Abstract
Background:Urinary tract infections (UTI) have been found to be associated with a variety of neuropsychiatric disorders, and could play a role in the pathophysiology of relapse of affective and nonaffective psychosis. In addition, prior history of infarction in areas of the brain such as the cerebellum, basal ganglia, and mid-brain have been reported in patients with new onset psychotic symptoms.Case presentation:A 29-year-old woman was brought to the hospital with acute mental status changes and signs of sepsis. Infectious work-up was initiated including blood cultures, brain imaging, lumbar tap and urinalysis. Brain MRI revealed abnormalities in the basal ganglia and the urinalysis revealed signs of a urinary tract infection (UTI). Further history revealed episodes of mania and depression compatible with bipolar disorder with psychotic features that had acutely worsened. The patient’s condition improved with intravenous antibiotics and the introduction of anti-psychotics. She was discharged in stable condition with outpatient psychiatric follow-up.Conclusion:Infectious diseases (UTIs in particular) are not only more prevalent among patients with acute relapse of psychiatric disorders, but have also been found to have triggered acute psychosis among stable psychiatric patients. Organic brain lesions must be thoroughly investigated among patients presenting with new psychiatric disorders in order to initiate appropriate therapy to control the symptoms.
Highlights
Urinary tract infections (UTI) have been found to be associated with a variety of neuropsychiatric disorders, and could play a role in the pathophysiology of relapse of affective and nonaffective psychosis
Among patients with psychiatric disorders, UTI occurring during pregnancy was found to confer a higher risk nonaffective psychosis to the offspring [3]
It has become apparent that alterations in the microbiome makeup, due to the presence of a precisely timed pathogen exposure in a person with genetically encoded altered immunity, may lead to an imbalance that have damaging consequences for the central nervous system (CNS) [4]
Summary
Infections have been recognized as triggers of acute episodes of psychosis among patients with neuropsychiatric disorders [1]. Schizophrenia patients who develop acute infections bear increased morbidity and mortality [2]. UTI are found at a high prevalence rate among patients with a variety of psychiatric presentations [2]. Among patients with psychiatric disorders, UTI occurring during pregnancy was found to confer a higher risk nonaffective psychosis to the offspring [3]. Brain imaging abnormalities such as cortical atrophy, encephalomalacia, hypodensities suggesting prior infarction and gliosis have been reported in patients with psychosis. Brain lesions have been postulated to alter the normal pathways leading to functional disturbances in the cortex regions that affect normal perception of reality affecting sensory, visual and behavior [5]
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