Urinary Tract Infections
Urinary tract infections (UTI), one of the most common bacterial infections, afflict 50 % of all women at least once in their lifetime with a 20–30 % chance of a recurrent infection [1]. Further, the risk of UTI is elevated in people with altered metaboli
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Introduction to Urinary Tract Infections Urinary tract infections (UTI), one of the most common bacterial infections, afflict 50 % of all women at least once in their lifetime with a 20–30 % chance of a recurrent infection [1]. Further, the risk of UTI is elevated in people with altered metabolism, including diabetes (see chapter “Diabetes mellitus”), obesity (see chapter “Metabolic syndrome”), and pregnancy (see chapter “Overview” under the part “Reproductive system”) [2–4]. The major etiological agent is uropathogenic Escherichia coli (UPEC) accounting for ~80 % of noncomplicated communityacquired UTI [1]. Three subclasses of UTI can be distinguished. Lower UTI, also known as bladder infection or cystitis, is characterized by the presence of bacteria in the urine with symptoms of frequent
M.S. Conover • M.E. Hibbing Department of Molecular Microbiology and Microbial Pathogenesis, Washington University in St. Louis, Saint Louis, MO 63110, USA e-mail: [email protected]; [email protected] S.J. Hultgren (*) Department of Molecular Microbiology and Microbial Pathogenesis, Center for Women’s Infectious Disease Research, Washington University in St. Louis, 4940 Parkview Place, Room 10102, Saint Louis, MO 63110, USA e-mail: [email protected]
painful urination and lower abdominal pain. Upper UTI or pyelonephritis (an inflammatory kidney infection) occurs when bacteria ascend to the kidney. It manifests with the additional symptoms of flank pain, pyuria (pus in the urine), and fever. Asymptomatic bacteriuria (ASB) is also frequently observed and is usually selfresolving [1].
Pathophysiology of Urinary Tract Infections and Metabolic Alterations While lower UTI represents the majority of UTIs, upper UTI can result in severe effects on host metabolism [1]. This is thought to be due to abrogation of kidney function via renal damage and scarring [5]. In response to bacterial kidney colonization, the immune system, predominantly the innate component (see chapter “Overview” under the part “Immune system”), mounts an aggressive response designed to eliminate the pathogen. This can result in significant kidney damage via reactive oxygen species and ischemia generated by a robust immune response and inflammation [6]. This damage can lead to severe metabolic complications including hypertension (see chapter “Hypertension”), uremia, and kidney failure (see chapter “Chronic kidney disease”) [5]. In the lower urinary tract, cystitis results from a toll-like receptor-mediated inflammatory response and remodeling which alters the tissue
E. Lammert, M. Zeeb (eds.), Metabolism of Human Diseases, DOI 10.1007/978-3-7091-0715-7_52, © Springer-Verlag Wien 2014
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Septicemia, hypertension, uremia, kidney failure
Kidney damage, scarring
Pyelonephritis
Bladder remodeling
Cystitis
Obesity
Diabetes
Pregnancy Bladder dysfunction
Fig. 1 The effects of metabolism and disease on urinary tract infection (UTI). The left side depicts the effects and consequences of UTI on host metabolism. Cyst
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