Diagnosis of Vulvovaginal Disease
William J. Ledger, Steven S. Witkin in Vulvovaginal Infections, 2017
The use of pH paper is a crucial component in the evaluation of a patient with vulvovaginal symptomatology. The vaginal pH is usually ≤4.5 in healthy white women, but can be as high as 5.0 in healthy Hispanics and African-Americans. Despite these variances among populations, an elevated vaginal pH can be the first clue to the etiology of the problem in symptomatic patients. This is comparable to a urine sample that is positive for leukocyte esterase. It should be followed up with a urine culture to rule out infection, but there are many more positive leukocyte esterase tests than positive cultures. An elevated pH is usually present in Trichomonas vaginitis, BV, desquamative inflammatory vaginitis, estrogen-lack vaginitis, and infections due to Neisseria gonorrhoeae, C. trachomatis, Staphylococcus aureus, and Group A Streptococcus.
Urinary tract infections
Prem Puri in Newborn Surgery, 2017
The definitive diagnostic test of a UTI is a positive urine culture. This can be obtained through suprapubic aspiration or urethral catheterization. A false-positive culture obtained via a bag specimen may lead to inappropriate treatment, misdiagnosis, and unnecessary testing. The urinalysis, which is immediately available, is suggestive but not diagnostic. Although the presence of leukocyte esterase has a high sensitivity, it lacks in specificity; conversely, the nitrate test behaves oppositely. When combined with microscopic findings, the sensitivity approaches 100% when all three are positive, and the specificity is 100% when all three are negative.16 The presence of any bacteria on Gram stain has a sensitivity of 93% and specificity of 95%, better than dipstick evaluation for leukocyte esterase and nitrates.21
Urinary Tract Disease
Vincenzo Berghella in Maternal-Fetal Evidence Based Guidelines, 2022
Dipstick urinalysis is easily available in the office, it is fast and inexpensive, and it is usually the first urine test performed. It permits the analysis of leukocyte esterase, nitrite, and red blood cells, which increase in UTIs. In pregnancy, the pooled sensitivity for either leukocyte esterase or nitrite is 73% with 89% specificity [50]. Microscopic urinalysis is performed with manual or automated light microscopy. The presence of leukocytes (pyuria: >5–10 WCB/high power field [hpf]) or bacteria (bacteriuria: >15 bacteria/hpf) in the urine can be helpful in diagnosing UTIs. In pregnancy, bacteriuria of >20 WBC/hpf was found to have sensitivity and specificity of 78% and 92% [50]. One or two bacteria per hpf on an unspun catheterized urine specimen, or >20 bacteria per hpf on spun urine, closely correlates with >100,000 cfu/ml of bacteria on urine culture.
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].
An unusual case of fungal ball on implantable cardioverter defibrillator wire and literature review
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Hiba Rauf, Waqas Ullah, Sohaib Roomi, Asrar Ahmad, Yasar Sattar, Zain Ali, Neethu Gopisetti
The laboratory studies revealed his Hb was 10.5, leukocytosis of 20,000 with platelet count of 26,000. His blood urea nitrogen (BUN) was 54 and creatinine was 1.47. Hepatic function panel revealed aspartate aminotransferase (AST) of 113, alanine aminotransferase (ALT) of 122, alkaline phosphatase (ALP) of 215 and albumin of 2.9. His lactate dehydrogenase (LDH) was also elevated. Coagulation profile was normal. Urinalysis was positive for leukocyte esterase, WBC and RBC. RBC indices and iron studies were suggestive of anemia of chronic disease. The stool examination was positive for fecal occult blood. The chest radiographs and electrocardiographic findings were normal. Urine culture reports came back positive for Candida with over 100 K colonies/ml. The blood was sent for cultures twice and was found positive for Candida Albicans.
IgA vasculitis presenting as abdominal pain and rash
Published in Baylor University Medical Center Proceedings, 2019
Anil Kopparapu, Diane Jarrett, Shashank Kraleti
His vital signs were within normal limits. Multiple nonpruritic, erythematous petechial and purpuric macules and papules were noted over the abdomen, lower back, and upper and lower extremities (Figure 1). Mild to moderate tenderness was noted in the right lower quadrant of the abdomen. The remainder of the physical exam was within normal limits. Significant laboratory findings were a mildly elevated white blood cell count (11.90 K/µL) and an elevated erythrocyte sedimentation rate (40 mm/hr) and C-reactive protein (20.20 mg/L). Urinalysis was negative for leukocyte esterase, nitrite, blood, glucose, and protein. Urine and blood cultures revealed no growth. Serology findings were nonreactive/negative for hepatitis A IgM, hepatitis B surface antigen, total anti-hepatitis B core antibody, anti-hepatitis B core antibody IgM, hepatitis C virus, and HIV P24 antigen screening and antibodies. No infectious etiology was noted. IgA levels (298 mg/dL), complement levels, renal function tests, and coagulation profile were normal (prothrombin time 12.4 seconds, activated partial thromboplastin time 28.6 seconds, international normalized ratio 1.1).
Related Knowledge Centers
- Amniotic Fluid
- Esterase
- Urinary Tract Infection
- White Blood Cell
- Infection
- Urinalysis
- Gonorrhea
- Nitrite Test
- Urine Test Strip
- Microbiological Culture