Cystitis: Definition, Epidemiology & Etiology

by John Fisher, MD

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    00:00 In our discussion of urinary tract infections, we turn to cystitis.

    00:06 To define it we'd call it a clinical syndrome characterized by dysuria, frequency, urgency, and occasionally suprapubic tenderness caused by inflammation and infection of the bladder.

    00:21 It's a disease that's much more common in women than men.

    00:25 In fact, women have an incidence of asymptomatic bacteriuria of around 1 to 3%.

    00:35 Up to 60% of women have had at least one episode of cystitis during their lifetime.

    00:43 And 10% have it once a year.

    00:46 The peak incidence is among young, sexually active women, 18-24 years of age and 2-5% have recurrent problems with cystitis.

    01:00 Men, on the other hand, have a very low prevalence of cystitis -- less than 0.1 %.

    01:09 And when a man has cystitis, we have to look for a complication because there's usually some kind of obstructive uropathy duplicating collecting system, some kind anatomical explanation for cystitis and we have to work them up for urologic abnormalities.

    01:30 The lack of circumcision predisposes some men to cystitis and among men who have sex with men anal insertive sexual intercourse is a predisposing factor.

    01:47 95% of the time, the cause is a single species of bacterium, so polymicrobial infections are unusual.

    01:56 The most common bug is, as you might expect, Escherichia coli.

    02:02 Now, we have lots of E. coli in our intestine -- lots of them.

    02:07 But only about 20% of this E. coli are what we would call uropathogenic E. coli.

    02:16 So these E. coli are different.

    02:19 They possess virulence factors that the other E. coli do not have that allow them to colonize and invade the urinary tract.

    02:28 Most of them have what we call Type 1 fimbriae -- this fringe that surrounds the surface.

    02:34 And this group of fimbria can attach to mannose residues which we find commonly on the glycoproteins on urothelium.

    02:44 And so they can attach to urothelium and they're not washed away in the urinary stream.

    02:51 These are called mannose-sensitive E. coli, and the other E. coli's don't have them.

    03:00 Furthermore, the normal urinary tract has a defense mechanism.

    03:07 There is a glycoprotein present in trace amounts in urine.

    03:12 It's called uromodulin.

    03:14 The old name is Tamm-Horsfall protein, and this uromodulin has mannose residues on it.

    03:23 So these mannose-sensitive E. coli will bind to the uromodulin and then be washed away in the urine stream.

    03:33 So they never get a chance to attach because of the uromodulin that's present normally in urine.

    03:42 Now recurrent and complicated cystitis leads to an increased incidence of more resistant organisms, that we don't usually find causing cystitis.

    03:55 That would be, for example, Proteus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterobacter species, and even some resistant E. coli, and among the Gram-positives -- Enterococcus.

    About the Lecture

    The lecture Cystitis: Definition, Epidemiology & Etiology by John Fisher, MD is from the course Urinary Tract Infections. It contains the following chapters:

    • Cysitis – Definition and Epidemiology
    • Cysitis – Etiology

    Included Quiz Questions

    1. A sexually active healthy 22-year-old woman
    2. A healthy 12-year-old girl
    3. A 4-year-old boy with constipation
    4. A 78-year-old man with hypertension
    5. A 65-year-old woman with well controlled diabetes
    1. Escherichia coli
    2. Proteus species
    3. Pseudomonas aeruginosa
    4. Enterobacter
    5. Klebsiella
    1. Tamm-Horsfall protein
    2. Glycosaminoglycan
    3. Lactoferrin
    4. Immunoglobulin heavy chains
    5. Albumin
    1. Men with cystitis are more likely to have underlying urinary tract abnormalities.
    2. Recurrent cystitis is more common in men than in women.
    3. Lack of circumcision is not a risk factor for urinary tract infections in men.
    4. Men who have sex with men are at a lower risk of cystitis.
    1. Type 1 fimbriae
    2. Cytotoxic necrotising factor 1
    3. Secreted autotransporter toxin
    4. Cytolysin A
    5. Yersiniabactin

    Author of lecture Cystitis: Definition, Epidemiology & Etiology

     John Fisher, MD

    John Fisher, MD

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    By David R. on 06. August 2019 for Cystitis: Definition, Epidemiology & Etiology

    If I´m paying for people to read the slides, Im out of this, TBH this whole Lecturio actually is super good only for just a few doctors, like Dr. Raj, and some others, but this man... really? reading everything? I´m actually pissed off.

    an easy and clear concept in brief.
    By Iftakhar A. on 06. March 2018 for Cystitis: Definition, Epidemiology & Etiology

    an easy and clear concept in brief.His speech quality is sharp.