32 foals: influence of intravenous fluid therapy, infection, and sepsis

Foals may present to a referral hospital with the primary diagnosis of uroperitoneum (UP), or they may develop UP while hospitalized for other reasons. Historical, physical, laboratory, and diagnostic variables of foals presenting with UP were compared to those developing UP while hospitalized. Emphasis was placed on the presence of electrolyte abnormalities, evidence of sepsis or infection, and development of anesthetic complications during surgical correction of the defect. Foals developing UP while in the hospital frequently had a history of dystocia and presented at a very young age (< 48 hours) with primary clinical signs compatible with intrauterine compromise or presumed hypoxic or ischemic insult with or without sepsis. Foals referred with suspected UP often had additional problems unrelated to the urinary system. These foals had hyponatremia and hyperkalemia on presentation, whereas foals receiving intravenous fluid therapy consisting of a balanced electrolyte solution did not develop the classical pattern of electrolyte abnormalities, yet a similar increase in serum creatinine and, frequently, decreasing urine production were noted. Infection was present in 63% of the foals, and 78% of foals revealed signs suggestive of sepsis or infection. Intrauterine compromise, presumed hypoxia or ischemia, and sepsis may predispose foals to development of UP. Anesthetic complications occurred in 16% of the foals undergoing surgical correction of the defect, although hyperkalemia was only present in half of the foals with anesthetic complications.

Thrombocytosis accompanying urinary tract infection suggests obstruction or abscess

OBJECTIVE

Reactive thrombocytosis can be found in patients with different types of infections, including upper urinary tract infection (UTI). In this study, we determined whether thrombocytosis in patients with upper UTI is a random phenomenon or is related to complications associated with the UTI.

METHODS

We reviewed the charts of patients admitted to the urology department with a diagnosis of upper UTI and thrombocytosis (platelet count >500 x 10(9)/L) in the years 1991 to 2003 (study group). Patients admitted to the urology department in the year 2003 with a diagnosis of upper UTI without thrombocytosis served as the control group.

RESULTS

The study group consisted of 83 patients admitted to the urology department with a diagnosis of upper UTI and thrombocytosis (mean platelet count, 593 x 10(9)/L; SD, 88; range, 501-949). The control group consisted of 99 patients. An obstructed kidney was found in 54 patients (65%) of the study group and in 18 patients (18%) of the control group (P < .00001). Perinephric abscess was found in 7 patients (8%) in the study group compared with none in the control group (P < .003). The positive predictive value of thrombocytosis for kidney obstruction or abscess in patients with upper UTI was 71%. Nephrectomy of a nonfunctioning infected kidney was required in 6 patients of the study group (7%) and 2 of the control group (P = .14). In 26 patients (31%) of the study group, the finding of thrombocytosis preceded the diagnosis of the complication (by a median period of 3 days). In these patients, thrombocytosis was essentially an early marker for the complication.

CONCLUSIONS

Thrombocytosis in a patient with upper UTI is not a random phenomenon. It is a marker of kidney obstruction or perinephric abscess. The finding of thrombocytosis in a patient with upper UTI should alert the attending physician to actively search for these complications. Cross-sectional imaging study (abdominal ultrasonography or computed tomography) should be performed.

RENAL SCARRING IS ASSOCIATED WITH NONSECRETION OF BLOOD TYPE ANTIGEN IN CHILDREN WITH PRIMARY VESICOURETERAL REFLUX

PURPOSE

Nonsecretor status of blood type antigen has been associated with higher risk of urinary tract infection (UTI) in women. However its implication in the modern management for pediatric UTI remains unclear. We evaluate the impact of secretor status on clinical course in children with primary vesicoureteral reflux (VUR).

MATERIALS AND METHODS

From 1998 to 2002, 382 cases of primary VUR presented to our institute and were treated either surgically or nonoperatively in accordance with the American Urological Association guideline. Of these potential candidates 128 patients and their guardians volunteered to be entered into the study. Antiseptic swabs to collect saliva were sent to them. The secretor status was determined using the hemagglutination inhibition assay from the eluted saliva on the swabs and medical records of responders were evaluated retrospectively.

RESULTS

Secretor status was not associated with gender, VUR grade, presentation, history of breakthrough UTI, laterality of VUR and conservative vs surgical treatment. However, nonsecretor status weakly correlated with decreased split renal function and significantly correlated with the presence of focal renal scarring (40.9% vs 21.7% for children with and without scarring, respectively) as determined by technetium dimercapto-succinic acid renal scan.

CONCLUSIONS

These results demonstrate that secretor status represents unrecognized host disposition that affects the clinical course of primary VUR. Further study is needed to determine the significance of secretor status for clinical management and pathophysiology of VUR.

Effect of L-methionine supplementation on plasma homocysteine and other free amino acids: a placebo-controlled double-blind cross-over study

OBJECTIVE

The essential amino acid L-methionine is a potential compound in the prophylaxis of recurrent or relapsing urinary tract infection due to acidification of urine. As an intermediate of L-methionine metabolism, homocysteine is formed. The objective was to study the metabolism of L-methionine and homocysteine, and to assess whether there are differences between patients with chronic urinary tract infection and healthy control subjects.

DESIGN

A randomized placebo-controlled double-blind intervention study with cross-over design.

SETTING

Department of Nutritional Physiology, Institute of Nutrition in cooperation with the Department of Internal Medicine III, Friedrich Schiller University of Jena, Germany.

SUBJECTS

Eight female patients with chronic urinary tract infection and 12 healthy women (controls).

INTERVENTIONS

After a methionine-loading test, the volunteers received 500 mg L-methionine or a placebo three times daily for 4 weeks.

MAIN OUTCOME MEASURES

Serum and urinary concentrations of methionine, homocysteine, cystathionine, cystine, serine, glycine and serum concentrations of vitamin B12, B6 and the state of folate.

RESULTS

Homocysteine plasma concentrations increased from 9.4+/-2.7 micromol/l (patients) and 8.9+/-1.8 micromol/l (controls) in the placebo period to 11.2+/-4.1 micromol/l (P=0.031) and 11.0+/-2.3 micromol/l (P=0.000), respectively, during L-methionine supplementation. There were significant increases in serum methionine (53.6+/-22.0 micromol/l; P=0.003; n=20) and cystathionine (0.62+/-0.30 micromol/l; P=0.000; n=20) concentrations compared with the placebo period (33.0+/-12.0 and 0.30+/-0.10 micromol/l; n=20). Simultaneously, renal excretion of methionine and homocysteine was significantly higher during L-methionine intake.

CONCLUSIONS

Despite an adequate vitamin status, the supplementation of 1500 mg of L-methionine daily significantly increases homocysteine plasma concentrations by an average of 2.0 micromol/l in patients and in control subjects. An optimal vitamin supplementation, especially with folate, might prevent such an increase.

[Leukemic reaction in the course of uterine myoma and urinary tract infection in pregnancy]

A leukaemic reaction is an increase of leukocytes count in peripheral blood between 20-50 G/l with significant percentage of immature white blood cells: metamyeloblasts, myelocytes and even myeloblasts in blood smear. The leukaemic reactions during cancers and many infections diseases, especially in the pregnancy, by their clinical symptoms and laboratory changes can imitate acute and chronic leukaemias. In this article we introduce a pregnant woman with the leukaemic reaction with leucocyte count 51 G/l and a presence of immature white blood cells with myeloblasts in peripheral blood smear. This leukaemic reaction was caused by inflammatory process in the myoma uteri and the urinary tract.

Procalcitonin as an early marker of infection in neonates and children

A child or neonate presenting with fever is a common medical problem. To differentiate between those with a severe bacterial infection and those with a localised bacterial or a viral infection can be a challenge. This review provides an overview of neonatal and paediatric studies that assess the use of procalcitonin as an early marker of bacterial infection. Procalcitonin is an excellent marker for severe, invasive bacterial infection in children. However, the use of procalcitonin in the diagnosis of neonatal bacterial infection is complicated, but if correctly used procalcitonin results in a higher specificity than C-reactive protein. In addition, procalcitonin has been shown to correlate with severity of disease (urinary tract infections and sepsis), and can therefore be used as a prognostic marker. Procalcitonin is therefore a useful additional tool for the diagnosis of bacterial disease in neonates and children.

The effects of acute infection on hematological parameters

This study was undertaken to investigate the effects of acute infections (e.g., upper respiratory tract infection, acute gastroenteritis, urinary tract infection) on total blood count, the relation of these effects with acute phase reactants, and the level of improvement in the total blood count after the resolution of acute infection. A total of 113 previously healthy children between the ages of 6 months and 12 years were enrolled in the study. The control group consisted of 43 healthy children with proper age and gender distribution. A total of 55.7% of the patients had a decrease of 0.10-2.40 g/dL in Hb values on the 3rd day of acute infections. The comparisons of the 1st, 3rd, and 15th day Htc, RBC, MCV, MCHC, RDW values of the study and control groups revealed no significant differences. 7he 1st day SI, SIBC, and TS values of the study group were low in majority of the patients. Then they gradually increased, finally reaching at their normal levels on the 15th day. There was no significant difference between the sTfR and sTfR/log ferritin values of the study and control groups.

Evaluation of cranberry supplement for reduction of urinary tract infections in individuals with neurogenic bladders secondary to spinal cord injury. A prospective, double-blinded, placebo-controlled, crossover study

OBJECTIVE

To determine the effectiveness of cranberry supplement at preventing urinary tract infections (UTIs) in persons with spinal cord injury (SCI).

DESIGN

A prospective, double-blinded, placebo-controlled, crossover study.

PARTICIPANTS

21 individuals with neurogenic bladders secondary to SCI.

MAIN OUTCOME MEASURES

Favorable or unfavorable response of cranberry supplement vs placebo on urinary bacterial counts and white blood cell (WBC) counts and the combination of bacterial and WBC counts.

METHODS

Individuals with neurogenic bladders due to SCI were recruited and randomly assigned to standardized 400-mg cranberry tablets or placebo 3 times a day for 4 weeks. After 4 weeks and an additional 1-week "washout period," participants were crossed over to the other group. Participants were seen weekly, during which a urine analysis was obtained. UTI was defined as significant bacterial or yeast colony counts in the urine and elevated WBC counts (WBC count > or = 10 per high power field) in centrifuged urine. Participants with symptomatic infections were treated with appropriate antibiotics for 7 days and restarted on the cranberry tablet/ placebo after a 7-day washout period. Urinary pH between the cranberry and placebo groups was compared weekly. Data were analyzed using the Ezzet and Whitehead's random effect approach.

RESULTS

There was no statistically significant treatment (favorable) effect for cranberry supplement beyond placebo when evaluating the 2 treatment groups for bacterial count, WBC count, or WBC and bacterial counts in combination. Urinary pH did not differ between the placebo and cranberry groups.

CONCLUSION

Cranberry tablets were not found to be effective at changing urinary pH or reducing bacterial counts, urinary WBC counts, or UTIs in individuals with neurogenic bladders. Further long-term studies evaluating specific types of bladder management and UTIs will help to determine whether there is any role for the use of cranberries in individuals with neurogenic bladders.