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Antimicrobial activity of
intraurethrally administered probiotic Lactobacillus casei
in a murine model of Escherichia coli urinary tract
infection.
Asahara T, Nomoto K, Watanuki M, Yokokura T. Yakult
Central Institute for Microbiological Research, Kunitachi,
Tokyo 186-8650, Japan.
Antimicrob Agents Chemother 2001 Jun;45(6):1751-60
The antimicrobial activity of the intraurethrally
administered probiotic Lactobacillus casei strain Shirota
against Escherichia coli in a murine urinary tract
infection (UTI) model was examined. UTI was induced by
intraurethral administration of Escherichia coli strain
HU-1 (a clinical isolate from a UTI patient, positive for
type 1 and P fimbriae), at a dose of 1 x 10(6) to 2 x 10(6)
CFU in 20 microl of saline, into a C3H/HeN mouse bladder
which had been traumatized with 0.1 N HCl followed
immediately by neutralization with 0.1 N NaOH 24 h before
the challenge infection. Chronic infection with the
pathogen at 10(6) CFU in the urinary tract (bladder and
kidneys) was maintained for more than 3 weeks after the
challenge, and the number of polymorphonuclear leukocytes
and yeloperoxidase activity in the urine were markedly
elevated during the infection period. A single
administration of L. casei Shirota at a dose of 10(8) CFU
24 h before the challenge infection dramatically inhibited
E. coli growth and inflammatory responses in the urinary
tract. Multiple daily treatments with L. casei Shirota
during the postinfection period also showed antimicrobial
activity in this UTI model. A heat-killed preparation of L.
casei Shirota exerted significant antimicrobial effects not
only with a single pretreatment (100 microg/mouse) but also
with multiple daily treatments during the postinfection
period. The other Lactobacillus strains tested, i.e., L.
fermentum ATCC 14931(T), L. jensenii ATCC 25258(T), L.
plantarum ATCC 14917(T), and L. reuteri JCM 1112(T), had no
significant antimicrobial activity. Taken together, these
results suggest that the probiotic L. casei strain Shirota
is a potent therapeutic agent for UTI.
[Can acupuncture prevent
cystitis in women?]
Aune A; Alraek T; Huo L; Baerheim A Bryggen Medisinske
Senter, Bergen.
Tidsskr Nor Laegeforen (NORWAY) Mar 30 1998, 118 (9)
p1370 2
67 adult women with a history of recurrent lower urinary
tract infection (UTI) were randomized for acupuncture
treatment, sham acupuncture, or no treatment. The incidence
rate of UTI over the following six months was noted. In the
acupuncture group a total of 85% was free of cystitis
during the six month observational period, as compared to
58% in the sham group (p < 0.05), and 36% in the
control group (p < 0.01). Compared to the
acupuncture group, twice as many incidents of cytitis
occurred in the sham group, and three times as many in the
control group (p < 0.05). Acupuncture seems a
worthwhile alternative in the prevention of frequently
recurring cystitis in women.
Reduction of bacteriuria
and pyuria after ingestion of cranberry juice.
Avorn J, Monane M, Gurwitz JH, Glynn RJ, Choodnovskiy I,
Lipsitz LA. Program for the Analysis of Clinical
Strategies, Brigham and Women's Hospital, Boston, MA
02115.
AMA. 1994 Mar 9;271(10):751-4.
OBJECTIVE--To determine the effect of regular intake of
cranberry juice beverage on bacteriuria and pyuria in
elderly women.
DESIGN--Randomized, double-blind, placebo-controlled
trial.
SUBJECTS--Volunteer sample of 153 elderly women (mean
age, 78.5 years).
INTERVENTION--Subjects were randomly assigned to consume
300 mL per day of a commercially available standard
cranberry beverage or a specially prepared synthetic
placebo drink that was indistinguishable in taste,
appearance, and vitamin C content but lacked cranberry
content.
OUTCOME MEASURES--A baseline urine sample and six
clean-voided study urine samples were collected at
approximately 1-month intervals and tested quantitatively
for bacteriuria and the presence of white blood cells.
RESULTS--Subjects randomized to the cranberry beverage
had odds of bacteriuria (defined as organisms numbering
> or = 10(5)/mL) with pyuria that were only 42% of
the odds in the control group (P = .004). Their odds of
remaining bacteriuric-pyuric, given that they were
bacteriuric-pyuric in the previous month, were only 27% of
the odds in the control group (P = .006).
CONCLUSIONS--These findings suggest that use of a
cranberry beverage reduces the frequency of bacteriuria
with pyuria in older women. Prevalent beliefs about the
effects of cranberry juice on the urinary tract may have
microbiologic justification.
New support for a folk
remedy: cranberry juice reduces bacteriuria and pyuria in
elderly women.
Fleet JC Human Nutrition Research Center on Aging, Tufts
University, Boston, MA 02111.
Nutr Rev (United States) May 1994, 52 (5) p168-70
Cranberry juice has developed a following as a simple,
nonpharmacologic means to reduce or treat urinary tract
infections, yet the scientific basis for such a claim has
been lacking. A new study suggests that bacterial
infections (bacteriuria) and associated influx of white
blood cells into the urine (pyuria) can be reduced by
nearly 50% in elderly women who drink 300 mL of cranberry
juice cocktail each day over the course of a 6-month study.
The results of this study suggest that consumption of
cranberry juice is more effective in treating than
preventing bacteriuria and pyuria. Along with earlier
reports on the ability of cranberry juice to inhibit
bacterial adherence to urinary epithelial cells in cell
culture, this new work suggests that drinking cranberry
juice each day may be clinically useful. Additional work
must be conducted, however, to more completely define the
efficacy of cranberry juice.
Incidence of acute
urinary tract infection in young women and use of male
condoms with and without nonoxynol-9
spermicides.
Handley MA, Reingold AL, Shiboski S, Padian NS. Division
of Public Health Biology and Epidemiology, School of Public
Health, University of California-Berkeley, Berkeley, CA,
USA. handley@itsa.ucsf.edu
Epidemiology 2002 Jul;13(4):431-6
BACKGROUND: Acute urinary tract infection is one of the
most common infections seen in primary care.
METHODS: We conducted a nested case-control study among
a cohort of 519 women, ages 15-29 years, enrolled in a
contraceptive acceptability study to examine whether recent
use of male condoms increases urinary tract infection
risk.
RESULTS: One hundred sixty-five incident urinary tract
infections were identified during 12-month follow-up
periods in a cohort study that was conducted between 1996
and 1999. After exclusions for urinary tract infection
recurrences, pregnancy, antibiotic use, diabetes,
diaphragm/cervical cap use, or urinary tract abnormalities,
there were 100 cases and 200 controls. Compared with women
not using barrier methods (and after adjustment for age,
urinary tract infection history, hormonal method use, and
frequency of sex) the odds ratio (OR) for any reported use
of condoms coated with spermicide (Nonoxynol-9) in the
previous 30 days was 2.8 (95% [confidence interval] CI =
1.2-6.5). The OR was 11.5 (95% CI = 2.5-53) for exclusive
Nonoxynol-9-coated condom use. The OR for exclusive use of
non-Nonoxynol-9-coated condoms was 7.4 (95% CI =
1.6-35).
CONCLUSIONS: In this study, use of male condoms was
associated with increased urinary tract infection risk; the
largest risk was associated with exclusive condom use and
use of Nonoxynol-9-coated condoms.
Cranberry juice and
adhesion of antibiotic-resistant uropathogens.
Howell, A.B., Foxman, B.
JAMA 2002 Jun 19; 287(23): 3082-3.
No abstract available.
Bacterial urinary tract
infections in diabetes.
Patterson JE, Andriole VT. Department of Medicine
(Infectious Diseases), University of Texas Health Science
Center at San Antonio, USA.
Infect Dis Clin North Am 1997 Sep;11(3):735-50
Diabetes mellitus has a number of long-term effects on
the genitourinary system. These effects predispose to
bacterial urinary tract infections in the patient with
diabetes mellitus. Bacteriuria is more common in diabetic
women than in nondiabetic women because of a combination of
host and local risk factors. Upper tract infection
complications are also more common in this group. Diabetic
patients are at higher risk for intrarenal abscess, with a
spectrum of disease ranging from acute focal bacterial
pyelonephritis to renal corticomedullary abscess, to the
renal carbuncle. A number of uncommon complicated urinary
tract infection complications occur more frequently in
diabetics, such as emphysematous pyelonephritis and
emphysematous pyelitis. Because of the frequency and
severity of urinary tract infection in diabetic patients,
prompt diagnosis and early therapy is warranted. A plain
abdominal radiograph is recommended as a minimum
radiographic screening tool in the patient with diabetes
presenting with systemic signs of urinary tract infection.
Ultrasonography or further radiographic studies such as CT
scanning may also be warranted, depending on the clinical
picture, to identify upper urinary tract complications
early for appropriate intervention.
Probiotic agents to
protect the urogenital tract against
infection.
Reid G. Lawson Research Institute and the Department of
Microbiology and Immunology, the University of Western
Ontario, Canada. gregor@julian.uwo.ca
Am J Clin Nutr 2001 Feb;73(2 Suppl):437S-443S
The urogenital microflora of a healthy woman comprises
approximately 50 species of organisms, which differ in
composition according to reproductive stages and exposure
to several factors, including antibiotics and spermicides.
Infections are very common with > 300 million cases
of urinary tract infections, bacterial vaginosis, and yeast
vaginitis worldwide per annum. At the time of infection in
the bladder and vagina, the urogenital flora is often
dominated by the infecting pathogens, in contrast with
healthy phases when indigenous organisms dominate.
Premenopausal women have a flora of mostly lactobacilli,
and certain properties of these strains, including adhesive
ability and production of acids, bacteriocins, hydrogen
peroxide, and biosurfactants, appear important in
conferring protection to the host. Efforts to artificially
restore an unbalanced flora with the use of probiotics have
met with mixed results but research aimed at selecting
scientifically based strains could well provide a reliable
alternative treatment and preventive regimen to antibiotics
in the future.
The role of cranberry and
probiotics in intestinal and urogenital tract
health.
Reid G. Lawson Research Institute, University of Western
Ontario, London, Canada. gregor@uwo.ca
Crit Rev Food Sci Nutr 2002;42(3 Suppl):293-300
Several forces are driving an expanded use of
nutraceuticals, particularly functional foods and
probiotics, as instruments of the restoration and
maintenance of well-being. These include consumer desire to
use natural rather than pharmaceutical products, the
mounting scientific evidence that shows efficacy of certain
nutraceutical products, and the increasing cost and
continued failure of drugs to cure or prevent disease.
There is now a strong scientific basis for use of
cranberries to reduce the risk of E. coli adhesion to
bladder cells and the onset of urinary tract infection.
There is also a mechanistic basis and clinical support for
use of Lactobacillus strains such as L. rhamnosus GR-1 and
L. fermentum RC-14 to colonize the intestine and vagina and
reduce the risk of intestinal and urogenital infections.
For such alternative approaches to be successful,
scientific rigor must be backed by public education and
physician acceptance. Given the emergence of virulent and
multidrug-resistant pathogens, time is not on our side.
Oral probiotics can
resolve urogenital infections.
Reid G, Bruce AW, Fraser N, Heinemann C, Owen J, Henning
B. Lawson Research Institute, London, Ont., Canada.
gregor@julian.uwo.ca
FEMS Immunol Med Microbiol 2001 Feb;30(1):49-52
We report the first clinical evidence that probiotic
lactobacilli can be delivered to the vagina following oral
intake. In 10 women with a history of recurrent yeast
vaginitis, bacterial vaginosis (BV) and urinary tract
infections, strains Lactobacillus rhamnosus GR-1 and
Lactobacillus fermentum RC-14 suspended in skim milk and
given twice daily for 14 days, were recovered from the
vagina and identified by morphology and molecular typing
within 1 week of commencement of therapy. In six cases of
asymptomatic BV or intermediate BV (based upon Nugent
scoring) was resolved within 1 week of therapy.
Use of Lactobacillus to
prevent infection by pathogenic bacteria.
Reid G, Burton J. Canadian Research and Development
Centre for Probiotics, Lawson Health Research Institute,
and Department of Microbiology and Immunology at the
University of Western Ontario, 268 Grosvenor Street,
London, Ontario, N6A 4V2, Canada. gregor@uwo.ca
Microbes Infect 2002 Mar;4(3):319-24
This review focuses on the use and potential of
Lactobacillus to prevent infections of the urogenital and
intestinal tracts. The presence and dominance of
Lactobacillus in the vagina is associated with a reduced
risk of bacterial vaginosis and urinary tract infections.
The mechanisms appear to involve anti-adhesion factors,
by-products such as hydrogen peroxide and bacteriocins
lethal to pathogens, and perhaps immune modulation or
signaling effects. The instillation of Lactobacillus GR-1
and B-54 or RC-14 strains into the vagina has been shown to
reduce the risk of urinary tract infections, and improve
the maintenance of a normal flora. Ingestion of these
strains into the gut has also been shown to modify the
vaginal flora to a more healthy state. In addition, these
strains inhibit the growth of intestinal, as well as
urogenital pathogens, colonize the gut and protect against
infections as shown in mice. Other probiotic strains, such
as Lactobacillus GG, have been shown to prevent and treat
gastroenteritis caused by rotavirus and bacteria. Given
that lactobacilli are not the dominant commensals in a gut
which comprises around 10(10) organisms, much work is still
needed to define the mechanisms whereby GR-1, RC-14, GG and
other strains contribute to health restoration and
maintenance. Such critically important studies will require
the medical science community to show a willingness to turn
away from pharmaceutical remedies as the only solution to
health and disease.
An examination of the
anti-adherence activity of cranberry juice on urinary and
nonurinary bacterial isolates.
Schmidt DR; Sobota AE Alliance City Hospital, Ohio.
Microbios (England) 1988, 55 (224-225) p173-81
In a previous investigation it was demonstrated that
cranberry juice cocktail was able to inhibit adherence in
77 clinical isolates of Escherichia coli obtained from
patients with diagnosed urinary tract infections. This work
has been extended to include clinical isolates of E. coli,
Proteus, Klebsiella, Enterobacter and Pseudomonas isolated
from urine, sputum, wound and stool. Bacterial strains
isolated from urine adhere in greater numbers to urinary
tract epithelial cells than organisms isolated from sputu
and wound sources. E. coli, isolated from urine, adheres to
urinary epithelial cells, in numbers three times greater
than E. coli isolated from other clinical sources, and thus
appears to represent a unique population of cells in terms
of adherence. Cranberry juice cocktail and urine and
urinary epithelial cells obtained after drinking the
cocktail all demonstrate antiadherence activity against
Gram-negative rods isolated from urine and other clinical
sources. Drinking the cocktail may be useful in managing
urinary tract infections in certain patients.
In vitro antagonistic
effect of Lactobacillus on organisms associated with
bacterial vaginosis.
Strus M, Malinowska M, Heczko PB. Department of
Bacteriology, Medical College of Jagiellonian University,
Department of Obstetrics and Gynecology, Health Care Trust
of the Ministry of Internal Affairs and Administration,
Krakow, Poland.
J Reprod Med 2002 Jan;47(1):41-6
OBJECTIVE: To assess antagonistic properties of
Lactobacillus strains isolated from the vaginas of healthy
women as compared to the most common bacterial agents
related to vaginosis.
STUDY DESIGN: Antagonistic activity of different
Lactobacillus strains isolated from the vaginas of healthy
women not treated for infections with an antibiotic for the
previous three months was screened using an agar slab
method. The activity was tested against test organisms
associated with bacterial vaginosis and/or urinary tract
infections: Staphylococcus aureus, Enterococcus faecalis,
Streptococcus agalactiae, Escherichia coli, Gardnerella
vaginalis, Peptostreptococcus anaerobius and Prevotella
bivia.
RESULTS: Many of the 146 Lactobacillus strains tested
exerted apparent antagonistic activities against
gram-positive aerobic cocci and gram-negative rods, such as
S aureus and E coli, and a marked number of Lactobacillus
strains inhibited facultative bacteria, such as Gardnerella
vaginalis and the anaerobes P anaerobius and P bivia. Only
a few lactobacilli were able to inhibit growth of E
faecalis and S agalactiae. Indicator bacteria growth
inhibition probably relies upon several different
complementary mechanisms. The specific indicator bacteria
species determines which mechanism predominates.
CONCLUSION: Lactobacillus strains taken from normal
vaginal flora demonstrated antagonistic activity against a
variety of bacteria related to vaginal and urinary tract
infections. The specific occurrence rates of active
Lactobacillus strains are different, and this difference is
dependent on the indicator bacteria species.
Cranberry juice and its
impact on peri-stomal skin conditions for urostomy
patients.
Tsukada K; Tokunaga K; Iwama T; Mishima Y; Tazawa K;
Fujimaki M
Ostomy Wound Manage (United States) Nov-Dec 1994, 40 (9)
p60-2, 64, 66-8
In urostomy patients, peristomal skin problems are
common and may stem from alkaline urine. Cranberry juice
appears to acidify urine and has bacteriostatic properties,
and is widely recommended for the reduction of urinary
tract infections. Therefore, it is hypothesized that
drinking cranberry juice might also prevent and/or improve
skin complications for urostomy patients. To test this
hypothesis, pH measurements of the skin around the stoma
and of the urine of 13 urostomy patients were taken before
and after instituting a regimen of drinking 160 to 320 g of
cranberry juice each day for an average period of six
months. Results showed an improvement in skin condition
from 6 patients with erythema, maceration or
pseudoepithelial hyperplasia at the beginning of the study
to 2 patients with maceration or PEH. The average pH of the
urine taken from the patients' pouches decreased a
statistically significant amount from 8.0 to 7.3 (p =
0.0277), yet unexpectantly, the average pH of the fresh
urine increased a statistically significant amount from 5.8
to 6.2 (p = 0.0178). Other results were not statistically
significant. The authors conclude that while drinking
cranpected, improvements were still seen in the skin
conditions of the study participants, suggesting that
drinking cranberry juice does positively impact the
incidence of skin complications for these patients.
Urinary tract
infections in women.
Valiquette L. Department of Surgery (Urology),
CHUM-Hopital St-Luc, Montreal, Quebec, Canada.
Can J Urol 2001 Jun;8 Suppl 1:6-12
Urinary tract infections (UTIs) are the most common
infections seen in the hospital setting, and the second
most common infections seen in the general population. Due
to women's anatomy, UTIs are especially problematic for
them, and up to one-third of all women will experience a
UTI at some point during their lifetimes. Appropriate
treatment of a UTI requires accurate classification that
includes infection site, complexity of the infection, and
the likelihood of recurrence. The predominant pathogen in
both complicated and uncomplicated UTI remains pathogenic
Escherichia coli, although Klebsiella sp. and Proteus
appear with increased frequency in complicated UTI. Most
often, bacteria cause UTIs by ascending means through the
urethra into the bladder. Bacteria must possess virulence
factors to cause UTI. Host defense factors that predispose
patients to UTI include urinary stasis, abnormal urinary
tract anatomy, diabetes mellitus, debility, and aging.
Estrogen-related issues and short urethras predispose women
to UTI. Although urine culture, with >105
colony-forming units/mL (CFU/mL) in symptomatic patients,
remains the diagnostic "gold standard," correlation of the
patient's history and physical examination with urinalysis
(including nitrite dipstick and leukocyte esterase test)
results usually suffices to diagnose UTI. Three-day of
antimicrobial treatment is recommended for simple cystitis.
Acute pyelonephritis, an infection of the kidney parenchyma
tissue, is treated with antibiotics for 7 to 14 days
depending on the antimicrobial agent used and the severity
of infection. In addition, patient classification
determines the need for hospitalization or for urological
imaging studies. Women with recurrent UTIs merit
consideration for antimicrobial prophylaxis.
Self-administered topical vaginal estradiol cream is an
important adjunct in UTI prevention for postmenopausal
women. Asymptomatic bacteruria only merits antimicrobial
therapy in high-risk patients or those colonized with
Proteus species.
SUGGESTED
READING
Widespread distribution
of urinary tract infections caused by a multidrug-resistant
Escherichia coli clonal group.
Manges AR, Johnson JR, Foxman B, O'Bryan TT, Fullerton
KE, Riley LW. Division of Epidemiology and Public Health
Biology, School of Public Health, University of California
at Berkeley, 94720, USA.
N Engl J Med 2001 Oct 4;345(14):1007-13
BACKGROUND: The management of urinary tract infections
is complicated by the increasing prevalence of
antibiotic-resistant strains of Escherichia coli. We
studied the clonal composition of E. coli isolates that
were resistant to trimethoprim-sulfamethoxazole from women
with community-acquired urinary tract infections.
METHODS: Prospectively collected E. coli isolates from
women with urinary tract infections in a university
community in California were evaluated for antibiotic
susceptibility, O:H serotype, DNA fingerprinting,
pulsed-field gel electrophoretic pattern, and virulence
factors. The prevalence and characteristics of an
antibiotic-resistant clone were evaluated in this group of
isolates and in those from comparison cohorts in Michigan
and Minnesota.
RESULTS: Fifty-five of the 255 E. coli isolates (22
percent) from the California cohort were resistant to
trimethoprim-sulfamethoxazole as well as other antibiotics.
There was a common pattern of DNA fingerprinting,
suggesting that the isolates belonged to the same clonal
group (clonal group A), in 28 of 55 isolates with
trimethoprim-sulfamethoxazole resistance (51 percent) and
in 2 of 50 randomly selected isolates that were susceptible
to trimethoprim-sulfamethoxazole (4 percent,
P<0.001). In addition, 11 of 29 resistant isolates
(38 percent) from the Michigan cohort and 7 of 18 (39
percent) from the Minnesota cohort belonged to clonal group
A. Most of the clonal group A isolates were serotype
O11:H(nt) or O77:H(nt), with similar patterns of virulence
factors, antibiotic susceptibility, and electrophoretic
features.
CONCLUSIONS: In three geographically diverse
communities, a single clonal group accounted for nearly
half of community-acquired urinary tract infections in
women that were caused by E. coli strains with resistance
to trimethoprim-sulfamethoxazole. The widespread
distribution and high prevalence of E. coli clonal group A
has major public health implications.
Sat, the Secreted
Autotransporter Toxin of Uropathogenic Escherichia coli, Is
a Vacuolating Cytotoxin for Bladder and Kidney Epithelial
Cells.
Guyer DM, Radulovic S, Jones FE, Mobley HL. Department
of Microbiology and Immunology, University of Maryland
School of Medicine, Baltimore, Maryland 21201.
Infect Immun 2002 Aug;70(8):4539-46
The secreted autotransporter toxin (Sat) of
uropathogenic Escherichia coli exhibits cytopathic activity
upon incubation with HEp-2 cells. We further investigated
the effects of Sat on cell lines more relevant to the
urinary tract, namely, those derived from bladder and
kidney epithelium. Sat elicited elongation of cells and
apparent loosening of cellular junctions upon incubation
with Vero kidney cells. Additionally, incubation with Sat
triggered significant vacuolation within the cytoplasm of
both human bladder (CRL-1749) and kidney (CRL-1573) cell
lines. This activity has been associated with only a few
other known toxins. Following transurethral infection of
CBA mice with a sat mutant, no reduction of CFU in urine,
bladder, or kidney tissue was seen compared to that in mice
infected with wild-type E. coli CFT073. However,
significant histological changes were observed within the
kidneys of mice infected with wild-type E. coli CFT073,
including dissolution of the glomerular membrane and
vacuolation of proximal tubule cells. Such damage was not
observed in kidney sections of mice infected with a
Sat-deficient mutant. These results indicate that Sat, a
vacuolating cytotoxin expressed by uropathogenic E. coli
CFT073, elicits defined damage to kidney epithelium during
upper urinary tract infection and thus contributes to
pathogenesis of urinary tract infection.
Structural basis of
tropism of Escherichia coli to the bladder during urinary
tract infection.
Hung CS, Bouckaert J, Hung D, Pinkner J, Widberg C,
DeFusco A, Auguste CG, Strouse R, Langermann S, Waksman G,
Hultgren SJ. Department of Molecular Microbiology,
Washington University School of Medicine, St. Louis, MO
63110, USA.
Mol Microbiol 2002 May;44(4):903-15
The first step in the colonization of the human urinary
tract by pathogenic Escherichia coli is the
mannose-sensitive binding of FimH, the adhesin present at
the tip of type 1 pili, to the bladder epithelium. We
elucidated crystallographically the interactions of FimH
with D-mannose. The unique site binding pocket occupied by
D-mannose was probed using site-directed mutagenesis. All
but one of the mutants examined had greatly diminished
mannose-binding activity and had also lost the ability to
bind human bladder cells. The binding activity of the
mono-saccharide D-mannose was delineated from this of
mannotriose (Man(alpha1-3)[Man(alpha1-6)]Man) by
gener-ating mutants that abolished D-mannose binding but
retained mannotriose binding activity. Our
structure/function analysis demonstrated that the binding
of the monosaccharide alpha-D-mannose is the primary
bladder cell receptor for uropathogenic E. coli and that
this event requires a highly conserved FimH binding pocket.
The residues in the FimH mannose-binding pocket were
sequenced and found to be invariant in over 200
uropathogenic strains of E. coli. Only enterohaemorrhagic
E. coli (EHEC) possess a sequence variation within the
mannose-binding pocket of FimH, suggesting a naturally
occurring mechanism of attenuation in EHEC bacteria that
would prevent them from being targeted to the urinary
tract.
Trends in antifungal
use and epidemiology of nosocomial yeast infections in a
university hospital.
Berrouane YF, Herwaldt LA, Pfaller MA. Departments of
Internal Medicine, University of Iowa College of Medicine,
Iowa City, Iowa, USA.
J Clin Microbiol 1999 Mar;37(3):531-7
This report describes both the trends in antifungal use
and the epidemiology of nosocomial yeast infections at the
University of Iowa Hospitals and Clinics between fiscal
year (FY) 1987-1988 and FY 1993-1994. Data were gathered
retrospectively from patients' medical records and from
computerized databases maintained by the Pharmacy, the
Program of Hospital Epidemiology, and the Medical Records
Department. After fluconazole was introduced, use of
ketoconazole decreased dramatically but adjusted use of
amphotericin B decreased only moderately. However, the
proportion of patients receiving antifungal therapy who
were treated with amphotericin B declined markedly. In FY
1993-1994, 26 patients of the gastrointestinal surgery
service received fluconazole. Among these patients,
fluconazole use was prophylactic in 16 (61%), empiric in 3
(12%), and directed to a documented fungal infection in 7
(27%). Rates of nosocomial yeast infection in the adult
bone marrow transplant unit increased from 6.77/1,000
patient days in FY 1987-1988 to 10.18 in FY 1989-1990 and
then decreased to 0 in FY 1992-1993. Rates of yeast
infections increased threefold in the medical and surgical
intensive care units, reaching rates in FY 1993-1994 of
6.95 and 5.25/1,000 patient days, respectively. The rate of
bloodstream infections increased from 0.044/1,000 patient
days to 0.098, and the incidence of catheter-related
urinary tract infections increased from 0.23/1,000 patient
days to 0.68. Although the proportion of infections caused
by yeast species other than Candida albicans did not
increase consistently, C. glabrata became an important
nosocomial pathogen.
Light-microscopic
morphology, ultrastructure, culture, and relationship to
disease of the nutritional and cell-wall-deficient
alpha-hemolytic streptococci.
Zierdt CH. Clinical Pathology Department, Warren G.
Magnuson Clinical Center, National Institutes of Health,
Bethesda, Maryland 20892.
Diagn Microbiol Infect Dis 1992 Mar-Apr;15(3):185-94
alpha-Hemolytic streptococci, variously described as
cell-wall deficient (C), L form (L), thiol dependent (O),
satelliting (S), pyridoxal dependent (PY), and
nutritionally deficient (N), or CLOSPYN, were isolated from
patients with endocarditis, brain abscess, subauricular
abscess, septicemia, acute and chronic urethritis,
recurrent aphthous stomatitis, and fever of undetermined
origin. With the aid of satelliting, most of the strains
were adapted to grow on a human Mycoplasma growth agar
consisting of brain-heart infusion agar fortified with 20%
human blood, yeast extract, and arginine. Selected CLOSPYN
strains required extensive subculture for only partial
reversion to parentallike characteristics. Four of six
strains biochemically tested were judged Streptococcus
morbillorum. Two were unidentifiable. The CLOSPYN form was
relatively inert biochemically, but glucose was converted
mainly to lactic acid, with acetic acid also present.
Guanine-cytosine values were 39%-43%. Cell wall material
was present by transmission electron microscopy (TEM), but
its synthesis was uneven on single cells and abnormally
thickened on other cells. Closely spaced, incompleted septa
occurred in cell chains, which resulted in unusually long
chains of flattened cells resembling on TEM a stack of
checkers. Mesosomes were frequent, greatly enlarged,
convoluted, and elongated. They were often sectioned as
circular and laminated, with 2-5 layers. Mesosomes were in
close contact with nucleoid bodies, which, in turn, were
closely apposed or integral with the cytoplasmic membranes
in areas of cross-wall development. Chaotic morphology
typifies the group. The inclusion of urinary tract
infections is new in the gamut of diseases caused by
CLOSPYN streptococci.
The use of amphotericin
B in nosocomial fungal infection.
Perfect JR, Pickard WW, Hunt DL, Palmer B, Schell WA.
Department of Medicine, Hospital Epidemiology, Durham,
North Carolina.
Rev Infect Dis 1991 May-Jun;13(3):474-9
The use of potent broad-spectrum antibacterial agents,
the increasing number of immunocompromised hosts, and the
use of invasive treatment modalities have exacerbated the
problems involved in the management of nosocomial fungal
infection. The hospital records at a tertiary-care medical
center were retrospectively reviewed in an effort to
determine the magnitude of these problems. A plethora of
fungal species were isolated from patients. Hospital
infection surveillance revealed between 30 and 40
nosocomial yeast infections per month, with 20% of
nosocomial urinary tract infections caused by yeasts rather
than by bacterial pathogens and one or two cases of
fungemia per week. Although these figures represent a large
number of nosocomial fungal infections, a significant
increase in the number of such infections over the last
several years could not be documented. The use of
amphotericin B was found to have increased each year. The
patterns of use of amphotericin B changed little between
1983 and 1987, but the number of patients treated with this
agent increased dramatically.
Relationship between
pinworm and urinary tract infections in young
girls.
Ok UZ, Ertan P, Limoncu E, Ece A, Ozbakkaloglu B.
Department of Microbiology and Clinical Microbiology,
Faculty of Medicine, Celal Bayar University, Manisa,
Turkey.
APMIS 1999 May;107(5):474-6
Urinary tract infection is particularly common in young
girls and Enterobius vermicularis (pinworm) is one of the
most prevalent worms found in children worldwide. Young
girls, with or without urinary tract infection, were
examined for pinworms in order to explore a possible
relationship between these two problems. Of the 55 young
girls with urinary tract infection, 20 (36.4%) had pinworm
eggs in the perianal and/or perineal region monitored using
the cellophane tape method, while 9 (16.4%) of 55 young
girls who had never previously had a urinary tract
infection were found to have Enterobius eggs in at least
one of the cellophane tape tests, and the difference was
found to be significant (p<0.05). These results
suggested that urinary tract infections may be related to
pinworms. When a urinary tract infection is diagnosed in
young girls, cellulose tape should be applied to both the
perianal and the perineal regions on at least three
consecutive occasions.
[Human urinary myiasis
caused by Fannia canicularis (Diptera, Muscidae) larvae in
Algeria] [Article in French]
Perez-Eid C, Mouffok N. Unite d'Ecologie des Systemes
Vectoriels, Institut Pasteur, Paris.
Presse Med 1999 Mar 20;28(11):580-1
BACKGROUND: Human urinary myiasis is caused by fly
larvae which complete their entire cycle in the human
body.
CASE REPORT: A 37-year-old woman living in a village
near Sidi Bel Abbes (Algeria) developed a parasite syndrome
caused by Fannia canicularis larvae. About twenty larvae
specimens were collected during her hospitalization. Larvae
were emitted for 2 weeks after a 6-day treatment with
cefotaxime for urinary tract infection.
DISCUSSION: Urogenital myiasis is almost always
subsequent to conditions of poor personal hygiene. In this
case authentic larvae infestation was evidenced. The
diagnosis of true urinary myiasis was confirmed by repeated
emissions of different larval stages including the
nymph.
Enterobius vermicularis
(pinworms), introital bacteriology and recurrent urinary
tract infection in children.
Kropp KA, Cichocki GA, Bansal NK.
J Urol 1978 Oct;120(4):480-2
The relationship between pinworm infectation and
introital cultures was investigated in 2 groups of girls.
Those children with recurrent urinary tract infections were
compared to agematched controls who had never had a urinary
tract infection. We found a higher incidence of enteric
organisms on the introital area and pinworm ova on the
perianal skin in the group of girls with recurrent
infection.
Enterobiasis and
urinary tract infection.
Jojart G.
Acta Paediatr Acad Sci Hung 1978;19(2):145-8
The correlation between enterobiasis and urinary tract
infection was studied in girls aged 6-14 years. Enterobius
ova were demonstrated in anorectal scrapings, carried out
three times in each case. Of the 84 patients suffering from
urinary tract infection, 55 were Enterobius positive, as
compared to 60 among 100 control girls. The difference was
not significant. Enterobiasis was not found to be more
frequent even when urinary tract infection reappeared
within 6 months. There was no significant difference among
patients with monosymptomatic bacteriuria and pyuria
either. Enterobiasis thus seems to play no pathogenic role
in urinary tract infections of girls.
Roles of host and
bacterial virulence factors in the development of upper
urinary tract infection caused by Escherichia
coli.
Tseng CC, Wu JJ, Liu HL, Sung JM, Huang JJ. Division of
Nephrology, Department of Internal Medicine, National Cheng
Kung University Hospital, Tainan, Taiwan, Republic of
China.
Am J Kidney Dis 2002 Apr;39(4):744-52
Aims of this study are to identify host and Escherichia
coli virulence factors associated with upper urinary tract
infection (UTI) by comparing them with those for lower UTI
and determining the association between major predisposing
host factors for upper UTI and urovirulence genes for E
coli. Host factors and urovirulence genes of E coli
associated with bacteremia in patients with upper UTI and
their interactions also were studied. One hundred
thirty-nine adult patients who fulfilled clinical
diagnostic criteria for upper (n = 81) or lower UTI (n =
58) caused by E coli between January 1997 and December 1999
were retrospectively enrolled into this study. Old age
(> or =60 years), male sex, diabetes with poor blood
glucose control (ie, glycosylated hemoglobin A1C >
or = 8.1%), immunosuppression, and urinary tract
obstruction were more frequently associated host factors
for patients with upper UTI than for those with lower UTI.
Using polymerase chain reaction, the papG class II allele
was detected more frequently for E coli strains isolated
from patients with upper UTI than for those from patients
with lower UTI (85% versus 52%; P < 0.0001).
Multivariate analysis showed that diabetes with poor blood
glucose control, immunosuppression, urinary tract
obstruction, and papG class II allele were independently
associated with upper UTI. For patients without these three
predisposing host factors, the prevalence of papG class II
allele was significantly greater in those with upper UTI
than those with lower UTI. However, the papG class II
allele was less prevalent in strains isolated from patients
with upper UTI with urinary tract obstruction or with two
of the three predisposing host factors. In addition, both
univariate and multivariate analyses showed that old age
and papG class II allele were risk factors for the
development of E coli bacteremia in patients with upper
UTI. In conclusion, both host and E coli virulence factors
contribute to the development of upper UTI, and less
virulent strains can cause upper UTI in hosts with
predisposing factors. Copyright 2002 by the National Kidney
Foundation, Inc.
Anastrozole alone or in
combination with tamoxifen versus tamoxifen alone for
adjuvant treatment of postmenopausal women with early
breast cancer: first results of the ATAC randomised
trial.
The ATAC Trialists' Group. Arimidex, tamoxifen alone or
in combination.
Lancet 2002 Jun 22;359(9324):2131-9
BACKGROUND: In the adjuvant setting, tamoxifen is the
established treatment for postmenopausal women with
hormone-sensitive breast cancer. However, it is associated
with several side-effects including endometrial cancer and
thromboembolic disorders. We aimed to compare the safety
and efficacy outcomes of tamoxifen with those of
anastrozole alone and the combination of anastrozole plus
tamoxifen for 5 years.
METHODS: Participants were postmenopausal patients with
invasive operable breast cancer who had completed primary
therapy and were eligible to receive adjuvant hormonal
therapy. The primary endpoints were disease-free survival
and occurrence of adverse events. Analysis for efficacy was
by intention to treat.
FINDINGS: 9366 patients were recruited, of whom 3125
were randomly assigned anastrozole, 3116 tamoxifen, and
3125 combination. Median follow-up was 33.3 months. 7839
(84%) patients were known to be hormone-receptor-positive.
Disease-free survival at 3 years was 89.4% on anastrozole
and 87.4% on tamoxifen (hazard ratio 0.83 [95% CI
0.71-0.96], p=0.013). Results with the combination were not
significantly different from those with tamoxifen alone
(87.2%, 1.02 [0.89-1.18], p=0.8). The improvement in
disease-free survival with anastrozole was seen in the
subgroup of hormone-receptor-positive patients, but not the
receptor-negative patients. Incidence of contralateral
breast cancer was significantly lower with anastrozole than
with tamoxifen (odds ratio 0.42 [0.22-0.79], p=0.007).
Anastrozole was significantly better tolerated than
tamoxifen with respect to endometrial cancer (p=0.02),
vaginal bleeding and discharge (p<0.0001 for both),
cerebrovascular events (p=0.0006), venous thromboembolic
events (p=0.0006), and hot flushes (p<0.0001).
Tamoxifen was significantly better tolerated than
anastrozole with respect to musculoskeletal disorders and
fractures (p<0.0001 for both).
INTERPRETATION: Anastrozole is an effective and well
tolerated endocrine option for the treatment of
postmenopausal patients with hormone-sensitive early breast
cancer. Longer follow-up is required before a final
benefit:risk assessment can be made.
[The role of E. coli
adhesins in the pathogenesis of urinary infection]
[Article in Spanish]
Dalet Escriba F, Segovia Talero T, del Rio Perez G.
Servicio de Microbiologia, Fundacion Puigvert, Barcelona.
Rev Clin Esp 1991 Jun;189(1):8-13
One thousand five hundred strains obtained from patients
suffering from different clinical forms of urinary
infections (UI) and dependent glands have been studied with
the aim of establishing the pathogenic responsibility of E.
coli adhesion protein (ADH) in urinary infections (UI). ADH
were determined using agglutination techniques with guinea
pig and human red cells, C. albicans and S. cerevisiae
spores and GAL-GAL sensitized latex. In non complicated UI,
the presence of ADH is the main invasion mechanism for E.
coli. The frequency of adherent strains is very high
(569/648) in acute cases (207/247 cystitis + 69/98
recurrent cystitis + 108/114 pyelonephritis + 140/154
prostatitis + 28/35 orchyepidimitis and scarce (14/184) in
asymptomatic or chronic cases (6/107 bacteriurias + 7/67
prostatitis + 1/10 orchyepidimitis). A close relationship
is established between the presence of ADH and clinical
symptoms. The acute cases with general symptoms are caused
in 85% of cases (188/216) by strains with ADH type MR
specially subtype P. The acute cases with local symptoms
(only urinary syndrome) are caused in 77% of cases
(297/387) by strains with ADH type Ms. In complicated UI
the expression of adhesion proteins does not constitute and
essential requisite in order to invade the urinary tract.
It is suggested that males are significantly more resistant
the females to UI both parenchymal and urinary tract. It is
deduced that underlying factors are more predisposing to UI
the smaller the adherence rate of isolated strains is.
Thus, reflux and neurogenic bladder probes are by far more
aggressive alterations than prostatic adenoma, bladder
tumor and lithiasis.
History, clinical
findings, sexual behavior and hygiene habits in women with
and without recurrent episodes of urinary
symptoms.
Tchoudomirova K; Mardh PA; Kallings I; Nilsson S;
Hellberg D Institute of Clinical Bacteriology, Uppsala
University, Sweden.
Acta Obstet Gynecol Scand (Denmark) Jul 1998, 77 (6)
p654-9
BACKGROUND: To compare women with and without a history
of recurrent symptoms suggestive of a urinary tract
infection but a current negative urine culture regarding
symptoms and signs of a genital infection, carriership of
sexually transmitted agents and vaginal flora changes,
sexual behavior and genital hygiene practice.
SETTINGS: Contraceptive attendees at family planning and
youth clinics.
MATERIALS AND METHODS: Two hundred and seventeen women
who reported recurrent symptoms of dysuria, frequent
micturition, and urgency and had a negative bacterial urine
culture were recruited as cases. Seven hundred and ten
culture-negative women lacking such symptoms served as
controls. A careful record was made including details about
gynecological symptoms, sexual behavior and genital hygiene
practice. Gynecological signs were noted at gynecological
examination. Genital infections, including sexually
transmitted diseases, were diagnosed.
RESULTS: The mean age of the two groups studied was 26.2
and 25.8 years, respectively. Symptoms, such as
dysmenorrhea, vaginal discharge, genital pruritus,
abdominal pain and superficial dyspareunia were more
frequent in the study group than among the controls. On
examination, only erythema was observed more often.
However, the cases more often had a history of genital
herpes and vulvovaginal candidosis. They used tampons only
for menstrual purposes, and soap for genital hygiene, but
more often used low-pH solutions and took hot baths less
frequently. The women with recurrent urinary symptoms more
often masturbated and more often had experience of anal sex
and sex during menstruation than the control group.
CONCLUSIONS: Sexual behavior and genital hygiene habits
may play an etiological role in the lives of women with
recurrent episodes of urinary symptoms with a negative
bacterial urine culture.
Acupuncture in the
prophylaxis of recurrent lower urinary tract infection in
adult women.
Aune A; Alraek T; LiHua H; Baerheim A Bryggen Medisinske
Senter, University of Bergen, Norway.
Scand J Prim Health Care (NORWAY) Mar 1998, 16 (1)
p37-9
OBJECTIVE: To evaluate the effect of acupuncture in the
prevention of recurrent lower urinary tract infection (UTI)
in adult women.
DESIGN: A controlled clinical trial with three arms: an
acupuncture group, a sham-acupuncture group, and an
untreated control group. Patients were followed for 6
months.
SETTING: An acupuncture clinic in Bergen, Norway.
SUBJECTS: Sixty-seven adult women with a history of
recurrent lower UTI.
MAIN OUTCOME MEASURES: Acute lower UTIs during the
6-month observation period.
RESULTS: Eighty-five percent were free of lower UTI
during the 6-month observation period in the acupuncture
group, compared with 58% in the sham group (p <
0.05), and 36% in the control group (p < 0.01).
There were half as many episodes of lower UTI per
person-half-year in the acupuncture group as in the sham
group, and a third as many as in the control group (p
< 0.05).
CONCLUSION: Acupuncture seems a worthwhile alternative
in the prevention of recurring lower UTI in women.
Urinary tract
infections in children: Why they occur and how to prevent
them
Hellerstein S. Dr. S. Hellerstein, Section of Pediatric
Nephrology, Children's Mercy Hospital, 2401 Gillham Rd.,
Kansas City, MO 64108 United States
American Family Physician (United States), 1998, 57/10
(2440-2446)
Urinary tract infections (UTIs) usually occur as a
consequence of colonization of the periurethral area by a
virulent organism that subsequently gains access to the
bladder. During the first few months of life, uncircumcised
male infants are at increased risk for UTIs, but thereafter
UTIs predominate in females. An important risk factor for
UTIs in girls is antibiotic therapy, which disrupts the
normal periurethral flora and fosters the growth of
uropathogenic bacteria. Another risk factor is voiding
dysfunction. Currently, the most effective intervention for
preventing recurrent UTIs in children is the identification
and treatment of voiding dysfunction. Imaging evaluation of
the urinary tract following a UTI should be individualized,
based on the child's clinical presentation and on clinical
judgment. Both bladder and upper urinary tract imaging with
ultrasonography and a voiding cystourethrogram should be
obtained in an infant or child with acute pyelonephritis.
Imaging studies may not be required, however, in older
children with cystitis who respond promptly to
treatment.
Urogenital aging - A
hidden problem
Samsioe G. Dr. G. Samsioe, Dept. of Obstetrics and
Gynecology, University of Lund, University Hospital, Lund
S-22185 Sweden
American Journal of Obstetrics and Gynecology (United
States), 1998, 178/5 (S245-S249)
Urogenital problems in the elderly female population are
experienced by one third of women from the age 50 years and
onward. Symptoms from the lower urinary tract include
incontinence, urethritis, and recurrent urinary tract
infections. Atrophic changes within the bladder neck and
urethra could be corrected by estrogen administration even
at doses so low that endometrial proliferation is avoided.
Hence such estrogens could be given without progestogen
comedication. Control of micturition is a complex process
of which estrogen deficiency is only one of several
factors. The aging process with subsequent changes in
membrane permeability, neuromuscular function, and collagen
synthesis contributes to the local problems of control of
micturition. In addition, the central control may also be
affected by degenerative changes of the nervous system.
Vaginal symptoms comprise dryness of vagina, dyspareunia,
and recurrent vaginitis often followed by a fowl odor and
discharge. The microflora with lactobacilli and low pH as
seen in fertile women is gradually replaced by a mixed germ
flora including several of the pathogenic organisms common
in urinary tract infections. Vaginal pH increases from
around 4 to between 6 and 7. It is a puzzling fact that the
urogenital tissues seem to be more 'sensitive' to estrogens
than other tissues. Conformational changes of the estrogen
receptor(s) brought about by the local cytokine milieu is
one possibility to explain the situation. The systemic
absorption of low-dose estrogen preparations is dependent
on the status of the vaginal mucosa. Absorption is high
when the vaginal mucosa is atrophic and gradually decreases
(but not to zero) as the vaginal mucosa matures under
estrogen influence.
Herbal urinary
antiseptics - Still up-to-date?
Stammwitz U. U. Stammwitz, Schape and Brummer GmbH and
Co. KG, Bahnhofstrasse 35, 38259 Salzgitter-Ringelheim
Germany
Zeitschrift fur Phytotherapie (Germany), 1998, 19/2
(90-95)
For herbal urinary antiseptics a positive monograph by
the commission E of the former German Bundesgesundheitsamt
(BGA) has been issued for bearberry leaf horseradish roots
and white sandalwood. Bearberry leaf is the only one of
these drugs suited for the (sole) therapy of inflammable
diseases of the lower urinary tract. Recent investigations
regarding pharmacokinetics and toxicology of Uvae-ursi
folium confirm the precautionary nature of restricting the
application. Herbal urinary antiseptics are preferred if
antibiotic treatment/chemotherapy is not considered
essential: for uncomplicated cystitis, asymptomatic
bacteriuria or in patients with permanent catheter.
Effect of cranberry
juice on urinary pH in older adults.
Jackson B; Hicks LE Department of Veteran Affairs,
Medical Center, Bay Pines, Florida, USA.
Home Healthc Nurse (United States) Mar 1997, 15 (3)
p198-202
Most research suggests that ingestion of cranberry juice
may be useful in preventing urinary tract infections. This
pilot study examines the effect of drinking moderate
amounts of commercially available cranberry juice cocktail
on urinary pH in older, institutionalized adults. The
results of the study have implications for home care nurses
who have similar patients in their case loads. (17
Refs.)
Infection control. The
therapeutic uses of cranberry juice.
Nazarko L
Nurs Stand (England) May 17-23 1995, 9 (34) p33-5
This article considers the treatment of recurrent
cystitis. It examines the evidence for drinking cranberry
juice to prevent recurrent urinary tract infections and
discusses the nursing issues raised, drawing conclusions
from the evidence presented.
Urinary problems after
formation of a Mitrofanoff stoma.
Gibbons M
Prof Nurse (England) Jan 1995, 10 (4) p221-4
1. Bladder irrigation reduces occlusion of drains with
clots and debris, thus protecting anastomoses.
2. Leakage from anastomoses is an acknowledged problem
postoperatively but resolves spontaneously in the majority
of cases.
3. To establish urinary continence a good fluid intake
is essential, bladder capacity must be developed,
intermittent catheterisation taught and excessive mucus
production eliminated.
4. The risk of urinary tract infections can be minimised
by drinking cranberry juice, prophylactic antibiotic
therapy and a good intermittent catheterisation technique.
A degree of bacteria is inevitable and not always
significant.
Inhibitory activity of
cranberry juice on adherence of type 1 and type P
fimbriated Escherichia coli to eucaryotic
cells.
Zafriri D; Ofek I; Adar R; Pocino M; Sharon N Department
of Human Microbiology, Sackler Faculty of Medicine, Tel
Aviv University, Israel.
Antimicrob Agents Chemother (United States) Jan 1989, 33
(1) p92-8
Inhibition of bacterial adherence to bladder cells has
been assumed to account for the beneficial action ascribed
to cranberry juice and cranberry juice cocktail in the
prevention of urinary tract infections (A. E. Sobota, J.
Urol. 131:1013-1016, 1984). We have examined the effect of
the cocktail and juice on the adherence of Escherichia coli
expressing surface lectins of defined sugar specificity to
yeasts, tissue culture cells, erythrocytes, and mouse
peritoneal macrophages. Cranberry juice cocktail inhibited
the adherence of urinary isolates expressing type 1
fimbriae (mannose specific) and P fimbriae [specific for
alpha-D-Gal(1----4)-beta-D-Gal] but had no effect on a
diarrheal isolate expressing a CFA/I adhesin. The cocktail
also inhibited yeast agglutination by purified type 1
fimbriae. The inhibitory activity for type 1 fimbriated E.
coli was dialyzable and could be ascribed to the fructose
present in the cocktail; this sugar was about 1/10 as
active as methyl alpha-D-mannoside in inhibiting the
adherence of type 1 fimbriated bacteria. The inhibitory
activity for the P fimbriated bacteria was nondialyzable
and was detected only after preincubation of the bacteria
with the cocktail. Cranberry juice, orange juice, and
pineapple juice also inhibited adherence of type 1
fimbriated E. coli, most likely because of their fructose
content. However, the two latter juices did not inhibit the
P f that cranberry juice contains at least two inhibitors
of lectin-mediated adherence of uropathogens to eucaryotic
cells. Further studies are required to establish whether
these inhibitors play a role in vivo.
Inhibition of bacterial
adherence by cranberry juice: potential use for the
treatment of urinary tract infections.
Sobota AE
J Urol (United States) May 1984, 131 (5) p1013-6
Cranberry juice has been widely used for the treatment
and prevention of urinary tract infections and is reputed
to give symptomatic relief from these infections. Attempts
to account for the potential benefit derived from the juice
have focused on urine acidification and bacteriostasis. In
this investigation it is demonstrated that cranberry juice
is a potent inhibitor of bacterial adherence. A total of 77
clinical isolates of Escherichia coli were tested.
Cranberry juice inhibited adherence by 75 per cent or more
in over 60 per cent of the clinical isolates. Cranberry
cocktail was also given to mice in the place of their
normal water supply for a period of 14 days. Urine
collected from these mice inhibited adherence of E. coli to
uroepithelial cells by approximately 80 per cent.
Antiadherence activity could also be detected in human
urine. Fifteen of 22 subjects showed significant
antiadherence activity in the urine 1 to 3 hours after
drinking 15 ounces of cranberry cocktail. It is concluded
that the reported benefits derived from the use of
cranberry juice may be related to its ability to inhibit
bacterial adherence.
Effect of cranberry
juice on urinary pH.
Nahata MC, McLeod DC
Nurs Res (1979 Sep-Oct) 28(5):287-90
Twenty-one female and 19 male subjects who had normal
physical and laboratory examinations were randomly assigned
into four groups of 10 subjects each. Each group was then
randomly assigned a number (150, 180, 210, 240) which
determined the amount of cranberry juice, in milliliters,
members of that group would ingest with each meal during
the experimental phase of the study. The study took place
over a 12- day period. A one-group before-and-after design
was used, with each subject serving as his or her own
control. Diet was controlled; menus on days 1 through 6
were repeated on days 7 through 12 with the addition of
cranberry juice at each meal. Subjects used nitrazine pH
tape to measure the pH of midstream urine at each voiding.
There were significant (.01 level) differences in mean
urinary pH between each control group and its corresponding
experimental group. Anticipated problems with increased
number of bowel movements, weight gain, increased voiding
frequency, and subject pH measurement inaccuracy did not
occur.
Urinary tract infections due
to Candida albicans.
Fisher JF, Chew WH, Shadomy S, Duma RJ, Mayhall CG,
House WC.
Rev Infect Dis 1982 Nov-Dec;4(6):1107-18
Infection of the urinary tract due to Candida albicans
is an uncommon but well-described complication of modern
therapeutics. Despite the rarity of this infection, culture
of properly collected urine yielding C. albicans requires
an explanation. The significance of systemic factors in the
defense of the urinary tract against candidal infection is
unknown, but secretions from the prostate gland in men and
from periurethral glands in women have been reported to be
fungistatic. In addition, growth of Candida at sites on
mucous membranes may be suppressed by other normal flora.
Conditions that predispose to candiduria include diabetes
mellitus, antibiotic and corticosteroid therapy, as well as
factors such as local physiology and disturbance of urine
flow. Lower urinary tract candidiasis is usually the result
of a retrograde infection, while renal parenchymal
infection most often follows candidemia. In addition to
asymptomatic candiduria, recognized clinical forms of
candidal urinary tract infections include bladder
infection, renal parenchymal infection, and infections
associated with fungus ball formation. Unfortunately,
clinical criteria alone are insufficient to distinguish
reliably among these clinical types. If the urine is found
to contain candidal organisms, the condition of the patient
should be considered for determination of appropriate
therapy. When infection is thought to be confined to the
bladder, patients without indwelling bladder catheters
should be considered for flucytosine therapy. For patients
requiring indwelling bladder catheterization, irrigation
with amphotericin B is usually successful. Although
flucytosine alone may be useful for renal parenchymal
candidal infection, iv amphotericin B alone or the
combination of amphotericin B and flucytosine is indicated
when systemic candidiasis cannot be excluded.
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