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Pyuria

The medical term for cloudy, frothy and foul smelling pus in the urine is pyuria. It means the presence of significantly elevated level of white blood cells (leukocytes) in urine. White blood cells work with the immune system to defend against infectious diseases. A small number of white blood cells are normally present in the urine. But elevated levels indicate urinary tract problems signaling possible damage to the kidneys, ureters, urethra or bladder, inflammation or a contaminant.


Pyuria symptoms

Pyuria can be symptomatic or asymptomatic. Pyuria due to bacterial infection is symptomatic unless partially treated. Pyuria is asymptomatic when related to chronic infection from tuberculosis or mycoplasma, long-time indwelling catheters, inflammatory conditions like hemorrhagic cystitis, tubulointerstital nephritis or chronic prostatitis in men, or a contaminant such as vaginal secretions, vaginitis, cystocele etc. Asymptomatic pyuria goes away on its own, even without treatment.


  • Cloudy or milky urine
  • Foul-smelling urine
  • Frequent urgent need to urinate
  • Discomfort when urinating
  • Fever

Time to test

The test is done when individuals notice symptoms and seek medical attention. A physical examination is followed by laboratory urine test for pyuria urinalysis. If the test indicates pyuria, a culture of urine is suggested to detect the strain of bacteria that causes pyuria. To detect kidney abnormalities or infection, an intravenous pyelogram or ultrasound imaging of kidney is done. The presence of more than 3-5 white blood cells per high power field in the spun urine confirms pyuria.


Pyuria Causes

Urinary tract infection: The chance of urinary tract infection is high in men and women who are diabetic. As the urethra in women is comparatively shorter than men, it is easier for microorganisms to enter the female urinary tract and cause infection which increases the chance of women contracting urinary tract infection.

Sexually transmitted diseases: Men and women with sexually transmitted diseases are prone to pyuria.

Other causes: Other causes can be infectious or non-infectious.


  • Viral infection
  • Fungal infection
  • Anaerobic infection
  • Fastidious bacteria
  • Infection in prostate glands in men
  • Chemical poisoning
  • Kidney Stones
  • Tuberculosis of the urinary tract
  • Cancer of the urinary organs or genital organs

Non infectious: Medications, advanced age, pregnancy, tumors either benign or malignant can cause pus in the urine. Any other underlying problem in the kidney can also result in excessive levels of white cells in the urine.


Pyuria Treatment

The cause for pyuria determines treatment. For urinary tract infections, doctors prescribe antibiotic medicines. If the cause is due to sexually transmitted diseases, hygiene and other precautionary measures is recommended. Drinking plenty of water, juices sans sugar, avoiding fried foods, practicing good hygiene, not delaying for too long the urgency to urinate are proven precautionary measures of pyuria.


Pyometra

Pyometra is an uterine condition that involves accumulation of pus in uterine cavity, caused by interference with natural drainage of uterus. It is a rare disorder that normally occurs in post-menopausal woman with concurrent medical conditions. Most pyometra cases are associated with malignant disease of the uterus. Other causes include:


  • Foreign bodies

  • Puerperal infections or Postpartum infections

  • Uterine anomalies

  • Fibroid degeneration

  • Senile Cervicitis

  • Uterine compression sutures used for postpartum hemorrhage to avoid hysterectomy

  • Genital tuberculosis.

Symptoms

Most often, Pyometra does not present with any symptoms and the condition could be incidentally found through imaging performed for different purpose. Some of the symptoms of Pyometra include


  • Blood-stained purulent vaginal discharge

  • Symmetrical uterine enlargement

  • Post menopausal bleeding

  • Lower abdominal pain

  • Nausea and vomiting

  • Diarrhea

  • Pyrexia (rarely)

Very rarely, pyometra leads to spontaneous perforation. It is a medical emergency and requires an immediate attention and treatment.


Diagnosis

Diagnostic tests are planned and performed on the lines of underlying condition that has resulted in Pyometra. If prevailing tuberculosis is causing symptoms of pyometra, diagnosis can be confirmed by tuberculin testing, histology, Hysterosalpingogram or PCR. Ultrasound scan, CT scan and MRI are generally recommended to diagnose the condition. Doppler scanning is used when pyometra has occurred due to endometrial cancer. X-ray shows the presence of spontaneous perforation of the uterus.


Treatment

Dilatation of the cervix and pus drainage is the treatment of choice, and it is important to rule out the possibility of cancer and differentiate the malignancy. However regular monitoring is necessary to look for recurrence. In few cases, Hysterectomy may be advised to avoid future complications. Medicine therapy with antibiotics becomes necessary if there is an infection. Tubercular pyometra should is treated with appropriate anti-tubercular chemotherapy.



Peritonitis

Inflammation of the peritoneum is called as Peritonitis. Inflammation may be the result of an infection caused due to the accumulation of blood, pus or body fluids in the abdominal cavity. It can rapidly spread across the body and cause death. Typical causes of peritonitis are burst appendix, burst stomach ulcer, diverticulitis and Crohn's disease. Cirrhosis and kidney dialysis can also lead to peritonitis.


Spontaneous peritonitis occurs due to infection in the fluid that has accumulated in the peritoneal cavity. This happens in cases of advanced kidney or liver disease.

Secondary peritonitis involves leakage of bile or pancreatic enzymes into the abdominal cavity.


Symptoms of peritonitis include nausea, lack of appetite, high fever and severe abdominal pain. The person might find it difficult to pass urine. Abdominal distension is observed. There is shortness of breath and racing. CT scan and blood tests are done to check the condition.

Severe obstructions may necessitate immediate surgery to prevent perforation. In other cases, Antibiotics are administered for about 7 days. They might be injected directly into the peritoneal area. In case there is extensive damage to any part of the peritoneum, that part of the perforated stomach of intestine might be surgically removed. Alternatively, any abscess is drained to aid healing.


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Bibliography / Reference

Collection of Pages - Last revised Date: November 22, 2019