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. Sexually active healthy 22 year old woman
    2. 12-year-old healthy girl
    3. 4-year-old boy with constipation
    4. 78-year-old man with hypertension
    5. 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 (uromodulin)
    2. Glycosaminoglycan
    3. Lactoferrin
    4. Lactobacillus species
    5. Albumin
    1. Less than 0.1%
    2. 1%
    3. 5%
    4. 60% lifetime prevalence
    5. 2-5%
    1. Type 1 fimbria
    2. Type IV cilia
    3. D-mannose cell wall bodies
    4. Anionic glycoproteins
    5. Anaerobic cellular metobolism

    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.