indigo-carmine and Syndrome

Purple urine bag syndrome (PUBS) is a rare occurrence, in which the patient has a purple-colored urine bag following urinary catheterization for hours to days. Most of authors believe it is a mixture of indigo (blue) and indirubin (red) that becomes purple. Previous study showed that PUBS occurred predominantly in chronically catheterized, constipated women. We collected 10 elderly patients with PUBS in two nursing homes. The first two cases were identified by chart review in 1987 and 2003, and then later eight cases (42.1%) were collected among 19 urinary catheterized elderly in the period between January 2007 and June 2007. In the present report, PUBS probably can occur in any patients with the right elements, namely urinary tract infection (UTI) with bacteria possessing these enzymes, diet with enough tryptophan, and being catheterized. Associations with bed-bound state, Alzheimer's, or dementia from other causes are reflections of the state of such patients who are at higher risk for UTI, and hence PUBS occurred. Although we presented PUBS as a harmless problem, prevention and control of the nosocomial catheter-associated UTIs (CAUTIs) has become very important in the new patient-centered medical era. Thus, we should decrease the duration of catheterization, improve catheter care, and deploy technological advances designed for prevention, especially in the elderly cared for in nursing homes.

Topics: Aged; Aged, 80 and over; Bacteria; Catheters, Indwelling; Cross Infection; Female; Humans; Indigo Carmine; Indoles; Male; Nursing Homes; Syndrome; Urinary Catheterization; Urinary Tract Infections

Topics: Amino Acid Metabolism, Inborn Errors; Biomarkers; Diagnosis, Differential; Humans; Indigo Carmine; Indoles; Infant; Infant, Newborn; Prognosis; Syndrome; Tryptophan

Serrated polyposis syndrome (SPS), characterized by multiple and/or large proximal serrated lesions, increases the risk of colorectal cancer. Serrated lesions often are missed during colonoscopy but panchromoendoscopy can increase their detection in an average-risk population. We performed a randomized controlled study to determine the efficacy of panchromoendoscopy in detection of polyps in patients with SPS.. Patients with SPS (n = 86 patients) underwent tandem high-definition (HD) colonoscopies from February 2015 through July 2016 at 7 centers in Spain. Patients were assigned randomly to groups that received 2 HD white-light endoscopy examinations (HD-WLE group; n = 43) or HD-WLE followed by 0.4% indigo carmine panchromoendoscopy (HD-CE group; n = 43). For each procedure, polyps detected were described, removed, and analyzed by histology. The primary outcome was additional polyp detection rate, defined as the number of polyps detected during the second inspection divided by the total number of polyps detected during the first and the second examination.. A total of 774 polyps were detected (362 in the HD-WLE group and 412 in the HD-CE group); 54.2% were hyperplastic, 13.8% were adenomas, and 10.9% were sessile serrated polyps. There was a significantly higher additional polyp detection rate in the HD-CE group (0.39; 95% CI, 0.35-0.44) than in the HD-WLE group (0.22; 95% CI, 0.18-0.27) (P < .001). A higher additional rate of serrated lesions proximal to the sigmoid colon were detected in the second inspection with HD-CE (0.40; 95% CI, 0.33-0.47) than with HD-WLE (0.24; 95% CI, 0.19-0.31) (P = .001). Detection of adenomas and serrated lesions greater than 10 mm did not differ significantly between groups. In a multivariate logistic regression analysis, only use of HD-CE was associated independently with increased polyp detection throughout the colon.. In a randomized controlled trial, we found that panchromoendoscopy increases detection of polyps (mostly of small serrated lesions) and should be considered the standard of care in patients with SPS. Studies are needed to determine the effects of this strategy on the incidence of advanced neoplasia during long-term follow-up evaluation. ClinicalTrials.gov no: NCT03476434.

Topics: Adenoma; Adenomatous Polyps; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Coloring Agents; Female; Humans; Indigo Carmine; Male; Middle Aged; Syndrome

Purple urine bag syndrome (PUBS) is a rare phenomenon in patients that is associated with the use of a long-term/indwelling urinary catheter. The purple color results from indigo and indirubin, accumulated from bacteria-mediated tryptophan conversion. High risk patients include: the elderly; women; immobilized patients; patients with an indwelling catheter, chronic constipation, alkaline urine or poor hygiene; and those with catheter bags and tubes made of certain types of plastic. We reported PUBS in an elderly woman with an indwelling catheter and chronic constipation which, to our knowledge, was the first case in our hospital. The patient underwent urinary catheter change and received intravenous ciprofloxacin, following which the urine returned to a yellow color and the patient was discharged. This case report describes the diagnosis, management and also strategies for the prevention of PUBS in Gatot Soebroto Army Hospital, Indonesia.

Topics: Aged; Catheters, Indwelling; Color; Female; Humans; Indigo Carmine; Indonesia; Middle Aged; Syndrome; Urinary Bladder, Neurogenic; Urinary Tract Infections; Urine

Topics: Color; Female; Humans; Indigo Carmine; Indoles; Middle Aged; Syndrome; Tryptophan; Urinary Catheterization; Urine

A change in the colour of urine is always of clinical significance, and a source of concern for the patient and his physician. Among the different urine colours observed, purple is the least common. Although purple discolouration of a catheter and a urine bag is an uncommon finding, it was reported in the literature as early as 1978, by Barlow and Dickson. We present a unique case of purple urine bag syndrome in a patient with bilateral nephrostomy tubes (NT) and associated urine bags (UB) with only the left nephrostomy tube and urine bag exhibiting the purple colour, which resolved with a course of appropriate antibiotics eradicating the causative bacterial pathogen, and change of NT and UB.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Catheters, Indwelling; Color; Humans; Indigo Carmine; Indoles; Male; Nephrostomy, Percutaneous; Pseudomonas aeruginosa; Syndrome; Urinary Catheterization; Urinary Tract Infections; Urine

Topics: Aged; Bacteriuria; Color; Female; Humans; Indigo Carmine; Syndrome; Urinary Catheterization; Urinary Retention

Topics: Aged; Bacteriuria; Color; Female; Humans; Incidental Findings; Indigo Carmine; Indoles; Polyvinyls; Syndrome; Urinary Catheterization; Urinary Tract Infections

Topics: Catheters, Indwelling; Diagnosis, Differential; Humans; Indigo Carmine; Indoles; Male; Middle Aged; Protein Kinase Inhibitors; Proteus Infections; Proteus mirabilis; Syndrome; Tryptophan; Urinalysis; Urinary Catheterization; Urinary Tract Infections

Purple urine bag syndrome (PUBS) is considered as an uncommon phenomenon. This cohort study aimed to figure out the causative factors and the potential risks of PUBS.. We recruited 84 patients with long-term urinary catheterization from seven nursing institutions and home care centre, then compared the differences of demographic, clinical, urine test and bacteriological data between the patients with and without PUBS.. The 2-month period prevalence of PUBS in chronic catheterized patients was 16.7%. PUBS-affecting patients had significantly higher proportion of female gender (P = 0.034), self oral intake (P = 0.036) and eating self-prepared food (P = 0.007). Otherwise, no statistical associations were found. Five different bacterial species were isolated from the urine of PUBS-affecting patients. No sequelae were found after forward follow-up for 6 months. We further discuss the associations between certain factors and PUBS according to literature review and the results of our study.. PUBS is not as rare as we thought before. The causative factors of PUBS have not been clearly characterized. It may be the combination of several factors that cause the PUBS. Female gender and food content were found to be associated factors of PUBS in our study. Asymptomatic PUBS is unnecessary to be treated by antibiotics.

Topics: Aged; Aged, 80 and over; Color; Constipation; Female; Humans; Hydrogen-Ion Concentration; Indigo Carmine; Indoles; Male; Middle Aged; Syndrome; Urinary Catheterization; Urinary Tract Infections

Topics: Aged, 80 and over; Consciousness Disorders; Female; Humans; Hyponatremia; Indican; Indigo Carmine; Indoles; Proteus Infections; Proteus mirabilis; Syndrome; Urinalysis; Urinary Catheterization; Urinary Tract Infections

Topics: Aged, 80 and over; Bacteria; Female; Humans; Indigo Carmine; Indoles; Intestines; Liver; Syndrome; Tryptophanase; Urine

Purple urinary bag syndrome (PUBS) is considered to be a benign condition observed in the urinary catheter and bag in some catheterized patients with urinary tract infections. This syndrome is usually reported to occur in alkaline urine.. We report of a catheterized patient with PUBS and slightly acidic urine (pH 6-6.5). A novel analysis method was developed using high pressure liquid chromatography and mass spectrometry (HPLC/MS) to detect compounds that are thought to be associated with PUBS. Urine, urinary sediment, and the plastic collection system were assayed and quantitated using these methods. The potential toxicity of one of these compounds, indoxyl sulfate, is discussed.. The presence of PUBS in a catheterized patient with slightly acidic urine is reported. A novel method for the analysis of chemical components of PUBS and the first direct confirmation of the presence of indigo in the urine sediment and collecting system are described.

Topics: Aged; Chromatography, High Pressure Liquid; Female; Humans; Hydrogen-Ion Concentration; Indican; Indigo Carmine; Indoles; Mass Spectrometry; Syndrome; Tryptophan; Urinary Catheterization; Urinary Tract Infections

Discoloration of urine is not uncommonly encountered in clinical practice and may indicate a significant pathology. However, the majority of instances are benign and occur as the result of trauma to the urological system during procedures or ingestions of substances such as medication or food. Purple discoloration of a urinary catheter bag is rare and can be alarming to both patients and healthcare workers. This phenomenon is known as the purple urine bag syndrome. It is associated with urinary tract infections occurring in catheterized patients, generally elderly females with significant comorbidities and constipation. The urine is usually alkaline. Gram-negative bacteria that produce sulfatase and phosphatase are involved in the formation of pigment, indirubin and indigo. Tryptophan metabolism is involved in the pathogenesis. We present two cases of this rare and interesting phenomenon and discuss the underlying pathogenesis.

Topics: Aged; Catheters, Indwelling; Chronic Disease; Constipation; Dehydration; Escherichia coli Infections; Fatal Outcome; Female; Humans; Hydrogen-Ion Concentration; Indigo Carmine; Indoles; Middle Aged; Phosphoric Monoester Hydrolases; Sulfatases; Syndrome; Urinary Catheterization; Urinary Tract Infections

Purple urine bag syndrome (PUBS) was first reported in 1978. PUBS is rare, occurs predominantly in constipated women, chronically catheterized and associated with some bacterial urinary infections that produce sulphatase/phosphatase. The etiology is due to indigo (blue) and indirubin (red) or to their mixture that becomes purple. A chain reaction begins in the gastrointestinal tract with tryptophan as described in the article.

Topics: Catheters, Indwelling; Female; Humans; Indican; Indigo Carmine; Indoles; Middle Aged; Syndrome; Tryptophan; Urinary Catheterization; Urinary Tract Infections; Urine

Topics: Appendicitis; Catheters, Indwelling; Chronic Disease; Constipation; Female; Humans; Indigo Carmine; Intestinal Perforation; Middle Aged; Rupture, Spontaneous; Syndrome; Urinary Catheterization; Urinary Tract Infections

The plastic of urinary catheter drainage bags occasionally turns purple hours or days after catheterization and the color becomes increasingly intense the longer the same drainage system is left in place. This phenomenon was first reported in 1978 as "purple urine bag syndrome", and had been known to occur with bacterial infection of the urinary tract with chronic constipation. Chronic constipation is commonly associated with bacterial overgrowth in the bowel in which tryptophan has been converted to indol and yields the high levels of indigo (blue) and indirubin (red) in urinary bags of patients with bacterial infection of the urine, because indigo-producing bacteria have indoxyl phosphatase or sulfatase that can produce indigo and indirubin. We determined the serum levels of amino acids in patients with purple urine bag syndrome. The serum level of tryptophan and valine were significantly reduced in patients with purple urine bag syndrome. This result suggests that absorption of amino acids was affected by disturbances of colonic motility and intestinal bacterial overgrowth.

Topics: Aged; Amino Acids; Catheters, Indwelling; Chronic Disease; Female; Humans; Indigo Carmine; Indoles; Syndrome; Time Factors; Urinary Catheterization; Urinary Tract Infections

We reported five patients with purple urine bag syndrome (PUBS). Four patients had indicanuria, and, in three of them, purple pigmentation was reproduced by inoculating urinary isolates, in the broth with indoxyl sulfate. Klebsiella pneumoniae, Pseudomonas aeruginosa and Enterococcus avium were considered to produce the purple pigment in three patients. However, attempts to reproduce the purple pigment failed in two patients, and one of them did not have indicanuria. These results suggest that indicanuria is not necessarily required for the development of PUBS.

Topics: Aged; Catheters, Indwelling; Female; Humans; Indican; Indigo Carmine; Indoles; Klebsiella pneumoniae; Male; Middle Aged; Pseudomonas aeruginosa; Sulfatases; Syndrome; Urinary Catheterization; Urinary Tract Infections