succimer and Escherichia-coli-Infections

The strong association between kidney and urinary tract anomalies and childhood urinary tract infection (UTI) often leads to imaging tests being performed. -Objective: To describe the epidemiology, characteristics, and imaging findings in Thai children with UTI and compare results between boys and girls.. We retrospectively reviewed the medical records of children with UTI aged < 15 years. Demographic characteristics and findings of investigations are presented.. One hundred seventy-eight boys and 170 girls with 432 UTI episodes were identified. The median (interquartile range) age at presentation was 1.4 (0.6-3.4) years, 1.0 for boys and 2.1 for girls (p < 0.001). Renal ultrasound, voiding cystourethrogram and 99mTc dimercaptosuccinic acid (DMSA) renal scans were performed in 273, 223 and 113 children, respectively. Overall, 283 children (81.3%) had at least one imaging study done and anomalies of the kidney and urinary tract were detected in 158 (45.4%). Primary vesicoureteral reflux was detected in 73 (32.7%) children. The remaining abnormalities were hydronephrosis (n = 54). DMSA scans detected 54 children with dysplastic or scarred kidneys.. First UTI in a group of Thai children occurred in approximately equal proportion in boys and girls but boys were younger at diagnosis. Kidney and urinary tract anomalies were detected in half of the children.

Topics: Child; Child, Preschool; Cystography; Escherichia coli Infections; Female; Humans; Infant; Infant, Newborn; Kidney; Male; Retrospective Studies; Sex Factors; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tertiary Healthcare; Thailand; Ultrasonography; Urinary Tract; Urinary Tract Infections; Vesico-Ureteral Reflux

In the absence of specific symptomatology in children, the early diagnosis of acute pyelonephritis is a challenge, particularly during infancy. In an attempt to differentiate acute pyelonephritis from lower urinary tract infection (UTI), we measured intrarenal resistive index (RI). We evaluated its ability to predict renal involvement as assessed by dimercaptosuccinic acid (DMSA) scintigraphy. In total 157 patients admitted to the pediatric department of the Sişli Etfal Hospital with clinical signs of febrile UTI were included in the study. The children were divided into groups according to their age at the time of ultrasonography (US). RI was measured from the renal arteries with Doppler US in the first 72 h in all 157 children. Renal involvement was assessed by (99m)Tc-DMSA scintigraphy in the first 7 days after admission. The examination was repeated at least 6 months later if the first result was abnormal. All available patients with an abnormal scintigraphy underwent voiding cystourethrography 4-6 weeks after the acute infection. All patients with vesicoureteral reflux and scarred kidneys were excluded from the study. DMSA scintigraphy demonstrated abnormal changes in 114 of 157 children and was normal in the remaining 43 children. Of these 114 children, 104 underwent repeat scintigraphy, of whom 77 showed partially or totally reversible lesion(s). Of these 77 children, 17 children (22%) with vesicoureteral reflux were excluded. Thus, we compared the 43 children with lower UTI with the 60 children with definite acute pyelonephritis at admission. Kidneys with changes of acute pyelonephritis had a mean RI of 0.744+/-0.06 in infants, 0.745+/-0.03 in preschool children, and 0.733+/-0.09 in patients of school age with upper UTI. However, the mean RI was 0.703+/-0.06 in infants, 0.696+/-0.1 in preschool children, and 0.671+/-0.09 in school-aged patients with lower UTI. The mean RI values were significantly higher in patients with upper UTI ( P<0.001). There was a highly significant correlation between RI values and the severity of the renal lesion as ranked by DMSA scintigraphy ( P<0.001). When the cut-off RI value was 0.715, there was an 80% sensitivity and a 89% specificity for diagnosing upper UTI. Refluxing kidneys and scarred kidneys also had higher RI values. In conclusion, RI values were increased significantly in children with febrile UTI when renal parenchymal involvement (assessed by DMSA scintigraphy) was present. Our results also support the vi

Topics: Child; Child, Preschool; Cicatrix; Escherichia coli Infections; Female; Fever; Humans; Infant; Male; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Risk Assessment; Severity of Illness Index; Succimer; Ultrasonography, Doppler, Color; Urinary Tract Infections; Vesico-Ureteral Reflux

In the absence of specific symptomatology in children, the early diagnosis of acute pyelonephritis is a challenge, particularly during infancy. In an attempt to differentiate acute pyelonephritis from lower urinary tract infection (UTI), we measured serum procalcitonin (PCT) levels and compared these with other commonly used inflammatory markers. We evaluated the ability of serum PCT levels to predict renal involvement, as assessed by dimercaptosuccinic acid (DMSA) scintigraphy. Serum C-reactive protein (CRP), leukocyte counts, and PCT levels were measured in 64 children admitted for suspected UTI. Renal parenchymal involvement was assessed by (99m)Tc-DMSA scintigraphy in the first 7 days after admission. In acute pyelonephritis, the median PCT level was significantly higher than in the lower UTI group (3.41, range 0.36-12.4 microg/l vs. 0.13, range 0.02-2.15 microg/l, P<0.0001). In these two groups, respectively, median CRP levels were 120 (range 62-249 mg/l) and 74.5 (range 14.5-235 mg/l, P=0.012) and leukocyte counts were 15,910/mm(3) (range 10,200-26,900) and 14,600/mm(3) (range 8,190-26,470, P=0.34). For the prediction of acute pyelonephritis, the sensitivity and specificity of PCT were 94.1% and 89.7%, respectively; CRP had a sensitivity of 100%, but a specificity of 18.5%. We conclude that serum PCT may be an accurate marker for early diagnosis of acute pyelonephritis.

Topics: Acute Disease; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child, Preschool; Diagnosis, Differential; Escherichia coli Infections; Female; Humans; Infant; Infant, Newborn; Kidney; Leukocyte Count; Male; Prognosis; Prospective Studies; Protein Precursors; Pyelonephritis; Radionuclide Imaging; Sensitivity and Specificity; Succimer; Urinary Tract Infections

To assess the value of an ultrasound examination in children with a proven urinary tract infection.. The results of renal ultrasound and 99mTc-dimercapto-succinic acid (DMSA) studies were compared in 112 children with a first documented symptomatic Escherichia coli urinary tract infection.. Ultrasound was particularly effective in detecting the presence of obstruction, renal swelling and parenchymal change consistent with acute pyelonephritis. However, ultrasound failed to detect half of the kidneys with photon deficient areas on 99mTc DMSA scan and was unreliable in detecting the presence of scarring.. An ultrasound examination alone should not be relied on in the child with an acute urinary tract infection.

Topics: Adolescent; Child; Child, Preschool; Escherichia coli Infections; Female; Humans; Infant; Kidney Diseases; Male; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Ureteral Obstruction; Urinary Tract Infections

Correlation of virulence factors of Escherichia coli with renal inflammation documented by 99mTc-dimercaptosuccinic acid renal scan was undertaken in 59 children with febrile urinary tract infections to identify more accurately the role of bacterial virulence factors in the development of pyelonephritis. P fimbriae were present in 63% of isolates from the positive scan group and 83% of those from the negative scan group (P = 0.126). Multivariate regression analysis showed no significant role for established E. coli virulence factors in the development of pyelonephritis. The pap genome was independently associated with negative scan (P less than 0.007) and with the absence of reflux (P = 0.031). E. coli pyelonephritogenic clone O16:K1:H6 was isolated from negative scan patients and did not produce hemolysin. We conclude that P fimbriae are important in the development of febrile urinary tract infection regardless of the level of infection. Virulent E. coli clones described in prior Scandinavian urinary tract infection studies were not common causes of pyelonephritis in our patient population.

Topics: Adolescent; Child; Child, Preschool; Escherichia coli; Escherichia coli Infections; Female; Fever; Fimbriae, Bacterial; Humans; Infant; Infant, Newborn; Male; Organotechnetium Compounds; Pyelonephritis; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Virulence

Using the established piglet model, renal scars were produced by a combination of vesicoureteric reflux and urinary infection. The presence and extent of scarring, as determined by postmortem examination, was compared with that detected by technetium 99m dimercaptosuccinic acid (DMSA) scans performed before sacrifice. Sixty female piglets (62 refluxing units) were studied. Overall the sensitivity (true-positive/(true-positive + false-negative)) of DMSA scanning in detecting macroscopic scarring was 85% and the specificity (true-negative/(true-negative + false-positive)) was 97%. There were five false-negatives, four of which were in kidneys with minor scarring and one in which there was major scarring. There were three false-positives. We conclude that DMSA scanning has a high specificity and sensitivity in detecting renal scars in female piglets, and suggest it is the preferred method for detecting renal scars in clinical practice.

Topics: Animals; Escherichia coli Infections; False Negative Reactions; False Positive Reactions; Female; Kidney Diseases; Organotechnetium Compounds; Predictive Value of Tests; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Swine; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Vesico-Ureteral Reflux

The use of 99mtechnetium dimercaptosuccinic acid (99mTc-DMSA) scintigraphy for the early diagnosis of pyelonephritis has been evaluated in a study performed on adolescent female Sprague-Dawley rats exposed to an ascending Escherichia coli infection. The rats were studied with DMSA scintigraphy either before and 5 days after the infection or 5 and 28 days after the infection. One group of rats received anti-microbial treatment during days 6-11. After the last DMSA scintigraphy the rats were sacrificed and the kidneys prepared for light microscopy study. Kidney morphology was normal and DMSA uptake was high and homogeneous in all control rats. The majority of the rats exposed to E. coli developed inflammatory changes, on light microscopy which extended to various degrees in the renal parenchyma. Five days after the infection the DMSA uptake was consistently reduced, if the inflammatory lesion on light microscopy involved more than 15% of the renal cortex. Twenty-eight days after infection the inflammatory changes were less extensive than at 5 days. The DMSA uptake had usually improved. At this time, however, areas of decreased DMSA uptake could be detected even if the light microscopy changes involved less than 15% of the parenchyma. Microscopical lesions were less frequent and less extensive in the treated than in the untreated rats. The complete return to normal of previously abnormal DMSA uptake was only observed in treated rats. In a few untreated rats cortical scars had formed by day 28. The scars appeared in areas with decreased DMSA uptake at 5 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Disease; Animals; Escherichia coli Infections; Female; Kidney; Organotechnetium Compounds; Pyelonephritis; Radionuclide Imaging; Rats; Rats, Inbred Strains; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid

Serial renal 99Tcm-labelled dimercaptosuccinic acid (DMSA) scintigrams were acquired 2-58 days after the introduction of urinary tract infection in 33 pigs with experimentally induced vesicoureteric reflux (VUR). In 29 animals VUR was unilateral and in four bilateral, a total of 37 refluxing systems. Animals were killed either at varying intervals after a scintigraphic defect was noted (24 refluxing kidneys) or after a period when sequential scintigrams were normal (13 refluxing kidneys). The appearance of the scintigram acquired on the day prior to death was compared with the renal pathology, each kidney and renal image being divided into three zones (upper, middle, lower) for separate consideration. Of the 37 refluxing systems pyelonephritic lesions were seen in 27, in a total of 61 zones. In the remaining ten kidneys no scintigraphic defect was detected and no pathological lesions were identified either macroscopically or microscopically. Where an abnormality was detected on the scintigram a lesion was always identified in the kidney (sensitivity 100%). Small pyelonephritic lesions in a total of 12 zones in six kidneys were not detected on the scintigram (specificity 82%). Of the lesions undetected by scintigraphy only one occurred in the upper pole.

Topics: Acute Disease; Animals; Escherichia coli Infections; Kidney; Organometallic Compounds; Pyelonephritis; Radionuclide Imaging; Succimer; Swine; Swine, Miniature; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Vesico-Ureteral Reflux

Between 1985 and 1987 102 children, age 0-14 years, presented with a first acute symptomatic E. coli urinary tract infection. Investigations included early 99mtechnetium dimercaptosuccinic acid (DMSA) scan (which was performed at a median of 27 days), ultrasonography, micturating cysto-urethrography and indirect voiding radionuclide cystography using 99mTc DTPA. Follow-up DMSA scan was carried out after 6 months. Twenty-one of 102 of initial DMSA studies showed diminished uptake of radionuclide and 12 showed cortical scarring. Twenty-nine patients had significant vesicoureteral reflux (VUR). The finding of diminished uptake on the initial scan was significantly associated with fever, systemic upset, length of symptoms and a peripheral blood leucocytosis, (p less than 0.05). In addition the finding was associated with fever and loin pain in the older child. Both diminished uptake and scarring were more common in refluxing kidney units. We propose that, in children with UTI, diminished uptake on early DMSA scan localises infection in the renal parenchyma.

Topics: Acute Disease; Adolescent; Child; Child, Preschool; Escherichia coli Infections; Female; Humans; Infant; Kidney; Male; Nephritis; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Vesico-Ureteral Reflux

Indium-111-labeled leukocyte scanning is a highly sensitive and specific method of detecting abscesses. This report describes a patient with polycystic kidneys and a single infected cyst. Ultrasound could not determine which cyst was infected, but the infected cyst could be localized by [111In]leukocyte imaging in conjunction with a [99mTc]DMSA renal scan. The two radionuclide studies were used to identify an infected renal cyst and direct ultrasound guided aspiration.

Topics: Adult; Escherichia coli Infections; Humans; Indium; Leukocytes; Male; Polycystic Kidney Diseases; Radioisotopes; Radionuclide Imaging; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography