Differential Diagnosis for Urinalysis Results

The urinalysis results showing moderate leukocyte esterase, 11-20 WBCs, 7-10 epithelial cells, and 2+ bacteria can indicate several conditions. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Urinary Tract Infection (UTI): The presence of moderate leukocyte esterase, elevated WBCs, and 2+ bacteria strongly suggests a UTI. Leukocyte esterase is an enzyme produced by white blood cells, and its presence indicates an inflammatory response, typically to a bacterial infection.

• Other Likely Diagnoses

  • Contamination: The presence of 7-10 epithelial cells could suggest contamination, especially if the sample was not collected properly. However, the combination of moderate leukocyte esterase and 2+ bacteria leans more towards an infection.
  • Asymptomatic Bacteriuria: This condition is characterized by the presence of bacteria in the urine of asymptomatic individuals. It's more common in certain populations, like the elderly or those with catheters, but the presence of WBCs and leukocyte esterase suggests a symptomatic infection.

• Do Not Miss Diagnoses

  • Pyelonephritis: Although the symptoms and urinalysis results provided do not specifically indicate pyelonephritis (an infection of the kidney), it's a serious condition that can arise from untreated UTIs. The presence of significant bacteriuria and leukocytosis should prompt consideration of this diagnosis, especially if the patient has flank pain, fever, or other systemic symptoms.
  • Sepsis: In rare cases, a UTI can lead to sepsis, a life-threatening condition. While the provided information does not directly suggest sepsis, any sign of infection, especially with significant bacteriuria, should prompt consideration of this possibility, especially in vulnerable populations.

• Rare Diagnoses

  • Tuberculosis (TB) of the Urinary Tract: Although rare, TB can infect the urinary tract and present with sterile pyuria (WBCs in the urine without bacterial growth on standard cultures). The presence of epithelial cells and moderate leukocyte esterase could be seen in this condition, but it would typically require additional diagnostic testing to confirm.
  • Interstitial Cystitis: This chronic condition causes bladder pressure, bladder pain, and sometimes pelvic pain. The symptoms can mimic those of a UTI, but the urinalysis results would typically not show significant bacteriuria. However, some cases might present with mild inflammatory changes, making it a rare consideration in this differential diagnosis.