Proteus Urinary Tract Infections Research Articles

Association between rheumatoid arthritis and urinary tract infections caused by Proteus spp.: a review

Rheumatoid arthritis (RA) is a systemic and arthritic autoimmune disease that affects millions of people worldwide. The World Health Organization has reinforced its concerns regarding RA morbidity. Characterized by inflammation of the joints which can lead to the destruction of the periarticular tissue, causing pain and joint deformities. During the last four decades, scientific data has suggested that urinary tract infections (UTI) caused by Proteus spp. have a key role in the aetiopathogenesis of RA. Here, we performed a qualitative systematic review of the available literature regarding the association between RA and UTI caused by Proteus spp . in a worldwide perspective. We selected four studies that either show increased isolation of Proteus spp . in the urine of patients with RA or show elevated levels of anti- Proteus antibodies in the serum of RA patients, of the population of different countries from three continents, always comparing with healthy and/or non-RA disease controls. This work reinforces the evidence linking Proteus spp . to RA, from the recurrent sub-clinical Proteus UTIs to the full development of RA. Antimicrobial susceptibility testing guided therapy must be considered crucial to ensure therapeutic success and prevent or minimize the occurrence of RA associated with UTI and future research should be performed with the aim to access if the usage of antibiotics against Proteus spp. from the urinary tract could be implemented as adjuvant therapies to treat RA. Additionally, due to the fact that no research regarding the described association has been performed in Portugal, we suggest the development of a future research project, to access if the Portuguese population follows the trend of the countries referred to in this review.

High incidence of abnormal imaging findings in circumcised boys diagnosed with urinary tract infections

The American Academy of Pediatrics guidelines recommend delaying voiding cystourethrogram (VCUG) until the second febrile urinary tract infection (UTI). Similarly, the NICE Guidelines do not recommend VCUG after the first febrile UTI in infants and children under three years of age. Currently, there is no good clinical indicator to determine which patients would benefit from an earlier cystogram. Here, we sought to identify clinical and bacteriologic findings that are associated with an increased risk of urinary tract anatomic anomalies in pediatric males presenting to the Emergency Department with a UTI. A retrospective review was performed of all urine cultures from the Emergency Department at our institution between 2006 and 2015. Males under 18 years of age with ≥50,000CFU/mL of Proteus, Klebsiella, Escherichia coli, Staphylococcus, Streptococcus and Enterococcus were included. Clean catch, catheterized and suprapubic aspiration specimens were included. Bagged specimens and specimens from patients on intermittent catheterization were excluded. Ultrasound and cystogram images were reviewed when available. Univariate and multivariable Poisson regression with robust variance was used to calculate and compare prevalence ratios. Statistical analysis was performed with Stata software, version 15.1MP (Stata Corporation, College Station, Texas, USA). We reviewed 1585 urine cultures, of which 812 met eligibility criteria including 619 (76.2%) E. coli, 84 (10.3%) Proteus, 55 (6.8%) Klebsiella, 29 (3.6%) Staphylococcus, 13 (1.6%) Enterococcus and 12 (1.5%) Streptococcus. Median age was six months (2.4-36 months IQR). After adjusting for age, ethnicity and bacterial species, the prevalence of dilating vesicoureteral reflux (VUR, defined as grades III-V) was 5.3 times higher in circumcised males compared to uncircumcised males (95% CI: 2.4-11.4, p=0.001). Circumcised males had a 3.1 times increased prevalence of high-grade hydronephrosis (defined as SFU grades 3 and 4) compared to uncircumcised males (prevalence ratio: 3.1, 95% CI: 1.0-10.0, p=0.05). Among bacterial pathogens, no patients with Proteus UTI had high-grade hydronephrosis or dilating VUR. In contrast, Staphylococcal infections were associated significantly with dilating VUR (prevalence ratio 10.1, 95% CI: 2.3, 44.8; p=0.002) and high-grade hydronephrosis (prevalence ratio 8.1, 95% CI: 1.7, 39.7; p=0.010). Circumcision status is an independent predictor of structural urinary anomalies of the bladder and upper tracts in pediatric males with UTI, therefore circumcised males should be considered for early imaging, including VCUG, after their first UTI. Furthermore, Staphylococcal infections were associated with an even higher prevalence of high-grade hydronephrosis and dilating VUR and therefore warrant early investigation with VCUG. In contrast, none of the Proteus infections, which were seen almost exclusively in uncircumcised males, were associated with dilating VUR or hydronephrosis, making initial observation more appropriate in these patients.

Rheumatoid arthritis in smokers could be linked to Proteus urinary tract infections

There is an interplay between genetic and environmental factors in the induction and development of rheumatoid arthritis (RA). The RA-associated HLA-DRB1 alleles which contain the shared epitope moiety as well as microbial triggers such as Proteus are involved in the aetiopathogenesis of this disease. Increased association between Proteus urinary tract infections (UTIs) and RA on one hand and the link between smoking and UTIs on the other hand could explain the increased frequency of RA among smokers. Novel therapeutic and prophylactic measures are proposed, which might help to treat and/or prevent the disease process in individuals who are susceptible to develop RA.

Treatment of staghorn calculi with extracorporeal shock-wave lithotripsy and percutaneous nephrolithotomy

Between August 1983 and August 1987, 72 staghorn calculi were treated in 66 patients. Treatment was with percutaneous nephrolithotomy (PCNL) in 30, extracorporeal shock-wave lithotripsy (ESWL) in 18, combination PCNL-ESWL in 23, and nephrectomy in 1. Complications occurred in 59 percent of patients and were twice as common after PCNL as after ESWL. Radiologic follow-up on 69 kidneys (97%) showed 58 percent were stone free, 15 percent had residual sand or matchheads < 5 mm, 17 percent had residual fragments of 5–15 mm, and 10 percent had >15 mm residual stone burden. With a mean follow-up of thirty months, 2 of 40 stone-free patients had persistent asymptomatic Proteus urinary tract infections, and 4 of 22 patients with residual calculi ≤ 15 mm required additional operative treatment.

Alkaline Urine Is Associated With Eating Disorders

Sir .—Alkaline urine has traditionally been associated with Proteus urinary tract infections. 1 In the absence of an infection, clinical findings might suggest other diagnoses, but these are rare in adolescents. The following are some of the traditional causes of alkaline urine 2 : (1) urinary tract infection ( Proteus and others); (2) metabolic alkalosis (pyloric stenosis and others); (3) failure of acidification (renal tubular acidosis, chronic renal failure, or aldosterone abnormalities); (4) ingestion (salicylate, sodium bicarbonate, acetazolamide, etc); and (5) respiratory alkalosis (hyperventilation). After noticing alkaline urine in a number of otherwise healthy patients with eating disorders, we prospectively examined urine pH in a hospital-based adolescent medicine practice to determine Urine pH (mean ± SE) in outpatients presenting to the adolescent medicine division. The difference between control subjects and patients with eating disorders was highly significant, at P

Circumcision and periurethral carriage of Proteus mirabilis in boys.

Swabs were taken for culture from the periurethral area and urethral meatus in 124 uncircumcised and 60 circumcised boys. Proteus mirabilis was grown from 28 (22.6%) swabs from uncircumcised boys and from only one (1.7%) swab from circumcised boys. This supports the idea that the prepuce may be the source of proteus urinary tract infection.

The use of the Dienes test in the epidemiology of proteus urinary tract infections in patients with spinal cord disease

The incidence of urinary tract infections in 47 patients with spinal cord injuries (11 women and 36 men) was studied and the aetiological agents identified. A high incidence of Proteus mirabilis infection was found and both auto- and cross-infection were identified by the Dienes test.

Xanthogranulomatous pyelonephritis masquerading as occult malignancy

Xanthogranulomatous pyelonephritis (XGP) can present with weight loss, anemia, leukemoid reaction, and generalized debility; there may be no signs or symptoms referable to the urinary tract. Confusion between XGP and renal adenocarcinoma is well recognized, but other malignancies can also be simulated. Case histories of patients with proved XGP whose clinical presentations suggested occult malignancies are recorded. Proteus urinary tract infection, calculi, and a nonvisualizing kidney on intravenous pyelogram should suggest the correct diagnosis. The pathology, bacteriology, diagnosis, and treatment are reviewed.