Monday, 2 December 2013

Cystitis - The Causes

Cystitis is defined as a condition of urinary bladder inflammation
Cystitis is caused by
1. Bacterial infection
Streptococcus agalactiae or group B streptococcus is a Gram-positive pathogen that is typically associated with neonatal disease and infection in pregnant women. Group B streptococcus also causes invasive infections in non-pregnant adults including urinary tract infections(5). Other researchers found that in 85.7% of cases following non-clostridial anaerobic (NCA) bacteria were identified in biopsy samples: Propionibacterium sp. (41.8%), Peptococcus sp. (35.7%), Eubacterium sp. (28.6%), Peptostreptococcus sp. (14.3%), and Bacteroides sp. (14.3%). Aerobic-anaerobic associations were observed in 7.1% of samples(6).

2. Nonbacterial infection
a. Viral cystitis
BK-virus is a very common polyomavirus in the global population, similar to the JC-virus responsible for Progressive Multifocal Leukoencephalopathy. BK-virus infections are an important diagnostic and therapeutic challenge in immuno-compromised patients, including: bone marrow transplant pediatric recipients in whom it may cause hemorrhagic cystitis(7).

b. Mycobacterial infection
There is a review of a to review clinical features, diagnosis and treatment of renal mycobacteriosis, illustrated by presentation of a case of pyelonephritis and cystitis caused by Mycobacterium chelonei(8).

c. Chlamydial infection
In the study of Male guinea pigs infected with the chlamydial agent of guinea pig inclusion conjunctivitis (GPIC) by intraurethral injection of chlamydiae or by placement of a drop of chlamydial suspension on the meatus of the extruded penis, researchers found that when infected animals were immunosuppressed with cyclophosphamide, the number of guinea pigs with cystitis was increased, and chlamydiae could be detected in the bladder for as long as 50 days after infection(9).

d. Fungal infection
There is a report of 4 cases of fungal cystitis. All patients had severe urgency, frequency and nocturia with sterile pyuria and microhematuria. Significant fungal growth was observed on routine blood agar cultur. Bladder biopsy was necessary to rule out tumor(10).

e. Schistosomal infection
In the study to evaluate the immunoreactivity for p53 and c-erbB-2 proteins  in 31 schistosomal urinary bladder carcinomas and 21 cases of schistosomal cystitis with hyperplastic, metaplastic and/or dysplastic (premalignant) lesions and compare with 30 carcinomas and 21 premalignant lesions of the urinary bladder without schistosomiasis showed that abnormal nuclear p53 protein accumulation was found in 17/31 schistosomal and in 15/30 non-schistosomal carcinomas and in 8/21 schistosomal cystitis with premalignant lesions of which five showed hyperplasia(11).

f. Etc.

3. Noninfection and Bladder syndrome/interstitial cystitis (PBS/IC)
In the study to describe the practice patterns among primary care physicians' (PCPs) managing patients with symptoms suggestive of interstitial cystitis/painful bladder syndrome (IC/PBS), indicated that of 290 completed questionnaires (response rate, 52%), regarding etiology, 90% correctly indicated that IC/PBS was a noninfectious disease((radiation cystitis, autoimmune, hypersensitivity), 76% correctly reported that it was not caused by a sexually transmitted infection, and 61% correctly indicated that it was not caused by a psychiatric illness(12).
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