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Dysuria in Children

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361. HLA-B27 Syndromes (Diagnosis)

in the treatment of resistant chronic uveitis, including chronic anterior uveitis in children with juvenile rheumatoid uveitis and idiopathic uveitis. This allowed the reduction of both systemic corticosteroids and/or systemic methotrexate. Oral tolerance involves administering an antigen orally to induce a specific peripheral immune tolerance. The mechanisms of oral tolerance are unclear, but it is believed that it involves a specific antigen and the generation of active suppression or clonal anergy dependent (...) in individuals who are HLA-B27 positive; in fact, 60-85% of patients with reactive arthritis are HLA-B27 positive. The disease is most common in persons aged 18-40 years, but it has been known to occur in children and older adults. The sex ratio varies, depending on whether the infection is enteric or venereally acquired. The sex ratio following gastrointestinal infection is 1:1, whereas the genitourinary disease primarily affects males. Prevalence of the disease also is high in homosexual and bisexual men


362. Menstruation Disorders (Overview)

, Roche AF, Kulin HE, Lee PA, Himes JH, et al. Age at menarche and racial comparisons in US girls. Pediatrics . 2003 Jan. 111(1):110-3. . Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child . 1969 Jun. 44(235):291-303. . . World Health Organization multicenter study on menstrual and ovulatory patterns in adolescent girls. II. Longitudinal study of menstrual patterns in the early postmenarcheal period, duration of bleeding episodes and menstrual cycles. World (...) of inherited bleeding disorders in women with menorrhagia. Lancet . 1998 Feb 14. 351(9101):485-9. . Ragni MV, Bontempo FA, Hassett AC. von Willebrand disease and bleeding in women. Haemophilia . 1999 Sep. 5(5):313-7. . Werner EJ, Broxson EH, Tucker EL, Giroux DS, Shults J, Abshire TC. Prevalence of von Willebrand disease in children: a multiethnic study. J Pediatr . 1993 Dec. 123(6):893-8. . Shankar M, Lee CA, Sabin CA, Economides DL, Kadir RA. von Willebrand disease in women with menorrhagia: a systematic

2014 eMedicine Pediatrics

363. Meatal Stenosis (Overview)

. [ ] Meatal stenosis is typically characterized by an upward-deflected, difficult-to-aim urinary stream and, rarely, by dysuria and urgent, frequent, and prolonged urination. Surgical meatotomy or meatoplasty is normally curative. For patient education resources, see the , as well as and . Next: Pathophysiology After circumcision, a child who is not toilet-trained persistently exposes the meatus to urine, which results in inflammation (ammoniac dermatitis) and mechanical trauma as the meatus rubs against (...) of meatal stenosis may not alleviate them. Previous References Van Howe RS. Incidence of meatal stenosis following neonatal circumcision in a primary care setting. Clin Pediatr (Phila) . 2006 Jan-Feb. 45 (1):49-54. . Joudi M, Fathi M, Hiradfar M. Incidence of asymptomatic meatal stenosis in children following neonatal circumcision. J Pediatr Urol . 2011 Oct. 7 (5):526-8. . Frisch M, Simonsen J. Cultural background, non-therapeutic circumcision and the risk of meatal stenosis and other urethral stricture

2014 eMedicine Pediatrics

364. Epididymitis (Diagnosis)

demonstrates increased blood flow in the epididymis resulting from the active inflammation. Signs and symptoms The following history findings are associated with acute epididymitis and orchitis: Gradual onset of scrotal pain and swelling, usually unilateral, often developing over several days (as opposed to hours for testicular torsion) Dysuria, frequency, or urgency Fever and chills (in only 25% of adults with acute epididymitis but in up to 71% of children with the condition) Usually, no nausea (...) resection of the ejaculatory ducts, resulting in epididymitis. It can also be a result of heavy physical activity such as weight lifting. In children, infection is less common an etiology. One study of a pediatric emergency department found only 4 (4.1%) of 97 children diagnosed with epididymitis had a positive urine culture. [ ] Children may have various congenital abnormalities or functional voiding problems that increase the risk of reflux into the ejaculatory ducts. For example, epididymitis may


365. Benign Lesions of the Ovaries (Diagnosis)

identification of purulent material from the fimbriated ends of the fallopian tubes (salpingitis) noted during diagnostic laparoscopy. The commonly reported symptoms of TOAs are dyspareunia and rectal discomfort, partial intestinal obstruction, dysuria, urinary frequency, and sterility. Occasionally, fever with the symptoms of pelvic peritonitis develops. Pelvic examination findings are characteristic. The uterus is retroverted, and cervical motion produces pain. Lateral to the uterus, enlarged masses (...) . The updated French guidelines indicate that transvaginal pelvic ultrasonography is the first-line modality for evaluating presumed benign ovarian tumors in adult women. [ ] Transvaginal ultrasonography is limited with regard to its role in assessing masses in neonates, children, and virginal adolescents. Color-coded Doppler ultrasonography improves the diagnostic accuracy of B-mode ultrasonography. Ultrasonography is easy, rapid, and able to provide critical information for the evaluation of an adnexal


366. Bacterial Infections and Pregnancy (Diagnosis)

with microabscesses. Twenty-two percent of perinatal infections result in neonatal death or stillbirth. [ ] Among women who have listeriosis during pregnancy, two thirds of surviving infants develop clinical neonatal listeriosis. Early diagnosis and antimicrobial treatment of infected women during pregnancy can lead to the birth of a healthy child. In neonates, the mortality rate is approximately 50%. Mortality is more likely in early-onset neonatal sepsis. Late-onset listeriosis typically manifests as meningitis (...) collection [ ] If the culture result is positive, the woman should be treated during labor If culture results are unknown at the time of delivery, a risk-based approach can be used, in which patients are deemed at high risk and receive treatment if they meet any of the following criteria: Previously delivered infant with invasive GBS infection GBS bacteriuria during current pregnancy Delivery before 37 weeks' gestation Duration of ruptured membranes longer than 18 hours Intrapartum temperature of more


367. Bladder Cancer (Diagnosis)

, uterus, and vagina with squamous cell carcinoma of the bladder infiltrating through the bladder wall into the vaginal wall. Signs and symptoms Clinical manifestations of bladder cancer are as follows: Painless gross hematuria - Approximately 80-90% of patients; classic presentation Irritative bladder symptoms (eg, dysuria, urgency, frequency of urination) - 20-30% of patients Pelvic or bony pain, lower-extremity edema, or flank pain - In patients with advanced disease Palpable mass on physical (...) , rhabdosarcoma, carcinosarcoma, lymphoma, and small cell carcinoma. Leiomyosarcoma is the most common sarcoma of the bladder. most commonly occur in children. Carcinosarcomas are highly malignant tumors that contain a combination of mesenchymal and epithelial elements. Primary bladder lymphomas arise in the submucosa of the bladder. Except for lymphomas, all these rare bladder cancers carry a poor prognosis. Small cell carcinoma of the urinary bladder is a poorly differentiated, malignant neoplasm


368. Benign Vulvar Lesions (Diagnosis)

, diaphragms Fixed drug eruption A fixed drug eruption is a cell-mediated allergic drug reaction typically recurring in the same site upon reexposure. Common causative agents include oral drugs such as nonsteroidal anti-inflammatory agents, acetaminophen, sulfonamides, tetracycline, and barbiturates. Fluconazole as a possible causative agent has also been recently reported. [ ] Atopic dermatitis Atopic dermatitis usually occurs in patients with a personal or family history of asthma, hay fever, childhood (...) of 180 kd now thought to be collagen XVII), located in the basement membrane of the skin. [ ] Mucosal lesions of the vulva occur less frequently and are less severe than other blistering disorders. [ ] A juvenile localized subtype of immunoglobulin G (IgG)–mediated bullous pemphigoid occurring in children in the first year of life and characterized by a self-limited nonscarring bullous pemphigoid–like process involving only the vulva has been described. [ ] Cicatricial pemphigoid Cicatricial


369. Hypercalciuria (Overview)

al. Prevalence and spot urine risk factors for renal stones in children taking topiramate. J Pediatr Urol . 2013 Jan 31. . . Vachvanichsanong P, Malagon M, Moore ES. Recurrent abdominal and flank pain in children with idiopathic hypercalciuria. Acta Paediatr . 2001 Jun. 90(6):643-8. . Alon US, Berenbom A. Idiopathic hypercalciuria of childhood: 4- to 11-year outcome. Pediatr Nephrol . 2000 Sep. 14(10-11):1011-5. . Escribano J, Balaguer A, Martin R, Feliu A, Espax R. Childhood idiopathic (...) degree of hematuria and back or abdominal pain and is also sometimes associated with voiding symptoms. Microcrystallization of calcium with urinary anions has been suggested to lead to injury of the uroepithelium in children with hypercalciuria. Consequently, when taking the history of the illness, attempt to identify symptoms relating to the urinary tract, paying special attention to the following signs and symptoms: Dysuria Abdominal pain Irritability (infants) Urinary frequency Urinary urgency

2014 eMedicine Pediatrics

370. Herpes Simplex Virus Infection (Overview)

> Pediatric Herpes Simplex Virus Infection Updated: Feb 27, 2019 Author: J Michael Klatte, MD; Chief Editor: Russell W Steele, MD Share Email Print Feedback Close Sections Sections Pediatric Herpes Simplex Virus Infection Overview Practice Essentials Herpes simplex virus (HSV) infections are ubiquitous and have a wide range of clinical manifestations (see the images below). Beyond the neonatal period, most primary HSV-1 infections occur in infancy and childhood and are transmitted primarily by contact (...) , most primary HSV-1 infections occur in infancy and childhood and are transmitted primarily by contact with infected saliva. Primary HSV-2 infections are acquired after onset of sexual activity and genital herpes infections are among the most common sexually transmitted infections (STIs). The prevalence of herpes simplex virus infections depends on socioeconomic status, age, race, and geographic location. For example, approximately 33% of children from lower socioeconomic backgrounds have serologic

2014 eMedicine Pediatrics

371. Hemorrhagic Cystitis (Overview)

stem cell transplantation. Biol Blood Marrow Transplant . 2011 Oct. 17(10):1512-9. . Hatakeyama N, Suzuki N, Yamamoto M, Kuroiwa Y, Hori T, Mizue N, et al. Detection of BK virus and adenovirus in the urine from children after allogeneic stem cell transplantation. Pediatr Infect Dis J . 2006 Jan. 25(1):84-5. . Hoffman JA, Shah AJ, Ross LA, Kapoor N. Adenoviral infections and a prospective trial of cidofovir in pediatric hematopoietic stem cell transplantation. Biol Blood Marrow Transplant . 2001. 7 (...) , Choi Y, et al. Isolation of adenovirus type 7 from the urine of children with acute hemorrhagic cystitis. Pediatr Infect Dis J . 1996 Jul. 15(7):633-4. . Mori T, Aisa Y, Shimizu T, Ikeda Y, Okamoto S, Okada K, et al. Hemorrhagic cystitis caused by adenovirus type 34 after allogeneic bone marrow transplantation. Transplantation . 2005 Mar 15. 79(5):624. . Umekawa T, Kurita T. Acute hemorrhagic cystitis by adenovirus type 11 with and without type 37 after kidney transplantation. Urol Int . 1996. 56(2

2014 eMedicine Pediatrics

372. Hematuria (Overview)

Nephrol . 2009 Oct. 24(10):1951-8. . Expert Panel on Pediatric Imaging:., Dillman JR, Rigsby CK, Iyer RS, Alazraki AL, Anupindi SA, et al. ACR Appropriateness Criteria ® Hematuria-Child. J Am Coll Radiol . 2018 May. 15 (5S):S91-S103. . Diven SC, Travis LB. A practical primary care approach to hematuria in children. Pediatr Nephrol . 2000 Jan. 14(1):65-72. . Dodge WF, West EF, Smith EH, Bruce Harvey 3rd. Proteinuria and hematuria in schoolchildren: epidemiology and early natural history. J Pediatr (...) . . Kalia A, Travis LB, Brouhard BH. The association of idiopathic hypercalciuria and asymptomatic gross hematuria in children. J Pediatr . 1981 Nov. 99(5):716-9. . Kincaid-Smith P, Fairley K. The investigation of hematuria. Semin Nephrol . 2005 May. 25(3):127-35. . Krieger I, Sargent DA. A postural sign in the sensory deprivation syndrome in infants. J Pediatr . 1967 Mar. 70(3):332-9. . Loo RK, Lieberman SF, Slezak JM, Landa HM, Mariani AJ, Nicolaisen G, et al. Stratifying risk of urinary tract

2014 eMedicine Pediatrics

373. Gonorrhea (Overview)

partners frequently enough to sustain the infection in a community are defined as core transmitters. Neonatal and pediatric gonococcal infection Neonatal gonococcal infection may follow conjunctival infection, which is obtained during passage through the birth canal. In addition, direct infection may occur through the scalp at the sites of fetal monitoring electrodes. In children, infection may occur from sexual abuse by an infected individual or possibly nonsexual contact in the child's household (...) of reported gonorrhea cases by age group and sex, United States, 2016. Courtesy of the Centers for Disease Control and Prevention (CDC). Infection in children is a marker for child sexual abuse and should be reported as such, although a 2007 review provided some support for nonsexual transmission between children and for transmission from adults to children related to poor hand hygiene. [ , ] Gonococcemia remains an important disease in the adolescent and young adult population, with a peak incidence

2014 eMedicine Pediatrics

374. Hematopoietic Stem Cell Transplantation (Overview)

hampered by small numbers. [ ] Patients treated with chemotherapy alone have achieved remission, but overall survival has been poor. [ , ] In a comparison allogeneic transplant versus chemotherapy in children with Phl + ALL (UK Medical Research Council trial for childhood ALL [MRC ALL 97] program from 1997-2002), 3-year survival was reported as 60% compared with 36%, respectively. [ ] Children with induction failure (M2 or M3 bone marrow status at the end of 1 mo of therapy) were found to have very (...) Leukocyte adhesion deficiency Indications for HSCT in specific diseases Acute myeloid leukemia Allogeneic HSCT is the treatment of choice for all children with acute myeloid leukemia (AML) with a human leukocyte antigen (HLA) ̶ matched sibling in their first complete remission (CR1). In adults, this is reserved for those with high-risk features in their CR1. In adults with standard or good risk features, stem cell transplantation is reserved for their second complete remission (CR2). HSCT is the only

2014 eMedicine Pediatrics

375. Colovesical Fistula (Overview)

. Although rare, fistulae due to cytotoxic therapy have been reported. One case involved a patient undergoing a CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) regimen for non-Hodgkin lymphoma. [ ] Another involved enterovesical fistula as a result of neutropenic enterocolitis (a complication of chemotherapy) in a pediatric patient with acute leukemia. [ ] Traumatic pathophysiology Urethral disruption caused by blunt trauma or a penetrating injury can result in fistulae (...) laparoscopic cholecystectomy) have been reported as a cause of colovesical fistulae. [ , , , , ] Previous Next: Presentation The presenting symptoms and signs of enterovesical fistulae occur primarily in the urinary tract. Symptoms include suprapubic pain, irritative voiding symptoms, and symptoms associated with chronic urinary tract infection (UTI). The hallmark of enterovesical fistulae may be described as Gouverneur syndrome, namely, suprapubic pain, frequency, dysuria, and tenesmus. Other signs


376. Tuberculosis (Overview)

to coma over a period of days to weeks Low-grade or absent fever Symptoms of skeletal TB may include the following: Back pain or stiffness Lower-extremity paralysis, in as many as half of patients with undiagnosed Tuberculous arthritis, usually involving only 1 joint (most often the hip or knee, followed by the ankle, elbow, wrist, and shoulder) Symptoms of genitourinary TB may include the following: Flank pain Dysuria Frequent urination In men, a painful scrotal mass, prostatitis, orchitis (...) considerations for drug therapy in children include the following: Most children with TB can be treated with isoniazid and rifampin for 6 months, along with pyrazinamide for the first 2 months if the culture from the source case is fully susceptible. For postnatal TB, the treatment duration may be increased to 9 or 12 months Ethambutol is often avoided in young children Special considerations for drug therapy in HIV-infected patients include the following: Dose adjustments may be necessary [ , ] Rifampin


377. Tuberculosis of the Genitourinary System (Overview)

, golf-hole appearance) with . Severe cases involve the entire bladder wall, where deep layers of muscle are eventually replaced by fibrous tissue, thus producing a thick fibrous bladder. Tubercles are rare in the bladder; if present, they usually appear at the ureteral orifice. Malignancy should be considered with any isolated tubercles away from the ureteral orifices. Epididymal and testicular TB The higher frequency of isolated epididymal TB lesions in children favors the possibility (...) order of frequency, include increased frequency of urination (during the day initially but at night later in the disease course), dysuria, frank pain, suprapubic pain, blood or pus in the urine, and fever. Urinary urgency is relatively uncommon unless the bladder is extensively involved. Patients with GUTB may also present with a painful testicular swelling, perianal sinus, or genital ulcer. Unexplained infertility in both men and women is sometimes attributable to GUTB. [ ] Physicians have also


378. Streptococcus Group B Infections (Overview)

bacteruria to cystitis and pyelonephritis with bacteremia): Fever, dysuria, flank pain, or pelvic pain See for more detail. Diagnosis Examination in patients with GBS infection may demonstrate the following findings: Lung consolidation, pleural effusion Tachypnea Tachycardia, murmur, evidence of heart failure Hypotension Headache, nuchal rigidity Confusion, altered mental status, neurologic dysfunction Evidence of an embolic event, phlebitis, Splenomegaly Vascular insufficiency of the lower extremity (...) B streptococcal disease from that caused by other pathogens. Pneumonia with bacteremia is common, while meningitis is less likely. Late group B streptococcal neonatal sepsis is defined as infection that presents between one week postpartum and age 3 months. Late disease commonly involves group B Streptococcus serotype III, typically characterized by bacteremia and meningitis. The absence of antibody to group B streptococci in infants is a risk factor for infection. Because antibodies to group B


379. Cervical Cancer (Overview)

cancer is an abnormal Papanicolaou (Pap) test result. Physical symptoms of cervical cancer may include the following: Abnormal vaginal bleeding Vaginal discomfort Malodorous discharge Dysuria See for more detail. Diagnosis ( ) infection must be present for cervical cancer to occur. Complete evaluation starts with . Screening recommendations Current screening recommendations for specific age groups, based on guidelines from the American Cancer Society (ACS), the American Society for Colposcopy (...) at the -308-promoter position of the tumor necrosis factor-alpha (TNF-alpha) gene and cervical cancer. Int J Gynecol Cancer . 2003 Mar-Apr. 13(2):148-53. . Govan VA, Constant D, Hoffman M, Williamson AL. The allelic distribution of -308 Tumor Necrosis Factor-alpha gene polymorphism in South African women with cervical cancer and control women. BMC Cancer . 2006 Jan 26. 6:24. . . Abrahamsson J, Carlsson B, Mellander L. Tumor necrosis factor-alpha in malignant disease. Am J Pediatr Hematol Oncol . 1993 Nov


380. Sepsis, Bacterial (Overview)

, abdominal pain, deranged cell count, and positive PD fluid culture result Urinary tract: Cystitis, pyelonephritis, urethritis, or renal abscess, among others, with urgency, dysuria, pelvic, suprapubic, or back pain; urine microscopy showing pyuria or a positive urine culture result; urosepsis has also been reported after prostatic biopsy [ ] Female genital tract: Pelvic inflammatory disease, cervicitis, or salpingitis, among others, with lower abdominal pain, vaginal discharge, positive results (...) on endocervical and high vaginal swabs Male genital tract: Orchitis, epididymitis, acute prostatitis, balanitis, or prostatic abscess, among others, with dysuria, frequency, urgency, urge incontinence, cloudy urine, prostatic tenderness, and positive urine Gram stain and culture results Bone: Osteomyelitis presenting with pain, warmth, swelling, decreased range of motion, positive blood and/or bone culture results, and MRI changes Joint: Septic arthritis presenting with pain, warmth, swelling, decreased range


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