The activity of penicillin against Proteus in vitro and in experimental infections of mice.
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A clinical isolate of Proteus mirabilis (Pr 990) and an isogenic non-flagellate allelic replacement mutant (Pr M9) were tested for their ability to cause infection in the ascending mouse model of urinary tract infection. Wild-type Pr 990 differentiates into swarmer cells in brain-heart infusion broth. Pr M9 neither has flagella nor does it apparently differentiate into swarmer cells after subculturing. The infectivity of both strains from an initial culture and the sixth subculture was assessed in the ascending urinary tract infection mouse model. Infection was ascertained by determining colony forming units from kidney and bladder homogenates from individual mice 7 days after inoculation. In all cases the nonflagellate mutant Pr M9 was at least as infective as Pr 990. Using bacteria from the first culture, Pr M9 infected 61.5% and Pr 990 infected 45.5% of mice tested. The levels of viable counts were similar between the Pr M9 and the Pr 990 infections. Using bacteria from the sixth subculture, Pr M9 infected 75% and Pr 990 infected 76.5% of mice tested. Again viable counts were similar. Pr 990 increased in infectivity from the first to the sixth subculture, whereas Pr M9 did not, but this may be a reflection of the high initial rate of infectivity with first culture Pr M9. These results suggest that neither flagella nor swarmer cells are required for P. mirabilis infectivity in ascending urinary tract infections in mice.
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The strains of Proteus species found in significant numbers and as pure cultures in urine from 217 individuals were isolated, identified to species level and typed for proticine production (P type) and proticine sensitivity (S type) to give their P/S type. Urinary-tract infections with Proteus, principally P. mirabilis, were associated with the elderly. Ninety seven distinct P/S types were found but three P/S types P3/S1,8, P3/S1,8,13 and P3/S1,13 were isolated at a much higher frequency (14%) then could be explained from their faecal carriage rate. These types were almost without exception restricted to patients with clinical symptoms of urinary-tract infection and it is suggested therefore that they have some special affinity for the urinary tract.
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Vesical foreign bodies readily lead to urolith formation but not in Brattleboro rats with diabetes insipidus. This experiment was designed to examine the roles of vesical foreign bodies, urine osmolality, and vesical infection in the formation of uroliths and associated reactive urothelial hyperplasia. ADH-deficient Brattleboro rats received surgical insertion of a silk suture in the bladder. Their bladders were infected with intravesical injection of urease positive P. vulgaris, while controls were similarly injected with sterile Ringer's sol. They received daily injections of either pitressin tannate in oil (1 U/kg body weight) or peanut oil. Urine flow rate, urine osmolality, urine culture, and gross and light microscopic examinations of the bladders were carried out at the end of 4th week. The results indicated that uroliths readily formed in the presence of all three factors; vesical foreign bodies, high urine osmolality, and infection, but not as readily in the presence of two or less of these three factors. The urothelial hyperplasia was prominent in infected bladders followed by non-infected bladder with high osmolar and low osmolar urine in this order.
Three interesting case histories of infection of the temperomandibular joint are reported. An unsuccessful search of the recent literature was made in the hope that some assistance would be obtained in understanding the pathology. These infections must have been more common in the pre-antibiotic era and perhaps a search of the older literature would have been more fruitful.
A case of secondary transient pseudohypoaldosteronism (PHA) in a three-month-old infant who had arrived in emergency conditions is reported. Clinically the patient presented dehydration associated with salt loss, metabolic acidosis, severe hyperkalemia, markedly elevated levels both of plasma renin activity and aldosterone concentration. Biochemical and instrumental tests and clinical evolution have given reason to consider it as a case of transient PHA, secondary to an obstructive uropathy (PUV) with urinary infection. Secondary forms of PHA have frequently been documented in young infants with urinary tract infection associated with both obstructive and non obstructive uropathy. After medical or surgical therapy the abnormalities quickly disappear. This reported case suggests that the pediatrician-neonatologist dealing with a young infant with obstructive uropathy should not only consider the surgical treatment but also the medical one, in the light of the associated physiopathological aspects.
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Bed-pads and long-term indwelling catheters were compared in the treatment of urinary incontinence in two groups of eight elderly bedridden women. The same silicone catheter could be left in situ on average for 2 months. A detailed description of the changes of urinary bacterial flora in patients of both experimental groups is given. At the end of the 6 months' study all of the patients in both groups had significant bacteriuria (greater than or equal to 10(8) CFU/1), Proteus species being the most common pathogen in catheterised patients. The development of multiple resistance was observed in both groups, but it was more pronounced in the catheterised group. The indwelling catheter was more economical (P less than 0.001), but carried a higher risk of infection.
An 18-year-old male developed C-5 complete tetraplegia following a motor-cycle accident in May 1975. The neuropathic bladder was managed by an indwelling urethral catheter. He developed recurrent episodes of urinary infection with Proteus species. In September 1975, an X-ray of the abdomen revealed small calculi in both the kidneys. In July 1976, he underwent transurethral resection of the bladder neck and division of the external urethral sphincter; subsequently, he was put on a penile sheath drainage. He continued to suffer from repeated episodes of urinary tract infection with Proteus, Providencia, and Pseudomonas species, and he was treated with antibiotics. In 1980, intravenous urography (IVU) showed two large stones in the left kidney with marked caliectasis. The IVU performed in 1984 showed an increase in the size of the calculi in the left kidney which was grossly hydronephrotic. There were clusters of small calculi in the right kidney. The left renal calculi were treated by percutaneous lithotripsy in two sessions. In 1988, an X-ray of the abdomen revealed staghorn calculus in the right kidney and recurrence of stones in the left kidney. The staghorn calculus in the right kidney was treated by percutaneous nephrostolithotomy in two sessions. In 1991, he was admitted with acute urinary infection. IVU showed a stone in the pelviureteric junction with no excretion of contrast in the left kidney. Percutaneous nephrostomy drainage was established followed by left percutaneous nephrostolithotomy. In 1992, he was found to retain large amount of urine in the bladder; subsequently, his mother was taught to perform regular intermittent catheterisations. In 1995, he was admitted with acute urine infection. Abdominal X-ray revealed recurrence of large stones in both kidneys. With multiple sessions of Extracorporeal Shockwave Lithotripsy (ESWL), about 80% clearance was achieved on the left side. Right staghorn renal stone awaits treatment. This case shows that recurrent urinary infection in spinal cord injury patients is a predisposing factor for renal lithiasis. These patients require annual urological evaluation. Urinary tract calculi, if detected, should be dealt with promptly to prevent renal damage due to urinary obstruction and urosepsis. Renal calculi can be treated effectively and safely by ESWL in spinal cord injury patients, thus avoiding the need for an invasive procedure. It is essential to achieve low-pressure, adequate emptying of the urinary bladder in patients with spinal cord injury in order to prevent recurrent urinary infection and its sequelae. Social issues involved in the care of a tetraplegic patient play a vital role in the implementation of ideal medical treatment and need to be addressed promptly to avoid any compromise in the quality of medical care.
Bacteriological examinations carried out in an infectious hospital revealed that the occurrence of Pseudomonas and Proteus grew 4-fold, and the rate of Klebsiella positive cultures 3.5-fold between 1958 and 1977. On the other hand, the occurrence of Staphylococcus aureus decreased to the half since 1961. The occurrence of Gram-negative facultative pathogens started to increase in the surgical wards in the fifties and the rise lasted until the mid-sixties. Pseudomonas aeruginosa was the most frequent among them. In contrast, Escherichia coli dominated and P. aeruginosa was the least frequent in the non-surgical wards. Here the Gram-negative facultative pathogens showed a more rapid increase and the incidence of P. aeruginosa and Proteus kept rising throughout the whole examination period. When Gram-negative facultative pathogens of hospital origin were colonizing, the proportion of sick persons versus symptomless carriers was significantly higher than in the case of extrahospital colonization on the basis of the records of 300 P. aeruginosa, 300 Proteus and 300 Klebsiella positive patients. This proportion changed parallel with the rate of the strains of hospital origin. The number of patients who acquired P. aeruginosa, Proteus or Klebsiella extrahospitally, kept continuously rising between 1958 and 1971. Thus, the advance of Gram-negative facultative pathogens is due not ony to nosocomial causes.