Pediatric emergency medicine trisk 1115 1115
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TABLE 57.2
CAUSES OF DYSURIA: DERMATOLOGIC CONDITIONS
Disorder
Age
Signs and
symptoms
Psoriasis
All
Pruritis
Physical examination
Sharply demarcated
erythematous, thick,
silver-scaled plaques of
the scalp, elbows, and
knees; may also involve
nails, joints, axilla, and
groin
Lichen
Infants and young Dry, tender, and
Depigmentation in
sclerosis
children
severely pruritic
anogenital area (most
(mostly female)
white plaques
common)
If no discharge is seen, urinalysis will identify the possibility of urinary tract
infection (UTI) (see Chapter 94 Infectious Disease Emergencies ). Clinical
suspicion should remain high among those with a history of dysuria, prolonged
fever, prior history of UTI or abnormal urinary tract, presence of fever, and flank
pain suggesting pyelonephritis. Urinalysis or urine dipstick evaluations are
performed as screening tools on urine collected via clean-catch technique
following cleaning of the perineum or urethral catheterization using sterile
technique. A positive result on urine dipstick (moderate or large leukocyte
esterase and/or positive nitrites) or the presence of pyuria on microscopic urine
analysis (≥5 WBC/hpf and bacteriuria) increases the likelihood of bacterial
infection (urethritis, cystitis, or pyelonephritis). Infection is confirmed by culture
results meeting colony forming unit (CFU) criteria in the presence of a urinary
pathogen. Inflammatory conditions, such as chemical urethritis, and nonbacterial
infections may also evoke a leukocyte response. Empiric antibiotic therapy may
be initiated based on urine dip or urinalysis results pending urine culture results.
