Fungal, parasitic, and other  inflammatory  diseases of the GU tract Pediatric GU Review UCSD Pediatric Urology George Chi...
Fungal Infections <ul><li>Candidiasis </li></ul><ul><ul><li>Systemic candidiasis will develop in as many as 4% of preterm ...
Fungal Infections <ul><li>Candidiasis </li></ul><ul><ul><li>IV catheters </li></ul></ul><ul><ul><li>Long term Abx </li></u...
Fungal Infections <ul><li>Candiduria </li></ul><ul><ul><li>Colony counts of greater than 10,000 Candida per 1 ml signify i...
Fungal Infections <ul><li>Aspergillosis </li></ul><ul><ul><li>2nd most common fungal infection </li></ul></ul><ul><ul><li>...
Fungal Infections <ul><li>Coccidioidomycosis </li></ul><ul><ul><li>Dimorphic fungus </li></ul></ul><ul><ul><li>GU disease ...
Parasitic Infections <ul><li>Schistosomiasis </li></ul><ul><ul><li>Endemic in Egypt and has spread </li></ul></ul><ul><ul>...
Parasitic Infections <ul><li>Schistosomiasis </li></ul><ul><ul><li>Acute episode 3-9 wks after infection with terminal hem...
Parasitic Infections <ul><li>Schistosomiasis </li></ul><ul><ul><li>Peripheral blood with eosinophilia </li></ul></ul><ul><...
Parasitic Infections <ul><li>Echinococcosis </li></ul><ul><ul><li>Most prevalent human cestode (hydatid cyst) </li></ul></...
Parasitic Infections <ul><li>Echinococcosis </li></ul><ul><ul><li>Treat with albendazole </li></ul></ul><ul><ul><li>Positi...
Parasitic Infections <ul><li>Enterobiasis </li></ul><ul><ul><li>Pinworm carried on fingernails, clothing, bedding </li></u...
Other Inflammatory  <ul><li>Chlamydia </li></ul><ul><ul><li>Obligate intracellular bacteria </li></ul></ul><ul><ul><li>Per...
Other Inflammatory  <ul><li>Viral Cystitis </li></ul><ul><ul><li>Severe hemorrhagic viral cystitis seen in pediatric patie...
Other Inflammatory  <ul><li>Viral Cystitis </li></ul><ul><ul><li>Use of ribavirin for acute adenovirus hemorrhagic cystiti...
Other Inflammatory  <ul><li>Eosinophilic cystitis </li></ul><ul><ul><li>Irritative voiding symptoms </li></ul></ul><ul><ul...
Other Inflammatory  <ul><li>Malacoplakia </li></ul><ul><ul><li>Benign granulomatous condition </li></ul></ul><ul><ul><li>D...
Other Inflammatory  <ul><li>Epididymitis </li></ul><ul><ul><li>Inflammatory reaction </li></ul></ul><ul><ul><li>Scrotal pa...
Other Inflammatory  <ul><li>Vulvovaginitis </li></ul><ul><ul><li>Most common prepubertal complaint </li></ul></ul><ul><ul>...
Other Inflammatory  <ul><li>Idiopathic scrotal and penile edema </li></ul><ul><ul><li>Up to 20% of acute scrotal inflammat...
Other Inflammatory  <ul><li>IC </li></ul><ul><ul><li>Day and night frequency, abdominal pain, decreased bladder capacity, ...
Upcoming SlideShare
Loading in …5
×

Pedi gu review fungal and parasitic infections

579 views

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
579
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
16
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Pedi gu review fungal and parasitic infections

  1. 1. Fungal, parasitic, and other inflammatory diseases of the GU tract Pediatric GU Review UCSD Pediatric Urology George Chiang MD Sara Marietti MD Outlined from The Kelalis-King-Belman Textbook of Clinical Pediatric Urology 2007 (not for reproduction, distribution, or sale without consent)
  2. 2. Fungal Infections <ul><li>Candidiasis </li></ul><ul><ul><li>Systemic candidiasis will develop in as many as 4% of preterm neonates weighing 1500 g and 10% weighing 1000g </li></ul></ul><ul><ul><li>Leading bloodstream isolate from children hospitalized with opportunistic infections </li></ul></ul><ul><ul><li>Impaired host resistance </li></ul></ul>
  3. 3. Fungal Infections <ul><li>Candidiasis </li></ul><ul><ul><li>IV catheters </li></ul></ul><ul><ul><li>Long term Abx </li></ul></ul><ul><ul><li>Steroids </li></ul></ul><ul><ul><li>Immunosuppressive agents </li></ul></ul><ul><ul><li>Cytotoxic drug therapy </li></ul></ul><ul><ul><li>Burns </li></ul></ul><ul><ul><li>Open surgical wounds </li></ul></ul><ul><ul><li>ICU stay </li></ul></ul><ul><ul><li>Surgery on the GI tract </li></ul></ul>
  4. 4. Fungal Infections <ul><li>Candiduria </li></ul><ul><ul><li>Colony counts of greater than 10,000 Candida per 1 ml signify infection </li></ul></ul><ul><ul><li>Anuria can result from bilateral pelvic fungal balls </li></ul></ul><ul><ul><li>Should clear after stopping antibiotics </li></ul></ul><ul><ul><ul><li>May require local skin care for skin irritation </li></ul></ul></ul><ul><ul><li>Infections limited to bladder may be treated with alkalinization or intermittent ampho B </li></ul></ul><ul><ul><li>Upper collecting system infection may require treatment with oral 5-flucytosine or NT irrigations with amph </li></ul></ul><ul><ul><ul><li>Not used with azotemia or bone marrow depression </li></ul></ul></ul><ul><ul><ul><li>Surgical removal or forced diuresis for fungal balls </li></ul></ul></ul><ul><li>Systemic candidiasis </li></ul><ul><ul><ul><li>IV ampho +/- 5-FC (follow Cr for nephrotoxicity) </li></ul></ul></ul><ul><ul><ul><li>Fluconazole has also been used </li></ul></ul></ul>
  5. 5. Fungal Infections <ul><li>Aspergillosis </li></ul><ul><ul><li>2nd most common fungal infection </li></ul></ul><ul><ul><li>Present in soil </li></ul></ul><ul><ul><li>Acquired via inhalation and then disseminated thru blood </li></ul></ul><ul><ul><li>Microscopic hematuria and pyuria </li></ul></ul><ul><ul><li>Urine cultures often inconclusive </li></ul></ul><ul><ul><li>IV Amphotericin B/irrigations </li></ul></ul>
  6. 6. Fungal Infections <ul><li>Coccidioidomycosis </li></ul><ul><ul><li>Dimorphic fungus </li></ul></ul><ul><ul><li>GU disease occurs with disseminated disease </li></ul></ul><ul><ul><li>Small miliary granulomas within kidney </li></ul></ul><ul><ul><li>Infundibular stenoses/blunted calyces </li></ul></ul><ul><ul><li>Ampho B, Fluconazole, Ketoconazole </li></ul></ul>
  7. 7. Parasitic Infections <ul><li>Schistosomiasis </li></ul><ul><ul><li>Endemic in Egypt and has spread </li></ul></ul><ul><ul><li>Humans infected thru contact in water and then crecariae migrate to portal circulation to reach sexual maturity </li></ul></ul><ul><ul><li>Adult worms migrate to perivesical and periureteral plexi </li></ul></ul><ul><ul><li>Upon fertilization, eggs deposited in venules which reach urinary lumen </li></ul></ul>
  8. 8. Parasitic Infections <ul><li>Schistosomiasis </li></ul><ul><ul><li>Acute episode 3-9 wks after infection with terminal hematuria and dysuria (anemia) </li></ul></ul><ul><ul><li>Urinary tract pathology can decrease with age </li></ul></ul><ul><ul><li>Eosinophilic infiltrate within bladder wall and collagen infiltration </li></ul></ul><ul><ul><li>Involvement of trigone and bladder neck pronounced </li></ul></ul><ul><ul><li>Vesical calculi </li></ul></ul><ul><ul><li>VUR in up to 50% </li></ul></ul><ul><ul><li>Diagnose via presence of terminal-spined eggs in urine </li></ul></ul>
  9. 9. Parasitic Infections <ul><li>Schistosomiasis </li></ul><ul><ul><li>Peripheral blood with eosinophilia </li></ul></ul><ul><ul><li>“ Egg shell” bladder on plain film </li></ul></ul><ul><ul><li>Hydro secondary to ureteral stricture </li></ul></ul><ul><ul><li>Drug of choice is praziquantel </li></ul></ul><ul><ul><li>Fibrosis and contracture may require autoaugment or replacement </li></ul></ul>
  10. 10. Parasitic Infections <ul><li>Echinococcosis </li></ul><ul><ul><li>Most prevalent human cestode (hydatid cyst) </li></ul></ul><ul><ul><li>Dog tapework Echinococcus granulosus </li></ul></ul><ul><ul><ul><li>Lives in intestine of dogs </li></ul></ul></ul><ul><ul><li>In humans affects primarily liver </li></ul></ul><ul><ul><li>3% of infections involve kidneys </li></ul></ul><ul><ul><li>Growth rate of 1 cm/yr </li></ul></ul><ul><ul><li>Present as painful flank mass </li></ul></ul><ul><ul><li>Sonography most useful </li></ul></ul><ul><ul><li>1/3 of children will have eosinophilia </li></ul></ul><ul><ul><li>Ab Immunoelectrophoresis is most specific </li></ul></ul>
  11. 11. Parasitic Infections <ul><li>Echinococcosis </li></ul><ul><ul><li>Treat with albendazole </li></ul></ul><ul><ul><li>Positive response in pediatrics 40-60% </li></ul></ul><ul><ul><ul><li>Follow with ultrasound </li></ul></ul></ul><ul><ul><li>Percutaneous drainage has become more succesful </li></ul></ul><ul><ul><ul><li>Anaphylactic reaction still a possibility </li></ul></ul></ul>
  12. 12. Parasitic Infections <ul><li>Enterobiasis </li></ul><ul><ul><li>Pinworm carried on fingernails, clothing, bedding </li></ul></ul><ul><ul><li>Live in large intestine </li></ul></ul><ul><ul><li>Perianal irritation </li></ul></ul><ul><ul><li>22% of girls with UTIs had pinworm infestation vs 5% of control </li></ul></ul><ul><ul><li>Diagnosis with adhesive tape to perianal region early in the morning </li></ul></ul><ul><ul><li>Treat with pyrantel pamoate or mebendazole </li></ul></ul>
  13. 13. Other Inflammatory <ul><li>Chlamydia </li></ul><ul><ul><li>Obligate intracellular bacteria </li></ul></ul><ul><ul><li>Perinatally transmitted or STD </li></ul></ul><ul><ul><ul><li>25% of pregnant women cervical infections </li></ul></ul></ul><ul><ul><ul><li>Conjunctivitis and pneumonia </li></ul></ul></ul><ul><ul><ul><li>May persist for 3 years without symptoms </li></ul></ul></ul><ul><ul><li>Boys clear mucoid urethral discharge with or without urinary symptoms </li></ul></ul><ul><ul><li>Diagnosis with culture </li></ul></ul><ul><ul><li>Antibiotics: Sulfonamides, E-mycin, tetracyclines 10-14 days </li></ul></ul>
  14. 14. Other Inflammatory <ul><li>Viral Cystitis </li></ul><ul><ul><li>Severe hemorrhagic viral cystitis seen in pediatric patients undergoing BMT </li></ul></ul><ul><ul><li>Usually adenovirus type 11, 21; Influenza A, CMV </li></ul></ul><ul><ul><li>Viral shedding 4 days to 2 weeks </li></ul></ul><ul><ul><li>Herpes zoster may also cause symptoms </li></ul></ul><ul><ul><li>Adenovirus diagnosed with immunofluorescence of antigen and u/s may show thickened bladder (resolves 2-3 weeks) </li></ul></ul><ul><ul><li>Polyoma BK virus:BMT patients </li></ul></ul><ul><ul><ul><li>Epithelial cells within the urine containing intranuclear inclusion bodies </li></ul></ul></ul><ul><ul><li>Many immunocompromised patients do not respond to traditional therapies for hemorrhagic cystiis and may progress to ARF </li></ul></ul>
  15. 15. Other Inflammatory <ul><li>Viral Cystitis </li></ul><ul><ul><li>Use of ribavirin for acute adenovirus hemorrhagic cystitis </li></ul></ul><ul><ul><li>Instillation of PG E1 in bladder for up to 7 days </li></ul></ul><ul><ul><li>Hyperbaric oxygen </li></ul></ul>
  16. 16. Other Inflammatory <ul><li>Eosinophilic cystitis </li></ul><ul><ul><li>Irritative voiding symptoms </li></ul></ul><ul><ul><li>Palpable suprapubic mass </li></ul></ul><ul><ul><li>Eosoniphilia usually not found </li></ul></ul><ul><ul><li>Focal thickening of the bladder </li></ul></ul><ul><ul><li>Definitive diagnosis by cysto/bx </li></ul></ul><ul><ul><li>Etiology unknown ?IgE mediated to allergen </li></ul></ul><ul><ul><ul><li>Tx with removing allergen (usually not identified) </li></ul></ul></ul><ul><ul><ul><ul><li>Cases usually resolve within 12 weeks </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Recurrence still possible </li></ul></ul></ul></ul>
  17. 17. Other Inflammatory <ul><li>Malacoplakia </li></ul><ul><ul><li>Benign granulomatous condition </li></ul></ul><ul><ul><li>Defective digestion of phagocytosed bacteria </li></ul></ul><ul><ul><li>Intracyctoplasic inclusions </li></ul></ul><ul><ul><li>Can affect multiple organs (most common kidney in pediatrics) </li></ul></ul><ul><ul><li>Occurs in setting of recurrent UTIs </li></ul></ul><ul><ul><li>Nephromegaly without abscess </li></ul></ul><ul><ul><li>Diagnosis with bx </li></ul></ul><ul><ul><li>Bilateral renal malacoplakia was considered fatal but can be tx with antimicrobial and G-CSF </li></ul></ul>
  18. 18. Other Inflammatory <ul><li>Epididymitis </li></ul><ul><ul><li>Inflammatory reaction </li></ul></ul><ul><ul><li>Scrotal pain/edema </li></ul></ul><ul><ul><li>Only 24% of patients had >10 WBC per hpf on UA and urine cultures only positive 10% </li></ul></ul><ul><ul><li>For culture proven bacterial epididymitis: </li></ul></ul><ul><ul><ul><li>At minimum RUS and VCUG should be performed </li></ul></ul></ul><ul><ul><li>Dysfunctional voiding 25% </li></ul></ul><ul><ul><ul><li>Uroflow, patch EMG, PVR for boys over age of 5 </li></ul></ul></ul>
  19. 19. Other Inflammatory <ul><li>Vulvovaginitis </li></ul><ul><ul><li>Most common prepubertal complaint </li></ul></ul><ul><ul><li>Ages 2-7 yrs with discharge, discomfort, pruritus, urinary symptoms </li></ul></ul><ul><ul><li>Vulva of young female is unprotected and children also have poor hygeine; also potential for foreign body and sexual abuse </li></ul></ul><ul><ul><li>History should entail chemical exposures </li></ul></ul><ul><ul><li>Formal vaginoscopy may be required </li></ul></ul><ul><ul><li>Treatment or behavioral modification </li></ul></ul>
  20. 20. Other Inflammatory <ul><li>Idiopathic scrotal and penile edema </li></ul><ul><ul><li>Up to 20% of acute scrotal inflammation </li></ul></ul><ul><ul><li>Sudden 1 day onset of unilateral/bilateral scrotal erythema </li></ul></ul><ul><ul><li>Occasional eosinophilia </li></ul></ul><ul><ul><li>May be related to angioedema and is self limitting </li></ul></ul>
  21. 21. Other Inflammatory <ul><li>IC </li></ul><ul><ul><li>Day and night frequency, abdominal pain, decreased bladder capacity, negative UA/culture </li></ul></ul><ul><ul><li>Of 16 individuals over a 12 year period, 70% girls and 30% boys </li></ul></ul><ul><ul><li>Glomerulations and terminal hematuria with hydrodistension </li></ul></ul><ul><ul><li>Treatment poor results </li></ul></ul>

×