Parasitic urinary tract infection

　　Parasitic urinary tract infections include infections caused by various pathogens, common ones being:
　　1. Trichomonas urinary tract infection
　　The main pathogen of trichomonas urinary tract infection is Trichomonas vaginalis, which can parasitize in the vagina, urethra, and prostate of women and men, causing vaginitis, urethritis, prostatitis, cystitis, etc. It can occasionally invade the kidneys and even cause perinephric abscess. The main route of infection is ascending.
　　2. Urinary amebiasis
　　Urinary amebiasis refers to the disease caused by the intracellular ameba invading the kidneys, bladder, and urethra. This disease often occurs secondary to amebic enteritis and amebic liver abscess.
　　3. Urinary filariasis
　　The disease is caused by the adult, larva, and metabolic products of the Onchocerca volvulus, leading to lymphangitis and lymphatic obstruction, which is prone to occur in the limbs, forming elephantiasis, hydrocele, and local lymphatic dilation.
　　4. Renal echinococcal disease (echinococcosis)
　　The disease is caused by the larval infection of the small grain echinococcus tapeworm in humans.

　　The main complications of parasitic urinary tract infections are as follows:
　　1. Filariasis of the urinary tract can lead to elephantiasis of the limbs, commonly known as 'elephant legs'; the enlargement of renal echinococcal cysts compresses the surrounding glomeruli, causing them to atrophy and rupture. Occasionally, the cyst may rupture into the renal pelvis or abdominal cavity, causing allergic symptoms such as urticaria, asthma, fever, and abdominal pain. In severe cases, anaphylactic shock may occur.
　　2. Hydrocele is a common clinical complication of the disease, and the fluid is mostly lymphatic fluid, while chyle is rare.
　

　　Parasitic urinary tract infections include infections caused by various pathogens, common symptoms of which are as follows:

　　1. Trichomonas urinary tract infection
　　The clinical manifestations are completely identical to those of bacterial urinary tract infection. Female patients are more likely to present with vaginitis, characterized by increased leukorrhea, pruritus of the vulva, and even itching around the vaginal opening. Urinary symptoms such as frequent urination, urgency, dysuria, and a burning sensation in the urethra after urination may also occur; male patients often have balanitis, and most patients with lower urinary tract infection excrete a small amount of purulent secretion in the morning urine, with a feeling of urethral itching. If the bladder is involved, there may be discomfort in the upper pubic area, with frequent terminal hematuria and a small amount of milky secretion may be discharged after urination. In the case of trichomonas pyelonephritis, symptoms such as chills, fever, abdominal pain, pyuria, and hematuria may occur. Some patients may have no systemic symptoms or urinary tract irritation symptoms.

　　2. Urinary tract amoebiasis
　　Clinical symptoms are not specific depending on the site and route of infection, similar to common bacterial urinary tract infections. The lesions are classified into the following types based on clinical manifestations:
　　1. Amoebic cystitis, urethritis: caused by intestinal bladder fistula or ascending urinary tract infection, symptoms include frequent urination, urgency, dysuria, and pain in the bladder area before and after urination. In patients with renal infection, symptoms such as chills, high fever, back pain, and renal area percussion pain may occur.
　　2. Amoebic renal abscess or perinephric abscess: caused by hematogenous infection or the rupture of amoebic abscesses in the liver or colon into the kidney, the main clinical manifestations include chills, fever, back pain, tenderness and percussion pain over the renal area, and tension of the lumbar muscles in the renal area, local masses may be palpable.

　　3. Urinary tract filariasis
　　Filariasis is caused by Wuchereria bancrofti adults, larvae, and their metabolic products, leading to lymphangitis and lymphatic obstruction, which is common in the limbs, causing elephantiasis, hydrocele, and local lymphatic dilation. Some patients may develop orchitis, epididymitis, and orchitis. If the lesion blocks the thoracic duct or chyle pool, the distal lymphatics may dilate and rupture, communicating with the urinary tract, causing chyluria. Swollen lymphatics may rupture into the renal calyces, pelvis, ureter, and bladder, but most of them rupture into the renal pelvis.

　　4. Renal echinococcosis
　　Renal hydatid cysts are mostly solitary, with the mother cyst containing daughter and granddaughter cysts. The lesions are often unilateral, mostly located at the lower pole of the kidney, and are round. The onset is insidious, and the course can last for several years or even decades. As the cysts enlarge, they compress the surrounding glomeruli, causing them to atrophy and rupture. Occasionally, the cysts may rupture into the renal pelvis or abdominal cavity, causing allergic symptoms such as urticaria, asthma, fever, and abdominal pain. In severe cases, anaphylactic shock may occur. If the cysts rupture into the renal pelvis, calyces, and the cyst fluid enters the bladder, hematuria and bladder irritation symptoms may appear. Cyst fragments entering the ureter can cause renal colic. The main signs of this disease are renal cystic masses, which may cause abdominal bulging when large, and a rebound sensation, known as 'hydatid cyst tremor', can be felt when heavily percussed, which can be distinguished from renal hydronephrosis and renal cysts.

　　For parasitic urinary tract infections, it is necessary to control the infection source, eliminate the primary disease and susceptible factors, pay attention to hygiene, cut off the transmission route, and effectively prevent the occurrence of this disease. Systematic general surveys and treatments should be carried out, and comprehensive treatment should be provided for collective units with more than 60% of the population infected, to reduce the density of egg pollution in the soil and thus reduce the opportunities for parasitic transmission. This disease is mainly transmitted through the oral route, so it is necessary to widely carry out health education and publicity. Pay attention to dietary hygiene, especially educate children to develop good hygiene habits, wash fruits and vegetables before eating, wash hands before and after meals, and trim nails frequently. Improve the environmental hygiene, eliminate mosquitoes and flies, and strengthen fecal management.

　　Ultrasonic, X-ray, or CT examination of the renal area in urinary amebiasis in parasitic urinary tract infections is helpful for the diagnosis of amebic renal abscess or perirenal abscess; cysticercosis is often complicated with liver cysticercosis, X-ray, ultrasound, or CT findings of renal space-occupying lesions are helpful for the diagnosis of cysticercosis.

　　Patients with parasitic urinary tract infections should supplement vitamin C, as vitamin C can increase the acidity of urine, making it difficult for various bacteria that cause urethral infections to survive. Therefore, drinking beverages rich in vitamin C such as orange juice, citric acid, and kiwi juice is beneficial for preventing urinary tract infections. In addition, drinking plenty of water has the effects of anti-inflammatory, antibacterial, and clearing heat and detoxifying.

　　Parasitic urinary tract infections include infections by various pathogens. The treatment of common pathogen infections is as follows:
　　1. Treatment of Trichomoniasis Urinary Tract Infection
　　Metronidazole, 10 days as a course of treatment, can be repeated after a month. Since trichomonads often invade the urinary tract first, bacterial urinary tract infection may exist, so antibiotics (such as oxytetracycline, tetracycline, etc.) can be used in combination or alternated with antibiotics. Male trichomoniasis urinary tract infections are often caused by sexual activity, and both partners should be treated simultaneously, and sexual activity should be prohibited during treatment.
　　2. Treatment of urinary filariasis
　　Currently, diethylcarbamazine (海群生) and carbarsone are commonly used for treatment. For patients with chronic chyluria who have not responded to long-term treatment, after cystoscopy and retrograde urography to determine the site of chyluria entering the urinary tract, surgical treatment can be considered.
　　3. Treatment of urinary amebiasis
　　Extraintestinal amebiasis is primarily treated with metronidazole (灭滴灵). For amebic renal abscess, the course of treatment should not be too short to avoid recurrence. Secondly, emetine (sulfuric acid emetine) can be used, administered by deep intramuscular injection. Diiodohydroxyquin, tetracycline, and others can be used according to circumstances. In cases of amebic renal abscess or perirenal abscess, incision and drainage may be necessary if necessary.
　　4. Treatment of Cysticercosis
　　The only method is to surgically remove the cyst. In case of an allergic reaction, active control should be implemented.