Urinary Tract Infection Alternative Treatment

Beat Urinary Tract Infections By Sherry Han

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Uti be gone Natural Urinary Tract Infection Cure Overview

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The Early Host Response To Urinary Tract Infection

In view of the rapid clearance kinetics following intravesical instillation of bacteria, we have investigated the molecular mechanisms used by the bacteria to elicit the early host response to urinary tract infection. Receptor fragmentation into ceramide and free oligosaccharide may represent a highly efficient strategy of the host defence. Release of the carbohydrate receptor makes the bacteria lose their grip until novel receptors are expressed. Soluble receptors may competitively inhibit further attachment and prevent experimental urinary tract infection in vivo 20. In addition, the ceramide signalling pathway triggers chemokines that recruit inflammatory cells which clear bacteria from the local site (see below)21,22.

Urinary tract infections

Colonization of the urinary tract occurs quite commonly in the ICU. Almost all patients in the ICU have a urinary catheter and the risk of colonization increases with the duration of catheterization (estimated incidence is 5 per day). About 20-30 of patients go on to have a urinary tract infection. Differentiating colonization from infection in a critically ill patient is not easy. The presence of pus cells is important, but their absence does not exclude infection. With regard to bacterial counts, whilst the presence of colony forming units of > 105 ml are significant, in critically ill catheterized patients counts of > 103 ml can rapidly increase and therefore should not be dismissed. In addition, it is not unusual for more than one organism to be cultured from critically ill patients and such a result should not be interpreted merely to represent contamination of the specimen. When suspected clinically, cultures should be sent from the urine and antibiotics tailored to organism...

Uncomplicated Bacterial Cystitis

Uncomplicated bacterial cystitis is characterized by dysuria, frequency, urgency, suprapubic pain and pyuria, in the absence of fever. Elevated temperature points to pyelonephritis or complicated infection. If there are no risk factors for a complicated infection (see above), it is sufficient for the diagnosis, to establish the presence of nitrate and or leukocyte esterase with a rapid dipstick method as summarized in Fig 1. If positive, a culture is not Figure 1 Approach ofuncomplicated bacterial cystitis. Figure 1 Approach ofuncomplicated bacterial cystitis.

Recurrent Cystitis

Positive cultures after adequate treatment occur in 20 of patients, mainly in women and should be categorized as persistence, recidive or reinfection. Persistence can be due to lack of compliance, insufficient absorption of the antibiotic, stones, resistant organisms or, rarely, structural or functional abnormalities which need further investigations with ultrasonography, radiologic imaging and eventually an urologist advice. Relapse occurs in general within one week after stopping therapy and is due to incomplete killing of organisms in relation with persistence and or chronic bacterial prostatitis or other deep seated infections. Reinfection is the most frequent form of recurrent cystitis (90 ). It occurs more than two weeks after the initial treatment and is due to a new microorganism introduced by ascending way from the vaginal or digestive flora. Factors favoring recurrent infections include use of diaphragm, incomplete voiding, sexual intercourse, instrumentation, genetic...

Second Malignancies

Like radiation, chemotherapy is associated with second malignancies. The most common iatrogenic cancers attributable to systemic treatment are myelodysplasia and acute leukemia. These are usually associated with drugs that have alkylation as at least one of their mechanisms of action. Classic alkylators like cyclophosphamide contain an electorphilic alkyl group with an affinity for the N7 position on guanine. As a result, it intercolates itself between DNA strands causing mispairing of neu-cleotides and single and double strand breaks. Other drugs, such as the platinums, anthracyclines, and epipodophyllotoxins, have a nonclassical alkylating mechanism that achieves similar effects on DNA through electrostatic means. This DNA damage, if it activates an oncogene or inactivates a tumor suppressor, can lead to transformation of cells and neoplasia. There are other examples of secondary cancers resulting from primary systemic cancer therapy. For example, tamoxifen can cause uterine cancer...

Miscellaneous Effects of Systemic Treatment

A series of other long-term and late effects are associated with specific systemic cancer drugs. For example, bleomycin causes pulmonary fibrosis at doses above 450 mg m2, especially in the elderly and those on supplemental oxygen,66 and the acrolein metabolite of cyclophosphamide and ifosfamide causes a hemorrhagic cystitis that in a small proportion of unfortunate patients can become chronic after a severe acute episode. Cisplatin can affect renal function, which can be either acute or of delayed-onset. Vinca alkyloids like vincristine cause sensory neuropathy, as do platinum drugs (cisplatin, oxaliplatin) and taxanes (paclitaxel, docetaxel). Many of these can reverse to some extent but take many months or even years to do so. Cisplatin's ototoxicity is often permanent.67

Description of Chief Complaint Data Used in Biosurveillance

Table 23.1 is a sample of chief complaints from a registration computer in an ED. The chief complaints are more terse (four or five words) than those recorded in physician notes. They also contain misspellings, unconventional abbreviations, and unorthodox punctuation. Only two of these chief complaints contain diagnoses (finger lac and uti, which are abbreviations Uti for finger laceration and urinary tract infection, respectively). The rest describe the patient's symptoms. The second column of the table shows the syndromes that a human expert assigned to the patient for purposes of training a Bayesian natural language processor. We will discuss syndromes shortly.

Outbreak Detection

2 We note that clinicians and especially veterinarians working in agribusiness do not always work-up a case to the highest level of diagnostic precision due to cost-benefit considerations. For example, medical practice guidelines suggest that a clinician treating a woman with uncomplicated urinary tract infection may treat this relatively imprecise diagnosis without obtaining a urine culture (to establish a more precise bacteriological diagnosis) because the probability of curing the condition with a broad-spectrum antibiotic is high.

Conclusions

Lower incidences of urinary tract infection and now has been shown to have a capacity to decrease peptic ulcer caused by Helicobacter pylori. Isolated compounds from cranberry have been shown to reduce the risk of CVD and cancer. Functional phenolic antioxidants from cranberry such as ellagic acid have been well documented to have antimutagenic and anticarcinogenic functionality. Even though many benefits have been associated with phytochemicals from cranberry, such as ellagic acid, their mechanism of action is still not very well understood. Emerging research exploring the mechanism of action of these phyto-chemicals from cranberry usually follows a reductionist approach, and is often focused on the disease or pathological target. These approaches to understanding the mechanism of action of phytochemicals have limitations as they are unable to explain the overall preventive mode of action of phenolic phytochemicals. The current proposed mechanisms of action of these phenolic...

Invasive Therapy

Sympathetic plexus or ganglion blocks are indicated if pain is predominantly visceral.46 Blocks of the superior hypogastric plexus are intended to relieve pelvic pain due to malignancy or radiation-induced cystitis or enteritis.4748 A network of sympathetic nerves lies anterior to the fifth lumbar vertebral body (Figure 26-2). At that level, it is a retroperitoneal bilateral structure that innervates the pelvic viscera via the hypogastric nerves. The block is performed with the patient in the prone position, and needles are inserted 5 to 7 cm from the midline bilaterally at the level of the L4-L5 spinous interspace. The needles are directed under computed tomography (CT) or fluoroscopic guidance until they reach the position of the plexus (see Figure 26-2, B). A diagnostic or prognostic block can be performed with 6 to 8 mL of 0.25 bupivacaine whereas injection of a neurolytic agent such as alcohol or phenol will give a prolonged block. The sacrococcygeal plexus or ganglion impar can...

Nephrotoxicity

Downstream from the kidneys, ifosfamide is well known to cause hemorrhagic cystitis.23 Once established, hemorrhagic cystitis is difficult to treat thus, prevention is important. Aggressive hydration, continuous infusion schedules, and the use of mesna (a sulfhydryl compound that binds the degradation products of ifosfamide within the bladder) have

Chest Radiation

Pelvic radiation can cause long-term radiation proctitis in a minority of patients. Analogous to the symptoms of a bladder infection, the inflamed rectum seeks to immediately discharge any small amount of stool that enters it. As a result, these patients can have severe fecal urgency and frequency, with each movement consisting of a disappointingly small amount of stool. Antispasmodics like Levsin or Anusol suppositories can help, and symptoms usually improve over the course of a couple of years. However, some patients with persistent debilitating symptoms eventually elect colostomy.

Gene Structure Of Uropathogens

Urinary Tract Infection From Basic Science to Clinical Application 3 4. VIRULENCE FACTORS It is of particular importance that yersiniabactin, an iron uptake system, first described for pathogenic Yersinia, is also encoded by the majority of uropathogenic E. coli6. This iron uptake system is located on a conserved pathogenicity island which is present in many enterobacteria. In addition, yersiniabactin and the seven iron uptake systems described for the nonpathogenic E. coli K-12 organisms, aerobactin is also produced by uropathogenic E. coli strains. Toxins are important for the pathogenesis of urinary tract infections7. In uropathogenicE. coli , the a -hemolysin toxin was described many years ago. Recently, an accumulating amount of data concerning the maturation of the a -hemolysin toxin in UPEC, its secretion and the regulation of the corresponding genes appeared. In addition, the cytotoxic necrotizing factor I, which is responsible for Rho modification and subsequent activation of...

Diagnostics Therapy Prevention

Factors important for virulence (e. g. adherence factors) and therapy (e. g. resistance factors) of UTI. In therapy, certain antibiotics are essential. A simple cystitis should be treated three days, pyelonephritis 10 to 14 days and a prostatitis over three months. Trimethoprim and other substances are well established in therapy of urinary tract infections. It will be certainly possible to use new drugs in the near future. For prevention antibiotics and oestrogens are used for certain groups of patients. It is doubtful, whether vaccination against uropathogens will play a major role in the future. Newly developed display systems, such as the FimH-molecule or the Flagella-protein, however, will certainly lead to new dead and live vaccine strains of potential importance for prevention of UTI. In addition, immue stimulation may also play a role in prevention of this infectious disease.

Epithelial Cells as Arbitrators of Neutrophil Recruitment to Mucosal Sites

Cytokines have local and systemic effects. Local inflammation causes changes in vascular permeability, recruitment of inflammatory cells, and disruption of tissue function. Systemic effects include fever, and the symptoms and signs of sepsis. We detected an IL-6 response in urine and blood of children with acute pyelonephritis25,26. The urine IL-6 response was specific for febrile UTI it was not found in children with other febrile infections. We also found positive correlations between fever, CRP and local or circulating IL-6 concentrations in adults with febrile UTI27,28. The role of epithelial chemokine production for neutrophil recruitment to mucosal site was studied in vivo, using the mouse UTI model. Following intravesical Escherichia co i infection, several C-X-C chemokines were secreted into the urine, but only MIP-2 concentrations correlated to neutrophil numbers36. Immunohistochemistry identified the kidney epithelium as a main source ofMIP-2. MIP-2 antibody treatment ofthe...

Identification Of Host Defects That Upset The Specific Or Innate Defenses

Early studies in the UTI model indicated that specific immunity was of minor importance for the mucosal host defense. Nude, xid, and scid mice with defective T lymphocyte, immunoglobulin, and B and T lymphocyte function, respectively, were shown to be fully resistant to infection37. Since the defects in these mice are vaguely defined and in some cases incomplete we wanted to re-evaluate the role of specific immunity, using mutant mice that lack specific lymphocyte populations. Experimental UTI was thus established in P T cell receptor (TCR) mutant3839-, 8 TCR mutant40, RAG-1 mutant41, and control mice. TCR ap mutant mice lack cytotoxic and helper T cells and have defective humoral and cellular responses to T-cell dependent antigens42 TCR 8 mutant mice have a normal peripheral aPT cell repertoire39 and intact humoral and cellular responses to T-cell dependent antigens42, but low levels of mucosal IgA43. y8 T cells have been implicated in the antimicrobial defense against Staphylococci,...

The IL8RDeficiency Confers Susceptibility to Acute Pyelonephritis

A marked loss of resistance to infection was noted in the IL-8R mutant mice. IL-8R mutant mice were unable to clear the bacteria from kidney and bladder tissue and showed abnormal neutrophil recruitment to the mucosa. They eventually developed bacteremia and symptoms of systemic disease. These results emphasize the role of innate immunity and IL-8 receptor function for the resistance to urinary tract infection in the mouse. The 1. Is it the neutrophil receptor deficiency or the epithelial cell that determines the susceptibility to UTI

Insertion of catheters

Catheter-induced sepsis is one of the commonest causes of nosocomial infection in the ICU but because intravascular cannulae and catheter placements for vascular access, monitoring and cardiac output measurements are now common practice, a sense of complacency has developed. Catheters must be inserted under sterile conditions a proper surgical approach to skin preparation with gowning and glove donning is best, especially for critically ill and immunocompromised patients and if catheterization is planned for long-term use. As catheter infection is rare during the first 3 days of placement, it is suggested that catheter-related sepsis may be minimized by changing the catheter within 48 h. Unfortunately, this practice increases the risk of complications associated with catheter insertion. A single lumen catheter is preferred to a multilumen one as they require less manipulation and there is less temptation to use them for drug administration also, although there is no evidence that this...

Complications And Prognosis

Prognosis has dramatically improved since the combination of CYC and GC has been utilized for severe disease presentations. Milder forms of WG, in which critical organ systems are not involved, may be effectively treated with weekly MTX or daily AZA. Recent studies have demonstrated that in severe disease, making a transition from CYC to MTX or AZA after approximately three months spares, or markedly reduces, CYC toxicities. These include cystitis, bladder cancer, lymphoma, myelodysplasia, and sterility. Almost all patients will achieve remission with these approaches to therapy. Because relapses are very common, patients should be closely monitored for early signs and symptoms of disease, so that treatment may be instituted or changed without delay.

Classic Infectious Disease

The major clear-cut associations between the human polyomaviruses and classically defined infectious diseases are those of JCV with PML and BKV with hemorrhagic cystitis (Weber and Major, 1997 Arthur et al., 1988 Barbanti-Brodano et al., 1998). BKV and JCV are ubiquitous in most human populations, The pathology of PML is due to viral replication in oligodendrocytes, which are the cells in the brain that produce myelin. Numerous studies have demonstrated that the JCV promoter and enhancer contain binding sites for a variety of transcription factors that are expressed in glial cells, although only one of these appears to be truly glial cell specific (Frisque and White, 1992 Raj and Khalili, 1995). Disease is also often accompanied by rearrangements in the transcriptional control region that appear to enhance TAg expression and, subsequently, replication (Dorries, 1997, 1998 Weber and Major, 1997). The BKV promoter and enhancer have not been dissected in nearly as much detail, making the...

Identification Of The Alternative Transcription Factor Sigb In S Epidermidis

In order to elucidate the possible involvement of the sigB factor in the regulation of biofilm expression in S. epidermidis we investigated the oB expression under conditions which are known to induce the ica expression. For this purpose we used again S. epidermidis 215 and a second isolate, S. epidermidis 567, which was obtained from a catheter-associated urinary tract infection. Northern blot analysis of the sigB transcription by using a 32P-labelled gene probe revealed that the operon is expressed in the stationary growth phase (Fig. 6, lanes 1, 2, 3, and 4), and upon osmotic stress by addition of 3,4, and 5 per cent sodium chloride to the growth medium (Fig

Storagefilling symptoms

These symptoms are seen in detrusor overactivity, formerly called detrusor instability, which can be proven with urody-namics (UDS). This condition may be secondary to increased stimulation of the trigone, for example bladder stone, urine infection, malignant cystitis or a neurological cause such as stroke. Alternatively, if no cause for the detrusor overactivity is identified, it is termed primary detrusor overactivity.

Bladder and prostate gland

Acute retention of urine results in an intense pain suprapubi-cally, with an unremitting desire to void. A similar pain can be experienced in a urinary infection, although more commonly there is severe suprapubic pain unrelieved by voiding which itself is painful. Irritation of the trigone, either by inflammation or mechanical trauma from a stone or catheter, can cause pain referred to the urethral meatus. Inflammation of the prostate causes a variety of urinary symptoms, which can include perineal and penile pain, as well as and a dull suprapubic or ill-defined rectal discomfort. These symptoms form part of the chronic pelvic pain syndrome. This syndrome can also affect women. In a minority of cases a diagnosis of interstitial cystitis can be made (see below).

Microscopy and culture

A mid-stream specimen of urine (MSSU) is collected, taking precautions to minimize contamination. Microscopy also allows red blood cells to be identified. If a urine infection is present, pus cells will be seen and bacteria will grow on the culture plates. If pus cells are present without evidence of infection (sterile pyuria), tuberculosis should be considered and special stains and culture medium used. Any bacterial cultured is tested for antibiotic sensitivities, according to local protocols.

Products Available

In the various studies and consumer references, many dosages and dosing regimens have been reported for the use of cranberry in prevention of renal calculi, prevention of urinary odor, and prevention and treatment of urinary tract infections. Prevention of urinary tract infection 8 oz of cranberry juice four times a day for several days, then twice daily (7) 300 mL day as cranberry juice cocktail (11). Treatment of urinary tract infection 6 oz cranberry juice of daily for 21 days (12) cranberry juice 6 oz twice daily (13).

Prevalence ofVirulence Factors

Characteristics of 111 isolated Escherichia coli. P-values of differences in numbers of virulence factors between cleared and persistent strains are given. Primers for type 1 fimbriae (type1), P fimbriae (papA), three alleles ofthe G-adhesinoftype P fimbriae (papG-I, papG-II, papG-III), S fimbriae (SFA), afimbrial adhesin (AFA), cytotoxic necrotizing factor (CNF), and aerobactin were used. O-UTI known uropathogenic O-serotypes (O1, O2, O4, O6, O7, O8, O16, O18, O25, O75). Phenotypes were also determined MSHA mannose-sensitive hemagglutination MRHA mannose-resistant hemagglutination and hemolysin. Table 1. Characteristics of 111 isolated Escherichia coli. P-values of differences in numbers of virulence factors between cleared and persistent strains are given. Primers for type 1 fimbriae (type1), P fimbriae (papA), three alleles ofthe G-adhesinoftype P fimbriae (papG-I, papG-II, papG-III), S fimbriae (SFA), afimbrial adhesin (AFA), cytotoxic necrotizing factor (CNF), and...

Virulence Determinant Characterisation

Type 1 fimbriae occur at a higher frequency among the E. coli isolates from patients with a reconstructed bladder than those isolates causing a cystitis infection. The other virulence determinants occur at a significantly lower frequency in the isolates from a reconstructed bladder as shown by the paired student t-test (P < 0.05). Cystitis community acquired

Bladder Bowel and Sexual Disturbances

Sphincter dyssynergia, may then lead to retention of urine and, particularly in males, to vesicoureteral reflux, with the threat of hydronephrosis and progressive renal failure (138). Retention of urine also increases the risk of urinary tract infection which, in turn, may suddenly precipitate urinary symptoms.

Multicystic dysplastic kidney

This condition is distinguished from polycystic kidney disease which is a rare genetic disorder. Multicystic dysplasia is usually unilateral and may be detected by ultrasonography both ante- and post-natally. The cysts are unconnected and there is no functioning renal parenchyma. Many multicystic dysplastic kidneys will atrophy with age and may not require treatment. Nephrectomy is carried out for persistent and symptomatic (urinary infection) lesions. The risk of late malignancy is considered very unlikely.

After radiotherapy for cervical carcinoma

Using radiation alone (external beam irradiation and brachytherapy) the incidence of severe rectal complications is variable. Perez109 in 1456 patients found respectively 4.1 , 3 , and 3 of major rectal, bladder and small intestinal complications. The most frequent grade 2 sequelae were proctitis (3 ) and cystitis (0.7 ) (Table 2.2.8-1).

Vesicoureteric reflux

Vesicoureteric reflux is found in 1 of children, and is a common cause of urinary infection (20-50 ). There is a female preponderance (85 ) and a familial tendency (30 incidence in siblings of affected patients, suggesting an autosomal dominant inheritance with variable penetrance). The oblique course of an intravesical, submucosal ureteral segment normally functions as a valve, failure of which (e.g. a short ureteral tunnel) results in reflux. Vesicoureteric reflux is only harmful when complicated by infection. Repeated urinary infection is associated with renal scarring, loss of renal function and eventually hypertension and renal failure.

Affected Organs And Cell Types In Polyomavirusassociated Disease And Persistent Virus Infection

Hemorrhagic cystitis (HC) is a serious BKV-associated complication of bone marrow transplantation (BMT) patients. Prevalence of HC varies from 10 to 68 and leads to severe hemorrhage in about 25 of bone marrow recipients (Arthur et al., 1985 Azzi et al., 1994 Bedi et al., 1995 Chan et al., 1994 Cotterill et al., 1992). Hemorrhage and viruria most likely are due to viral activation in the uroepithelium, as virus particles can be detected in exfoliated urinary cells by means of electron microscopy (Hiraoka et al., 1991). Prolonged hematuria is associated with severe morbidity and increasing viral load in urine (Azzi et al., 1999). Viruria in BMT patients was reported as early as 1975 (Reese et al., 1975). Although before transplantation only 1 of patients shed BKV (Arthur et al., 1985), increases have been reported to 22 , 48 (Arthur et al., 1988, 1989 Cotterill et al., 1992 Jin et al., 1993), 67 (Jin et al., 1995), and even 100 of patients in the post-transplant period if classic...

Incidence and risk factors

As for intestinal complications, old age is not a risk factor for urinary complications97'99'111'121, whereas prior abdominal surgery is one96,111. Stage is a risk factor too127. The correlation between radiation dose and bladder complication is well documented96'98'109'122'124'125. For Logsdon125, major pelvic complications significantly increase when the dose of external radiation is superior to 52 Gy. Montana190 reported 3 of severe cystitis for patients receiving less than 50 Gy to the bladder, versus 12 for doses superior to 80 Gy, with a significant relationship between bladder dose and severity of complication. Sinistrero124 found a correlation between bladder dose and severity of cystitis too. Using low dose rate brachytherapy, bladder complications are more frequent with the higher dose rates109,129,130. Perez109 reported 2.9 of grade 2-3 morbidity with dose rate inferior to 0.8 Gy h, and 6.1 with higher dose rates. Lawton98 reported 2.6 of grade 3 or higher cystitis, with...

Conventional treatment

Mild urinary frequency, caused by a minor reduction in the bladder capacity, can be treated with antispasmodics192. Hemorrhagic cystitis require bladder irrigation through a transurethral catheter193. For intractable hematuria, intravesical formalin instillation has been studied by several authors, with good results125'186'188'194-199. A preinstillation cystogram is necessary, to search a vesicoureteral reflux. General or intradural anesthesia is required. Contact time is ranged from 5 to 30 minutes125,188 after instillation bladder irrigation is performed. One of the most important published trial included 35 patients different concentrations have been used 1, 2 and 4 . Complete response has been observed in 31 patients after a single instillation complication occurred in 31 of the patients. A 1 solution was as effective as higher concentration, and was associated with less morbidity194. Another retrospective study of 25 patients (15 cases of radiation cystitis) obtained the same...

Hyperbaric oxygen therapy

Radiation cystitis174,178,206-221 (Table 2.2.8-3). Bevers206 reported a prospective study of 40 patients most of them required transfusion. Patients had received unsuccessful treatments clot evacuation, electrocoagulation, alum, tranexamic acid. They received 20 sessions of 100 oxygen at 3 bar pressure for 90 minutes, 5 or 6 times a week. In 4 patients, 40 sessions were given because of persistence of symptoms. Hematuria stopped in 30 patients occasional slight hematuria persisted in 7 patients with a median follow up of 23 months, 9 recurrences occurred. The severity of initial hematuria appeared to influence the response to hyperbaric oxygen failure of treatment was seen only in patients with a very severe hemorrhagic cystitis (3 patients with a mean blood transfusion need of 26 units ). Lee211 reported a retrospective study of 20 patients. They received an average of 44 sessions (2.5 ata, 100 minutes session). Bleeding stopped in 16 patients, and markedly decreased in 2, with a...

Possible Mechanisms Of Activation

Transactivation may also involve herpesviruses, which can act on polyoma-virus DNA replication. Cytomegalovirus (CMV) is highly prevalent in the human population and can infect virtually any organ of its host (Sinzger and Jahn, 1996 Tevethia and Spector, 1989). Co-infection can occur in the kidney, lung, CNS, and lymphoid organs. Specifically, epithelial cells, fibroblasts, and endothelial cells are potential common host cells for BKV and CMV. Stromal cells and CD34-positive bone marrow progenitor cells might be cell types that can be co-targeted by JCV and CMV (Mendelson et al., 1996 Sinclair and Sissons, 1996). CMV infection is often activated in AIDS patients after RT, and there is a high incidence of CMV infection in patients with hemorrhagic cystitis (HC) after BMT (Childs et al., 1998). In AIDS patients no co-detection and no correlation between polyomavirus and CMV viruria was observed (Sundsfjord et al., 1994a). Similarly, the high incidence of CMV after kidney

Cytokine Responses And Disease In The Human Urinary Tract

The response to UPEC was examined by injection of bacteria into the urinary tract of patients. Colonization with non-virulent bacteria was performed in an attempt to protect special patient groups from recurrent, symptomatic UTI. This strategy was based on clinical observations that ABU in children protected against symptomatic UTI. Those who were left untreated were shown to have a lower frequency of symptomatic recurrences than the patients who were given antibiotics in order to eliminate the bacteriuria, and there were no adverse effects on renal function. This study examined the role of P fimbriae for the establishment and persistence of bacteria in the human urinary tract53. Eleven patients with recurrent symptomatic urinary tract infections (UTI) were subjected to The findings in the mutant mice demonstrated that IL-8R expression influences the susceptibility to E.coli UTI through an effect on neutrophil recruitment. So, could abnormal IL-8R expression be a cause of...

Uropathogenic Organism

Urinary tract infections can be divided into complicated and noncomplicated infectious diseases. The main pathogen of non-complicated urinary tract infections is Escherichia coli. E. coli is not only detected in urinary tract infections in humans but also plays an important role in UTI of certain animals, especially dogs. It is interesting to note that also intestinal pathogens ofporcine origin exhibit features of uropathogenicE. coli1 Over the last few years several non-E. coli bacteria were identified to be uropathogenic. Those bacteria were often found in patients suffering from complicated urinary tract infections, including patients with either catheters or suffering from stone formation or in immunocompromized patients. Thus, multiresistant Klebsiella pneumoniae and Pseudomonas aeruginosa as well as certain Proteus species are important ofnon-E. coli uropathogens. One has to take in mind that especially the newly established species Proteus penneri seems to be a newly emerging...

Infection

Ad infections occur worldwide as epidemic, endemic, and sporadic infections. Of the 51 human Ad serotypes currently known, the most common in clinical materials are the respiratory types of subgenus C (Ad1, Ad2, Ad5) and subgenus B (Ad3 and Ad7) (102,103). Along with being an important cause of respiratory tract infections, Ad can also cause conjunctivitis and gastrointestinal disease. Ads have been implicated in aseptic meningitis, encephalitis, hepatitis, and hemorrhagic cystitis and may cause severe disseminated infections in immunocompromised patients of all ages (104). In humans, the majority of Ad infections in immunocompetent hosts are subclinical, meaning that no apparent symptoms are present. This feature has made Ad an attractive platform for numerous gene therapy applications, including cancer. However, like most human virus pathogens, Ads possess a substantial genetic armamentarium to interfere with the immune system of the host to ensure their evolutionary survival...

Innate Immunity

We have shown that innate immune mechanisms provide the most potent defence of the mucosal barrier against UTI, and have identified neutrophils as important local effectors of the mucosal defence36. The work was based on earlier observation in C3H HeJ (Ipsd, Ipsd) mice that lack the neutrophil response to UTI, and fail to clear bacteria from the tissues47,48. More recently, studies directly addressing the role of neutrophils have been performed.

Patients

In 53 women (mean age 42 ++ 12 years) with chronic non-obstructive pyelonephritis, E. coli strains were examined. All patients suffering from an acute UTI were examined micro-biologically. Subsequent investigations of the patients did not provide any clinical or biochemical clues to an acute infection. The diagnosis was established on the basis of clinical history as well as clinical, laboratory and radiological findings (renal scarring, caliceal clubbing and blunting). In all patients, a vesicoureteral reflux, an obstruction due to concrements or a metabolic disorder (diabetes mellitus, hyperuricemia) were ruled out. In no case was urinary tract infection associated with glomerulonephritis or a gynecological disease. No immunocompromised host was included.

Voiding symptoms

As the obstruction increases the bladder detrusor muscle may decompensate and acute urine retention be precipitated. This can occur secondary to constipation, a urine infection or simply delaying passing urine, for example waiting until the end of the after-dinner speeches The pain of acute retention of urine is intense and felt suprapubically.

Timothy S Tracy

It appears that cranberry juice may be effective in preventing the recurrence of urinary tract infections, but not in treating urinary tract infections. It is generally well tolerated and relatively free of adverse effects. There have been case reports of coadministration of cranberry juice and warfarin resulting in bleeding events, but this potential interaction remains to be conclusively established. Key Words Vaccinium macrocarpon prophylaxis urinary tract infection kidney stones.

Special tests

Prostate-specific antigen (PSA) is a glycoprotein, responsible for liquefying semen in vivo. As a tumour marker it is used to aid in the diagnosis and also monitor treatment of prostate cancer. It should be remembered that the 'normal range' for PSA varies with age and that PSA levels can also be effected by other conditions, such as urinary tract infection (UTI). The widespread use of PSA testing as part of a process of prostate cancer screening (particularly in the USA) has significantly reduced the proportion of patients diagnosed with advanced stage prostate cancer. In the UK, however, the use of PSA for screening remains controversial.

Stones

Stone formation occurs as a result of an imbalance between the solubility of salts and their crystallization. In the Western world, 70-80 of stones are composed of calcium oxalate. Ureteric stones form initially in a renal papilla from a small submucosal concretion. As the crystallization increases, it separates from the papilla and passes into the collecting system with the urine. Before they pass into the calyces, such stones are seldom symptomatic although they can be associated with recurrent urinary infections. Conversely, a staghorn renal calculus that fills the renal pelvis and calyces is formed within the collecting system. Such stones are often seen with urine chronically infected with Proteus mirabilis. This bacterium splits urea to ammonia, alkalinizes the urine and precipitates magnesium ammonia phosphate. This becomes calcified and the stone may form a complete cast of the collecting system. Staghorn stones represent a surgical challenge. If there is minimal renal...

Definitions

ASB was defined as the presence of at least 105 cfu ml of one or two microorganisms in a culture from a clean-voided midstream urine of a patient without symptoms of a UTI or fever (> 38.3 C)17. Cleared strains were defined as strains, which were isolated from the first urine of a patient with a sterile urine culture 2-4 months later. Persistent strains were defined as strains, which were cultured from the first urine of a patient with a positive urine culture with the same E. coli strain (considering the virulence factors) 2-4 months later. Known uropathogenic O-serotypes are O1, O2, O4, O6, O7, O8, O16, O18, O25 and O7518.

Tumour

Classically, a TCC presents with painless haematuria, although urine infection is also commonly seen. Cystoscopy allows a biopsy to confirm the diagnosis and a resection biopsy of the base of the tumour will allow the pathologist to stage the tumour, by determining whether muscle invasion has occurred.

Spinal pathology

Children born with a spinal defect often have neurological problems affecting the lower limbs, bladder and rectum. Many patients have neuropathic bladders and may require surgery because of severe voiding dysfunction. Options include management by either an indwelling catheter, ISC or urinary diversion. Due to immobility and chronically poor voiding, renal stone formation and recurrent UTIs are common.

Results 31 Study

26 patients took part in this study, 19 males and 7 females, with an average age of 53 years. Fig 1 shows the distribution of surgical reconstruction procedure performed and which section of the bowel was used. The majority of reconstruction procedures utilise a combination of the two bowel tissues, the ileum and caecum. On entering into this study 11 out of the 26 patients complained of recurrent UTIs, although the remaining 15 agreed to take part due to problems with UTIs in the past. In 5 of these 11 patients E. coli was previously documented to be the main or only causative bacterial spp. In this study, 2 out of these 5 patients still had persistent bacteriuria with E. coli. Of the remaining 6 patients, 4 had previous chronic recurrent episodes of UTI and were taking prophylactic antibiotics, either Cephalexin, Trimethoprim or Nalidixic acid. In this study, 3 of these 4 had persistent bacteriuria, one with only E. coli.

Epidemiology

The prevalence UTI varies according sex and age3. The female gender is more prone to infection for anatomical reasons short and straight urethra and short distance between the ostium of the urethra and the anus contribute to the easy colonization of the periurethral region with enteric bacteria equipped with appropriate pili, fimbriae, etc attaching to the mucosal surface. In female the prevalence is 1 in newborns (congenital defects with functional or anatomic reflux), 4-5 in toddlers for the same reasons, 4-5 The most frequent organisms causing UTI are Escherichia coli, less common are Klebsiella spp. Enterobacter spp, Proteus spp, Staphylococcus syprophyticus (women only), Pseudomonas spp, Acinetobacter spp, streptococci group B and enterococci, whereas Haemophilus influenzae, salmonella, shigella, anaerobes, yeasts or mycobacteria are rare. A clear link to UTI has not been established for Gardnerella vaginalis, Ureaplasma urealyticum and Mycoplasma hominis. For therapeutic reasons...

Urine Cultures

Urine cultures should be performed only if essential for the management of the patient to control the efficacy of treatment, in complicated UTI including paraplegic patients, neurogenic bladder, chronic bacterial prostatitis, after renal transplantation, in the setting of gynecological or urological surgery or in any other particular clinical situation. Asymptomatic

Urethral Syndrome

The urethral syndrome, also known as dysuria-pyuria syndrome, is an acute UTI with low number of microorganisms, 102-105cfu ml observed in women only. The cause can be an infection with Ureaplasma urealyticum, Chlamydia trachomatis or other sexually transmitted diseases confined to the proximal urethra or an infection of the para-urethral glands with lactobacilli. Some cases are due to chemical irritation with deodorants, bubble bath etc., to mechanical or psychological trauma. The therapeutic measures are the same as those mentioned for recurrent cystitis. Specific treatment with doxycycline (200 mg daily for 10 days, azithromycine (1 g in a single dose) or fluoroquinolones (10 days) is indicated for Ureaplasma urealyticum, or Chlamydia trachomatis.

Acute Pyelonephritis

Acute pyelonephritis is characterized by fever, lumbar pain, nausea and vomiting. Lower UTI symptoms may be absent. The severity of clinical symptoms is variable and can go from sepsis to multi-organ failure. There is no adequate laboratory test for localization antibody-coated bacteria are neither sensitive, nor specific and have been abandoned. Leucocyturia and significant bacteriuria (in 20 < 105cfu ml) are always present, blood cultures are positive in 15-20 . Fifty percent of acute pyelonephritis are uncomplicated and observed mainly in young women. The other 50 concern mainly elderly men with prostata hyperplasia with recent or indwelling catheters. Patients with acute pyelonephritis should be hospitalized ifcomplicated or severely ill, unstable, immunocompromised, pregnant, or if they are children or men. Persistent vomiting, unsuitable home situation and any suspicion of abscess, obstruction or kidney stones are also indications for hospitalization12.

Methods

The patients were recruited in the diabetes outpatient clinics of the University Hospital Utrecht (tertiary care hospital), four non-university hospitals (Diakonessenhuis Utrecht, Bosch Medicentrum 's Hertogenbosch, Catharinahospital Eindhoven) and the offices of seven general practitioners in The Netherlands. Women were included with either DM type 1 or DM type 2, age between 18-75 years. All patients were asked to collect two consecutive midstream urine specimens during a 2-4 month period. Exclusion criteria were Pregnancy, recent hospitalization or surgery (< 4 months), known urinary tract abnormalities, symptoms of a UTI or the use of antimicrobial drugs in the previous 14 days. Finally 636 women entered the study group. During the first visit of the study all patients were interviewed and the medical history was obtained from the hospital files using a standardized questionnaire, which included Age, type and duration of DM, medication, secondary complications of the DM...

Paediatric Urology

Urinary tract infection in infants and children is most often caused by urinary stasis which can result from vesicoureteric reflux, obstructive uropathy, neuropathy dysfunction of urinary tract, or rarely stones ascending infection can occur in girls after bubble-bath because of the short urethra. A urine culture is obtained and antibiotics given. All young children should be investigated after the first documented episode of urinary sepsis with ultrasonography and micturating cystourethrogram.

Duplex system

There are varying degrees of duplication of the urinary tract, some of which are inconsequential, for example partial bifid ureter. In accordance to embryology, the lower pole ureter generally inserts more lateral and cephalad into the bladder than the upper pole ureter which has a more medial and caudal orifice that is sometimes ectopic. As a consequence, the lower pole ureter is more prone to reflux, whereas the upper pole ureter is more often obstructed (Weigert-Meyer law). The commonest entity requiring treatment consists of a poorly functioning upper kidney moiety drained by an ectopic ureter. The ureter may open into a ureterocele in the bladder, or rarely outside the bladder in which case the child typically wets in between normal voids. Urinary infection is more commonly the presenting symptom. Treatment consists of upper pole nephroureterectomy. Associated anomalies, for example ureterocele, may require additional procedures.

Ureterocele

Ureterocele is a cyst-like dilatation at the lower end of a ureter. Occasionally, it is small and orthotopic, originating from a single ureter. More commonly, it is associated with an ectopic ureter which usually drains an upper kidney moiety of a duplex system. Apart from obstruction to the ureter, reflux may coexist. Urinary infection is the commonest

Wetting

Wetting in children can be caused by anatomic incontinence (ectopic ureter, bladder obstruction, extrophy), neurogenic incontinence (spinal dysraphism, trauma, tumours), functional incontinence (urge syndrome, fractional voiding), enuresis (nocturnal, diurnal), and other conditions (urinary infection, polyuria). Incontinence is characterized by failure of voluntary bladder control and incomplete emptying whereas in enuresis emptying is complete and the child is often unaware when wetting occurs.

Phimosis

Non-retractility of foreskin in early life is, however, normal (physiological phimosis) as the epithelial layers of the glans and foreskin are fused at birth. This probably protects the infant from ammoniacal excoriation and hence neonatal circumcision has no medical grounds. This procedure is commonly performed in United States (US) for reasons of 'hygiene', 'perhaps lowering the risk of urinary infection', 'social habit', etc. The other major non-medical reason for circumcision is religion, notably for Jews and Muslims. Natural separation of foreskin usually occurs so that by the age of 4 years, the foreskin becomes retractile in 90 of boys. Prior to this, sometimes anxious parents may discover pea-sized swellings underneath the foreskin. These are collections of smegma, are harmless and will resolve when foreskin separation is complete.

Bladder

Endothelium continues several months after the treatment. Obliterative endarteritis with perivascular fibrosis result in ischemia185. Telangiectasia can be observed. Smooth muscle fibrosis, with collagen deposition, is responsible for the reduction of bladder capacity (urinary frequency, urgency)186-188. Cystitis is a syndrome characterized by irritative symptoms such frequency and dysuria hematuria may or may not be a part of cystitis (RTOG definition)98. The SOMA LENT score for bladder and urethral complications includes dysuria, frequency, hematuria, incontinence and decreased stream103.

Infection Viral

Adenovirus is the most common cause of viral pharyngitis. It is a double-stranded DNA virus. Serotypes 3,4, and 7 are frequently associated with viral pharyngitis. It is transmitted by either respiratory droplets or direct contact. School-aged children are most commonly affected. The classic presentation includes fever, sore throat, coryza, and red eyes. Adenovirus is cytolytic to the epithelial cells it invades and induces a localized inflammatory response in the surrounding tissues. Nasopharyngeal swabs can be obtained for viral cultures and a negative monospot test should be confirmed. It is usually self-limiting and lasts five to seven days. Treatment is supportive. Severe morbidity and mortality are rare and only seen in patients with altered immune function. Complications of adenovirus infection include keratoconjunctivitis (pink eye), acute hemorrhagic cystitis nephritis, and gastroenteritis. Ribavirin has been advocated in several case reports when systemic...