Emphysematous cystitis

Last updated
Emphysematous cystitis
Emphysematous cystitis - X-rax - SHF.jpg
Emphysematous cystitis as incidental finding in a case of hip fracture on the right
Specialty Infectious disease

Emphysematous cystitis is a rare type of infection of the bladder wall by gas-forming bacteria or fungi. The most frequent offending organism is E. coli . Other gram negative bacteria, including Klebsiella and Proteus are also commonly isolated. Fungi, such as Candida , have also been reported as causative organisms. Citrobacter and Enterococci have also been found to cause emphysematous cystitis. [1] Although it is a rare type of bladder infection, it is the most common type of all gas-forming bladder infections. [2] The condition is characterized by the formation of air bubbles in and around the bladder wall. The gas found in the bladder consists of nitrogen, hydrogen, oxygen, and carbon dioxide. The disease most commonly affects elderly diabetic and immunocompromised patients. [3] The first case was identified in a post-mortem examination in 1888. [4]

Contents

Signs and symptoms

Signs and symptoms of emphysematous cystitis include air in the bladder wall, altered mental status, severe abdominal pain, weakness, dark urine, dysuria, fever, lethargy, vomiting, as well as white blood cells and bacteria in the urine. [2] Where some patients may be asymptomatic, others may present with septic shock. [5] Symptoms can vary greatly from patient to patient, which makes the disease difficult to diagnose. In some cases of emphysematous cystitis, patients do not even claim to have any urinary symptoms. [1] Urinary symptoms can include blood in the urine, increased urinary frequency, urgency, occasional incontinence, difficulty voiding, and burning sensation. Emphysematous cystitis is often indicated in patients who have air in the urine. [6] In some cases, emphysematous cystitis can cause thickening of the bladder wall. [7] Clinical subcutaneous emphysema is a rare complication of emphysematous cystitis that has a poor prognosis. [8]

Risk factors

Risk factors include catheter use and chronic urinary tract infections, being female, diabetes mellitus, neurogenic bladder, and being in an immunocompromised state. [7] In 50% of cases, patients are elderly and diabetic. Obstruction of the urinary tract as well as urinary stasis, often brought on by paralysis of the urinary tract, are also major risk factors in addition to diabetes. [5] Transplant recipients have also been found to be at risk. [7] Introduction of infection from external means was discovered in one case study where a male with no history of diabetes or abnormalities to his immune system had recently undergone a transrectal ultrasound needle-guided prostate biopsy contracted a severe case of sepsis, which led to a case of Emphysematous cystitis. The patient went on to develop disseminated intravascular coagulopathy and acute respiratory distress syndrome. After a stay in Intensive Care undergoing broad-spectrum antibiotic therapy, the patient was eventually discharged in stable condition. [9] Patients diagnosed with Emphysematous Cystitis are also commonly diagnosed with urinary tract infections and sepsis. [2] Cases of Emphysematous Cystitis in a clinical study have shown to progress quickly and are life-threatening and sometimes fatal due to inflammation caused by gas forming organisms. [1]

Diagnosis

Due to the atypical presentation and rarity of the infection, it takes a physician longer to diagnose than more common types of bladder infections. Diagnosis requires a personalized investigation with consideration to risk factors and symptoms. [6] Radiology of the abdominal or pubic region has proven to be an important tool in reaching a definitive diagnosis of conditions causing gas in the urinary tract. Computer tomography, or CT scans, are of most help due to their high sensitivity in detecting gas and air bubbles. [10] However, radiology is normally not the first tool used to diagnose. Most diagnoses are made by chance after imaging examination. [7] Sometimes, even when patients don't show symptoms, their Emphysematous cystitis infection level can be very advanced already. [5] Gas in the bladder wall will often have the appearance of cobblestone or a “beaded necklace” with the use of conventional radiography. [7] Delayed diagnosis can lead to a severe infection, extension of the uterus, rupturing of the bladder, and death. Emphysematous cystitis has an overall mortality rate of 7%. However, surgery is only considered in severe cases where the disease progresses involving the ureters, kidneys, or adrenal glands. When required, surgery may be extensive. [5]

Treatment

Even when caught early, aggressive treatment is required. [6] Antibiotics are proven to cure Emphysematous cystitis over time and reduce the amount of gas inside the bladder wall. Prognosis is poor if antibiotics are not used to treat the patient. Additional treatment consists of urinary drainage and good control of blood glucose. The treatment of underlying comorbid diseases, such as diabetes, is extremely important because they can intensify the infection. [10] Hyperbaric oxygen is an effective treatment, and has cured some cases in as little as 48 hours. Although it is unclear as to how gas formation occurs in emphysematous cystitis, it's dependent on whether or not the patient has contributing diseases. [2] Gas formation in diabetic patients diagnosed with Emphysematous cystitis has been determined to occur due to the production of carbon dioxide as a result of the fermentation of the high concentrations of glucose. Gas formation in nondiabetic patients is most likely due to the breaking down of urinary lactulose and tissue proteins. Inflammation caused by infection increases pressure and decreases circulation, which provides the perfect environment for bacteria to produce gas. [3]

Related Research Articles

<span class="mw-page-title-main">Interstitial cystitis</span> Medical condition

Interstitial cystitis (IC), a type of bladder pain syndrome (BPS), is chronic pain in the bladder and pelvic floor of unknown cause. It is the urologic chronic pelvic pain syndrome of women. Symptoms include feeling the need to urinate right away, needing to urinate often, and pain with sex. IC/BPS is associated with depression and lower quality of life. Many of those affected also have irritable bowel syndrome and fibromyalgia.

<span class="mw-page-title-main">Urinary tract infection</span> Infection that affects part of the urinary tract

A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidney infection (pyelonephritis). Symptoms from a lower urinary tract infection include pain with urination, frequent urination, and feeling the need to urinate despite having an empty bladder. Symptoms of a kidney infection include fever and flank pain usually in addition to the symptoms of a lower UTI. Rarely the urine may appear bloody. In the very old and the very young, symptoms may be vague or non-specific.

<span class="mw-page-title-main">Benign prostatic hyperplasia</span> Noncancerous increase in size of the prostate gland

Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss of bladder control. Complications can include urinary tract infections, bladder stones, and chronic kidney problems.

<span class="mw-page-title-main">Cystoscopy</span> Medical procedure; endoscopy of the urinary bladder via the urethra

Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.

Glomerulation refers to bladder hemorrhages which are thought to be associated with some types of interstitial cystitis (IC).

<span class="mw-page-title-main">Urinary retention</span> Inability to completely empty the bladder

Urinary retention is an inability to completely empty the bladder. Onset can be sudden or gradual. When of sudden onset, symptoms include an inability to urinate and lower abdominal pain. When of gradual onset, symptoms may include loss of bladder control, mild lower abdominal pain, and a weak urine stream. Those with long-term problems are at risk of urinary tract infections.

<span class="mw-page-title-main">Pyelonephritis</span> Medical condition

Pyelonephritis is inflammation of the kidney, typically due to a bacterial infection. Symptoms most often include fever and flank tenderness. Other symptoms may include nausea, burning with urination, and frequent urination. Complications may include pus around the kidney, sepsis, or kidney failure.

Nocturia is defined by the International Continence Society (ICS) as “the complaint that the individual has to wake at night one or more times for voiding .” The term is derived from Latin nox, night, and Greek [τα] ούρα, urine. Causes are varied and can be difficult to discern. Although not every patient needs treatment, most people seek treatment for severe nocturia, waking up to void more than 2–3 times per night.

<span class="mw-page-title-main">Hemorrhagic cystitis</span> Medical condition

Hemorrhagic cystitis or haemorrhagic cystitis is an inflammation of the bladder defined by lower urinary tract symptoms that include dysuria, hematuria, and hemorrhage. The disease can occur as a complication of cyclophosphamide, ifosfamide and radiation therapy. In addition to hemorrhagic cystitis, temporary hematuria can also be seen in bladder infection or in children as a result of viral infection.

<span class="mw-page-title-main">Vesicoureteral reflux</span> Medical condition

Vesicoureteral reflux (VUR), also known as vesicoureteric reflux, is a condition in which urine flows retrograde, or backward, from the bladder into one or both ureters and then to the renal calyx or kidneys. Urine normally travels in one direction from the kidneys to the bladder via the ureters, with a one-way valve at the vesicoureteral (ureteral-bladder) junction preventing backflow. The valve is formed by oblique tunneling of the distal ureter through the wall of the bladder, creating a short length of ureter (1–2 cm) that can be compressed as the bladder fills. Reflux occurs if the ureter enters the bladder without sufficient tunneling, i.e., too "end-on".

Neurogenic bladder dysfunction, or neurogenic bladder, refers to urinary bladder problems due to disease or injury of the central nervous system or peripheral nerves involved in the control of urination. There are multiple types of neurogenic bladder depending on the underlying cause and the symptoms. Symptoms include overactive bladder, urinary urgency, frequency, incontinence or difficulty passing urine. A range of diseases or conditions can cause neurogenic bladder including spinal cord injury, multiple sclerosis, stroke, brain injury, spina bifida, peripheral nerve damage, Parkinson's disease, or other neurodegenerative diseases. Neurogenic bladder can be diagnosed through a history and physical as well as imaging and more specialized testing. Treatment depends on underlying disease as well as symptoms and can be managed with behavioral changes, medications, surgeries, or other procedures. The symptoms of neurogenic bladder, especially incontinence, can have a significant impact on quality of life.

<span class="mw-page-title-main">Pneumaturia</span> Medical condition

Pneumaturia is the passage of gas or "air" in urine. This may be seen or described as "bubbles in the urine".

<span class="mw-page-title-main">Malakoplakia</span> Medical condition

Malakoplakia is a rare inflammatory condition which makes its presence known as a papule, plaque or ulceration that usually affects the genitourinary tract. However, it may also be associated with other bodily organs. It was initially described in the early 20th century as soft yellowish plaques found on the mucosa of the urinary bladder. Microscopically it is characterized by the presence of foamy histiocytes with basophilic inclusions called Michaelis–Gutmann bodies.

<span class="mw-page-title-main">Bacteriuria</span> Medical condition

Bacteriuria is the presence of bacteria in urine. Bacteriuria accompanied by symptoms is a urinary tract infection while that without is known as asymptomatic bacteriuria. Diagnosis is by urinalysis or urine culture. Escherichia coli is the most common bacterium found. People without symptoms should generally not be tested for the condition. Differential diagnosis include contamination.

Lower urinary tract symptoms (LUTS) refer to a group of clinical symptoms involving the bladder, urinary sphincter, urethra and, in men, the prostate. The term is more commonly applied to men—over 40% of older men are affected—but lower urinary tract symptoms also affect women. The condition is also termed prostatism in men, but LUTS is preferred.

<span class="mw-page-title-main">Chronic bacterial prostatitis</span> Bacterial infection of the prostate gland

Chronic bacterial prostatitis is a bacterial infection of the prostate gland. It should be distinguished from other forms of prostatitis such as acute bacterial prostatitis and chronic pelvic pain syndrome (CPPS).

<span class="mw-page-title-main">Chronic prostatitis/chronic pelvic pain syndrome</span> Medical condition

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), previously known as chronic nonbacterial prostatitis, is long-term pelvic pain and lower urinary tract symptoms (LUTS) without evidence of a bacterial infection. It affects about 2–6% of men. Together with IC/BPS, it makes up urologic chronic pelvic pain syndrome (UCPPS).

Urinary bladder disease includes urinary bladder inflammation such as cystitis, bladder rupture and bladder obstruction (tamponade). Cystitis is common, sometimes referred to as urinary tract infection (UTI) caused by bacteria, bladder rupture occurs when the bladder is overfilled and not emptied while bladder tamponade is a result of blood clot formation near the bladder outlet.

Urologic diseases or conditions include urinary tract infections, kidney stones, bladder control problems, and prostate problems, among others. Some urologic conditions do not affect a person for that long and some are lifetime conditions. Kidney diseases are normally investigated and treated by nephrologists, while the specialty of urology deals with problems in the other organs. Gynecologists may deal with problems of incontinence in women.

Feline idiopathic cystitis (FIC) or feline interstitial cystitis or cystitis in cats, is one of the most frequently observed forms of feline lower urinary tract disease (FLUTD). Feline cystitis means "inflammation of the bladder in cats". The term idiopathic means unknown cause; however, certain behaviours have been known to aggravate the illness once it has been initiated. It can affect both males and females of any breed of cat. It is more commonly found in female cats; however, when males do exhibit cystitis, it is usually more dangerous.

References

  1. 1 2 3 Mokabberi R, Ravakhah K (February 2007). "Emphysematous urinary tract infections: diagnosis, treatment and survival (case review series)". The American Journal of the Medical Sciences. 333 (2): 111–6. doi:10.1097/00000441-200702000-00009. PMID   17301591. S2CID   20930228.
  2. 1 2 3 4 McCabe JB, Mc-Ginn Merritt W, Olsson D, Wright V, Camporesi EM (2004). "Emphysematous cystitis: rapid resolution of symptoms with hyperbaric treatment: a case report". Undersea & Hyperbaric Medicine. 31 (3): 281–4. PMID   15568415.
  3. 1 2 Sereno M, Gómez-Raposo C, Gutiérrez-Gutiérrez G, López-Gómez M, Casado E (June 2011). "Severe emphysematous cystitis: Outcome after seven days of antibiotics". McGill Journal of Medicine. 13 (1): 13. PMC   3277337 . PMID   22363178.
  4. ↑ Nemati E, Basra R, Fernandes J, Levy JB (March 2005). "Emphysematous cystitis". Nephrology, Dialysis, Transplantation. 20 (3): 652–3. doi: 10.1093/ndt/gfh566 . PMID   15735251.
  5. 1 2 3 4 De Baets K, Baert J, Coene L, Claessens M, Hente R, Tailly G (2011). "Emphysematous cystitis: report of an atypical case". Case Reports in Urology. 2011: 280426. doi: 10.1155/2011/280426 . PMC   3350004 . PMID   22606608.
  6. 1 2 3 Bobba RK, Arsura EL, Sarna PS, Sawh AK (October 2004). "Emphysematous cystitis: an unusual disease of the Genito-Urinary system suspected on imaging". Annals of Clinical Microbiology and Antimicrobials. 3: 20. doi: 10.1186/1476-0711-3-20 . PMC   524183 . PMID   15462675.
  7. 1 2 3 4 5 Dixon A. "Radiology Reference Article: Emphysematous cystitis". Radiopaedia.org. Retrieved 2018-11-17.
  8. ↑ Sadek AR, Blake H, Mehta A (June 2011). "Emphysematous cystitis with clinical subcutaneous emphysema". International Journal of Emergency Medicine. 4 (1): 26. doi: 10.1186/1865-1380-4-26 . PMC   3123544 . PMID   21668949.
  9. ↑ Hashimoto T, Namiki K, Tanaka A, Shimodaira K, Gondo T, Tachibana M (November 2012). "Emphysematous cystitis following a transrectal needle guided biopsy of the prostate". BMC Infectious Diseases. 12: 322. doi: 10.1186/1471-2334-12-322 . PMC   3519746 . PMID   23176639.
  10. 1 2 Gheonea IA, Stoica Z, Bondari S (October 2012). "Emphysematous Cystitis. Case report and imaging features". Current Health Sciences Journal. 38 (4): 191–4. PMC   3945275 . PMID   24778851.

Further reading

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.