struvite and Cystitis

Encrusted cystitis is a very rare chronic inflammatory disease of the bladder characterized by precipitation and incrustation of phosphate and ammonium-magnesium salts on the vescical mucosa, caused by urinary infection due to urolithic microorganisms. Corynebacterium urealyticum or Corynebacterium group D2, a multiple antibiotic-resistant urea-splitting bacterium, is the most frequently incriminated aetiology. We report a case of a 57-year-old man affected by systemic erythematosus lupus with a long history of dysuria and suprapubic pain who underwent percutaneous nephrostomy drainage with urethral stenting for lupoid obstructive uropathy. Before the diagnosis of encrusted cystitis by Corynebacterium urealyticum was established, the patient underwent five cystoscopies to remove the plaques and multiple unsuccessful antibiotic treatment courses. Eventually the infection was definitively cured after a two-week course with intramuscular teicoplanin.

Topics: Anti-Bacterial Agents; Apatites; Bacterial Proteins; Chemical Precipitation; Chronic Disease; Combined Modality Therapy; Corynebacterium; Corynebacterium Infections; Crystallization; Cystitis; Drug Resistance, Multiple, Bacterial; Humans; Hydronephrosis; Immunocompromised Host; Lupus Erythematosus, Systemic; Magnesium Compounds; Male; Nephrostomy, Percutaneous; Phosphates; Pyelitis; Remission Induction; Stents; Struvite; Teicoplanin; Urease

To report our experience with the management of encrusted cystitis and pyelitis (EC and EP) in the pediatric population. EC and EP are well-known entities in adults but are rarely identified in children. They consist of mucosal encrustations and are due to specific microorganisms.. Between 1996 and 2001, 4 children with a mean age of 9 years (range 4 to 13) were treated for EC (n = 2), EP (n = 1), and EC and EP (n = 1). The latter was a kidney transplant recipient. We retrospectively evaluated the clinical characteristics of the patients and the results of conservative management.. The delay between the beginning of the symptoms and the diagnosis was longer than 1 month in all cases. The diagnosis of EC was not evoked and was made during cystoscopy in all cases. EP was diagnosed during pyelotomy in 1 patient because it was evoked and confirmed by computed tomography scan in the kidney transplant recipient. Corynebacterium urealyticum was identified in the urine of all patients. EC was treated by antibiotics and endoscopic debulking, and EP was treated by antibiotics and local acidification. The duration of antibiotic therapy was between 1 and 6 months. The tolerance to local acidification of the kidneys was poor. Cure was achieved in 3 cases, but the treatment of EP failed in the kidney transplant recipient and graft removal was decided after 6 months of failed management because intractable febrile urinary tract infections became life threatening for the patient.. EC and EP are uncommon in children; however, these diseases must be considered. They must be diagnosed rapidly and require, if possible, conservative management. Nevertheless, kidney loss can occur in transplant recipients with EP.

Topics: Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Combined Modality Therapy; Corynebacterium; Corynebacterium Infections; Cystitis; Disease Susceptibility; Drug Therapy, Combination; Endoscopy; Female; Follow-Up Studies; Glycopeptides; Humans; Hydrogen-Ion Concentration; Isotonic Solutions; Kidney Transplantation; Magnesium Compounds; Male; Phosphates; Postoperative Complications; Pyelitis; Retrospective Studies; Struvite; Tomography, X-Ray Computed; Treatment Outcome; Urea; Urine

Companion animal diets may be related to prevention, pathogenesis and/or treatment of diseases of the lower urinary tract. For example, urolithiasis can be either diet induced or nutrient sensitive. One of the most interesting developments in veterinary urolithiasis research has been the recent change in the composition of stones recovered from cats. In 1984, 88% of stones analyzed by quantitative methods were > 70% struvite, whereas < 1% were calcium oxalate. In 1992, the percentage of struvite had dropped to 62, whereas the percentage of calcium oxalate had increased to 24. Another recent development in lower urinary tract disease of cats is the recognition that urolithiasis appears to be a minor cause of the signs of frequency, urgency and hematuria for which patients are presented. This suggests that diet may no longer be involved, or be involved in previously unrecognized ways, in many current cases of this disease. Some of these feline patients may have a disease similar to interstitial cystitis, a disease of humans that appears to be of neuroepithelial origin. Our laboratory has been studying this possibility recently, and many similarities between the two diseases have been found.

Topics: Animal Feed; Animals; Calcium Oxalate; Cat Diseases; Cats; Cystitis; Female; Humans; Magnesium Compounds; Male; Phosphates; Struvite; Urinary Calculi; Urologic Diseases

The aim of the study was to identify any dietary, signalment, geographic and clinical factors associated with hematuric struvite crystalluria (HSC) in a population of cats that visit general care veterinary hospitals in the USA.. In total, 4032 cats that had a first-time diagnosis of HSC and 8064 control cats with no history of hematuria or crystalluria were identified from medical records of all cats examined between 2007 and 2011 at 790 US veterinary hospitals. Extracted variables included age, sex, neuter status, breed, diet, urinalysis results and history of cystitis. Potential associations between these variables and HSC were estimated.. Controlling for other factors, young cats fed a dry diet had an increased likelihood of HSC relative to young cats fed a non-dry diet. However, as age increased, the likelihood of HSC declined for cats fed a dry diet and increased for cats fed a non-dry diet. Moreover, the odds of HSC were significantly greater when cats were unneutered (vs neutered; odds ratio [OR] 45.52) or had a thin (vs heavy) body condition (OR 23.81), diagnosis of cystitis (OR 2.84), urine protein concentration >30 mg/dl (OR 4.72), alkaline (vs neutral) urine pH (OR 3.34), pyuria (OR 23.67) or bacteriuria (OR 2.24).. The present study provides estimates of the strengths of association between HSC and certain signalment and clinical characteristics of cats. This information could help clinicians to perform a more directed screening for struvite crystalluria in certain cat populations. Follow-up studies that build on the findings of this study could explore the clinical importance of HSC in cats.

Topics: Animal Feed; Animals; Cat Diseases; Cats; Cystitis; Diet; Female; Male; Struvite; Urinary Calculi

A 7-year-old female spayed shih tzu dog was presented with hematuria of 4 weeks' duration. Radiographs revealed 1 cystic calculus. A polypoid mass was found incidentally during cystotomy and was removed by partial cystectomy. Histopathology revealed eosinophilic polypoid cystitis and urolith analysis reported struvite. A urinary tract infection was treated.

Topics: Animals; Cystitis; Dog Diseases; Dogs; Eosinophilia; Struvite; Urolithiasis

Female nude mice (J:NU-Foxn1nu; age, 6 wk) were injected with 1 million MCF7 human breast cancer cells in the fourth mammary fat pads and received a 21-d sustained-release estrogen pellet (0.25 mg) subcutaneously in the dorsum of the neck. All mice were maintained in sterile housing and provided sterile water and irradiated rodent chow. Approximately 6 wk after implantation, 4 of the 30 mice showed clinical signs of depression and dehydration. The 2 animals most severely affected were euthanized and presented for necropsy. The urinary bladders of these animals were distended with variable sized white, opaque uroliths. Urinalysis revealed coccal bacteria, erythrocytes, neutrophils and struvite crystals. Urine cultures from both necropsied animals grew heavy, pure growths of Staphylococcus xylosus. The organism was sensitive to all antibiotics tested except erythromycin (intermediate). Analysis of the uroliths revealed 100% struvite composition. Remaining mice in the study were evaluated clinically for hydration status, the ability to urinate, and the presence of palpable stones in the urinary bladder; one additional mouse had a firm, nonpainful bladder (urolithiasis suspected). Given the sensitivity of the organisms cultured from urine samples, the remaining mice were placed on enrofloxacin in the drinking water (0.5 mg/mL). All remaining mice completed the study without further morbidity or mortality. Previous studies have reported the association of estrogen supplementation with urinary bladder pathology, including infection and urolithiasis. Here we present a case of urolithiasis and cystitis in nude mice receiving estrogen supplementation that was associated with Staphylococcus xylosus, which previously was unreported in this context. When assessing these nude mice for urolithiasis, we found that visualizing the stones through the body wall, bladder palpation, and bladder expression were helpful in identifying affected mice.

Topics: Animals; Cystitis; Estrogens; Female; Humans; MCF-7 Cells; Mice; Mice, Nude; Staphylococcus; Struvite; Urolithiasis

Topics: Aged, 80 and over; Bacterial Proteins; Carcinoma, Transitional Cell; Catheter-Related Infections; Corynebacterium; Corynebacterium Infections; Crystallization; Cystitis; Disease Susceptibility; Female; Humans; Hydronephrosis; Male; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Struvite; Urease; Urinary Bladder Neoplasms; Urinary Catheterization; Urinary Retention

We describe a case of a large amount of mineralised material, presumed to be struvite crystals, within the urinary bladder of a cat with feline idiopathic cystitis. The presence of this material coincided with episodes of lower urinary tract signs in this cat over a 2-year period.. Although struvite crystalluria is widely considered to be clinically insignificant, this generalisation may not be true for all cats with lower urinary tract disease. Imaging of the urinary tract is recommended in all cats with lower urinary tract signs.

Topics: Animals; Cat Diseases; Cats; Cystitis; Magnesium Compounds; Male; Phosphates; Struvite; Ultrasonography; Urethra; Urinary Bladder

Urinary stasis is a risk factor for recurrent urinary tract infection (UTI). Homozygous mutant Megabladder (Mgb-/-) mice exhibit incomplete bladder emptying as a consequence of congenital detrusor aplasia. We hypothesize that this predisposes Mgb-/- mice to spontaneous and experimental UTI.. Mgb-/-, Mgb+/-, and wild-type female mice underwent serial ultrasound and urine cultures at 4, 6, and 8 weeks to detect spontaneous UTI. Urine bacterial isolates were analyzed by Gram stain and speciated. Bladder stones were analyzed by x-ray diffractometry. Bladders and kidneys were subject to histologic analysis. The pathogenicity of coagulase-negative Staphylococcus (CONS) isolated from Mgb-/- urine was tested by transurethral administration to culture-negative Mgb-/- or wild-type animals. The contribution of urinary stasis to CONS susceptibility was evaluated by cutaneous vesicostomy in Mgb-/- mice.. Mgb-/- mice develop spontaneous bacteriuria (42%) and struvite bladder stones (31%) by 8 weeks, findings absent in Mgb+/- and wild-type controls. CONS was cultured as a solitary isolate from Mgb-/- bladder stones. Bladders and kidneys from mice with struvite stones exhibit mucosal injury, inflammation, and fibrosis. These pathologic features of cystitis and pyelonephritis are replicated by transurethral inoculation of CONS in culture-negative Mgb-/- females, whereas wild-type animals are less susceptible to CONS colonization and organ injury. Cutaneous vesicostomy prior to CONS inoculation significantly reduces the quantity of CONS recovered from Mgb-/- urine, bladders, and kidneys.. CONS is an opportunistic uropathogen in the setting of urinary stasis, leading to enhanced UTI incidence and severity in Mgb-/- mice.

Topics: Animals; Bacteriuria; Cystitis; Disease Susceptibility; Female; Hydrogen-Ion Concentration; Magnesium Compounds; Mice; Mice, Mutant Strains; Phosphates; Pyelonephritis; Staphylococcus; Struvite; Urinary Bladder; Urinary Diversion; Urinary Tract; Urinary Tract Infections; Urolithiasis

Feline idiopathic cystitis (FIC) is the most common cause of feline lower urinary tract disease (FLUTD). This retrospective, case-controlled study evaluated possible risk factors associated with FIC and compared different clinical presentations in 64 cats with FIC. Several risk factors known to be involved in FLUTD were identified as playing a role in FIC. Of the stressful situations considered, most did not occur with increased frequency in cats with FIC compared to controls, except for a house move. The presence of pyuria, haematuria and an increased urine protein:creatinine ratio were significantly higher in obstructed males compared with non-obstructed males. An obstruction was significantly more likely in cats with struvite crystalluria compared with cats without struvite crystalluria. These findings suggest that urethral plugs might be an important cause or contributing factor of obstruction in FIC. Episodes of FIC seem to occur mainly in susceptible cats in combination with a deficient environment.

Topics: Animals; Belgium; Breeding; Case-Control Studies; Cat Diseases; Cats; Cystitis; Female; Magnesium Compounds; Male; Phosphates; Retrospective Studies; Risk Factors; Struvite

Topics: Animals; Cystitis; Magnesium Compounds; Male; Phosphates; Radiography; Rats; Rats, Sprague-Dawley; Rodent Diseases; Struvite; Urinary Calculi

To identify the underlying cause of clinical signs in cats with nonobstructive diseases of the bladder and urethra.. Prospective case series.. 109 cats examined by the urology service of The Ohio State University's veterinary teaching hospital because of stranguria, hematuria, pollakiuria, or urination in inappropriate locations.. History was obtained and a CBC, serum biochemical analyses, serologic tests for FeLV and feline immunodeficiency virus, urinalysis, bacterial culture of urine, and contrast radiography or urethrocystoscopy (females only) were performed.. 16 cats had cystic calculi: 8 had struvite uroliths, 7 had calcium oxalate uroliths, and 1 had a urolith of unknown composition in conjunction with an anatomic defect. Anatomic defects, including diverticulae, urethral strictures, and a malpositioned urethra, were identified in 12 cats. A urinary tract infection was identified in 1 cat, and neoplasia was diagnosed in 2. One of the cats with neoplasia also had a struvite urolith. The remaining 80 cats did not have an anatomic defect, urolith, or tumor. Ten of these cats also did not have radiographic or cystoscopic abnormalities and were presumed to have a behavioral disorder. The remaining 70 cats had radiographic or cystoscopic abnormalities, and idiopathic cystitis was diagnosed. In 14 of the cats with idiopathic cystitis, results of a urinalysis were normal. Cats with idiopathic cystitis were significantly more likely to eat dry food exclusively (59%) than were cats in the general population (19%).. Results suggest that idiopathic cystitis occurs commonly in cats with stranguria, hematuria, pollakiuria, or inappropriate elimination and is associated with consumption of dry foods. Contrast radiography or cystoscopy is necessary for differentiating idiopathic cystitis from behavioral disorders in some cats.

Topics: Animal Feed; Animals; Cat Diseases; Cats; Cystitis; Cystoscopy; Diverticulum; Female; Hematuria; Hydrogen-Ion Concentration; Magnesium Compounds; Male; Phosphates; Prospective Studies; Proteinuria; Specific Gravity; Struvite; Urethra; Urethral Stricture; Urinary Bladder Calculi; Urinary Bladder Diseases; Urine; Urologic Diseases

In a 2 year carcinogenicity bioassay using B6C3F1 mice, one male mouse developed clinical signs near termination of the study, comprising skin sores around the prepuce, penile prolapse and urine scalding. The predominant finding at necropsy was a markedly distended urinary bladder filled with numerous crystallized particles. Microscopically, there was subacute cystitis with marked hyperplasia of the transitional epithelium. X-ray diffraction analysis of the crystals showed a diffraction pattern characteristic of struvite (ammonium magnesium phosphate). The implications of the spontaneous occurrence of bladder stones in rodents on long-term toxicology studies are discussed.

Topics: Animals; Crystallization; Cystitis; Female; Magnesium; Magnesium Compounds; Male; Mice; Mice, Inbred C3H; Mice, Inbred C57BL; Phosphates; Rodent Diseases; Struvite; Urinary Calculi; X-Ray Diffraction

Corynebacterium D2, a saprophytic microorganism of skin, causes alkaline encrusted cystitis in patients with a previous bladder injury. In 5 patients that had presented this nosological entity, these gram-positive rods were isolated in urine cultures and calculi. Four patients had undergone urological instrumentation maneuvers and one patient (female) had a history of recurrent cystitis from gram-negative bacteria. Corynebacterium D2 grows slowly and under certain conditions, as those described above, must be considered pathological despite counts of less than 100,000/ufc-cc. It is ureolytic and highly resistant to antibiotics. The synergistic effects of antimicrobials, acetohydroxamic acid and transurethral resection of the lithiasic plaques achieve satisfactory treatment of alkaline encrusted cystitis from Corynebacterium D2.

Topics: Aged; Aged, 80 and over; Bacteriological Techniques; Corynebacterium; Corynebacterium Infections; Cystitis; Female; Humans; Magnesium; Magnesium Compounds; Male; Middle Aged; Phosphates; Struvite; Urea; Urinary Calculi; Urinary Catheterization

Corynebacterium group D2 inoculated into normal human urine formed struvite crystals and an increase in pH and ammonium concentration after 24 h of incubation. Zinc disks dipped into a broth culture of this microorganism and inserted into the bladders of rats produced stones with a mean weight of 12.5 mg (ranging from 1 to 57.7 mg) after 12 days. Analysis of the infrared spectrum determined the stones to be composed of struvite. From these results its seems that stone formation by Corynebacterium group D2 may be possible both in vitro and in vivo, which may confirm a previous report involving these bacteria in human clinical encrusted cystitis.

Topics: Animals; Corynebacterium; Corynebacterium Infections; Cystitis; Escherichia coli; Escherichia coli Infections; Female; Humans; Hydrogen-Ion Concentration; Magnesium; Magnesium Compounds; Phosphates; Proteus Infections; Proteus vulgaris; Rats; Rats, Inbred Strains; Struvite; Urinary Bladder Calculi