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Urinary tract disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
Leukocyte esterase (LE) is an enzyme found in white blood cells and its detection in the urine is a marker of their presence, i.e. pyuria. Unfortunately, pyuria has been found to be present in 32% of older (mean age 86), ambulant women without bacteriuria (possible alternative explanations include vaginitis) and in over 90% of this group with ASB.11
Urinary Tract Disease
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Symptoms and signs are indicative of the diagnosis, that needs to be confirmed by a positive urine culture with ≥ 100,000 CFU/mL. Pyuria or the presence of leukocyte casts are also consistent with the diagnosis. Urinary dipstick testing for leukocyte esterase and nitrites is often positive. Pathogens causing pyelonephritis are the same that cause lower UTIs [54, 60].
Drug-Induced and Other Acute Psychoses in an Emergency-Room Setting
Published in Ragy R. Girgis, Gary Brucato, Jeffrey A. Lieberman, Understanding and Caring for People with Schizophrenia, 2020
Ragy R. Girgis, Gary Brucato, Jeffrey A. Lieberman
Darrell, who provided the aforementioned background information, was distraught and said that he was upset that he had heard a doctor, who never actually met with her, refer to her as “psychotic” based upon perfunctory details. After our assessment, we ordered a routine set of blood and urine laboratories, discontinued the benzodiazepines, and ordered a one-time dose of 5mg of olanzapine. We also performed a spot urinalysis and noticed positive leukocyte esterase and nitrites, as well as small amounts of protein and red blood cells. Suspecting a urinary tract infection, we ordered a dose of piperacillin/tazobactam.
Accuracy of blood-tests and synovial fluid-tests in the diagnosis of periprosthetic joint infections
Published in Expert Review of Anti-infective Therapy, 2020
Emanuele Chisari, Javad Parvizi
Leukocyte esterase is another leukocyte-derived enzyme and has traditionally been used to help diagnose lower urinary tract infections in the inpatient and outpatient settings [70]. Part of the reason for its widespread usage and inclusion within the standard PJI diagnostic algorithm by the ICM is that it can be measured quickly and easily with a colorimetric strip (urinalysis dipstick) [71]. Furthermore, synovial fluid LE testing is the most inexpensive test available for PJI with an estimated cost of 0.17 USD per test [10]. Ultimately, the time request for the qualitative test is around the 2 minutes if the synovial fluid is clear, or five if centrifugation is needed to exclude blood cells, which can affect the color change results [72–74]. When this protocol is followed, LE has shown to be a useful diagnostic tool for PJI with a pooled sensitivity of 81% coupled with a specificity of 97% (Table 2.) using a ‘++’ reading as a threshold for PJI [10]. Another recent study compared the performance of LE using (+) and (++) as threshold along with standard diagnostic tests (including serum ESR, serum CRP, synovial fluid WBC, and PMN %) and found ‘++’ LE to have the highest test performance for diagnosing PJI (OR 30.06, 95% CI 17.8–50.7) [61].
Renal and perinephric abscesses involving Lactobacillus jensenii and Prevotella bivia in a young woman following ureteral stent procedure
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Abhinav Mohan, Jacob Rubin, Priyank Chauhan, Juan Lemos Ramirez, German Giese
In the emergency department, she presented with fevers (38.3 ⁰C) and tachycardia (117). Significant right abdominal and costovertebral angle tenderness were present on the exam. Complete blood count showed mild leukocytosis (11.4). Urinalysis showed rare bacteria with negative leukocyte esterase, and urine culture was negative. CT abdomen/pelvis with contrast showed enlarged right kidney with a 4 cm renal cyst, as well as a complicated right-sided perinephric fluid collection, suspicious for abscess or hematoma (Figure 1). She was admitted for sepsis and started on cefepime and vancomycin. A percutaneous drain was placed into the renal cyst, and purulent fluid was removed. Cultures of the drained fluid grew Lactobacillus, Streptococcus viridans species, and ‘mixed anaerobes’. Blood cultures grew Lactobacillus jensenii on anaerobic media. This was confirmed by both rapid ANA sequencing and MALDI-TOF Mass Spectrometry.
Urine dipstick low sensitivity for UTI diagnosis in febrile infants**
Published in Infectious Diseases, 2019
Idan Lendner, Naphtali Justman, Noga Givon-Lavi, Michal S. Maimon, Inbal Kestenbaum, Shalom Ben-Shimol
Leukocyte esterase is usually a sensitive test for detecting leukocyturia (pyuria). Indeed, positive LE (indicating leukocyturia) has been reported in many clinical situations, such as infections and non-infectious inflammatory diseases [11]. While LE sensitivity for detecting UTI is variable, [17–20] in children older than 2 months old, LE is considered a sufficient test to raise concern of UTI [9]. Diminished LE sensitivity rates may be explained, among other reasons, by hosts who are unable to mount an adequate inflammatory response; low pathogen ability to induce an inflammatory process; and urine culture contamination [21]. Similarly, LE specificity for diagnosing UTI may be diminished due to prior antibiotic treatment, difficulties in cultivating specific bacteria, and the presence of other, non-UTI, inflammatory processes [11]. Nitrites result from certain bacteria ability to reduce urinary nitrates to nitrites, making this test highly specific, albeit non-sensitive for UTI diagnosis. The nitrite test shows a sensitivity of approximately 30% to 40% and therefore is not used for ruling out UTI [10,11].