Šlapimo organų infekcija (ŠOI) vaikams yra antra pagal dažnį po kvėpavimo organų infekcijų. Tai dažniausia vaikų nefrologinė liga. ŠOI iki 3–6 mėn. amžiaus dažniau serga berniukai, vyresniame amžiuje – mergaitės. Priešmokykliniame amžiuje mergaitės simptomine šlapimo organų infekcija serga 6–20 kartų dažniau nei berniukai. Beveik kas trečia moteris iki 24 metų ŠOI yra sirgusi bent vieną kartą, o per gyvenimą ŠOI yra sirgusi beveik kas antra moteris. ŠOI linkusi pasikartoti. Kartojantis ŠOI, liga gali įgauti lėtinę eigą, sukelti inkstų randėjimą, lėtinį inkstų funkcijos nepakankamumą (IFN), nulemti hipertenzijos atsiradimą, o moterims – nėštumo komplikacijas. 29 % vaikų, kuriems buvo atliktos inkstų transplantacijos, inkstų pažeidimas buvo sąlygotas pielonefrito ar intersticinio nefrito. Lietuvoje vaikų lėtinio IFN priežastis 31,7 proc. obstrukcinė nefropatija ir lėtinis pielonefritas. Kol nebuvo taikomas profilaktinis gydymas, 60 proc. mergaičių ir 20 proc. berniukų ŠOI pasikartodavo jau pirmaisiais metais po pirmos ŠOI. Taikant profilaktinį gydymą, 1 m. laikotarpyje po persirgtos ŠOI. infekcijos pasikartojimas sumažėjo iki 15 proc. Mažo amžiaus vaikams ŠOI pasikartojimą dažniausiai lemia įgimtos šlapimo organų anomalijos. Dauguma jaunesnio mokyklinio amžiaus vaikų, kuriems yra pasikartojanti ŠOI, turi organiškai nepakitusius šlapimo organus. Pastaruoju metu atliekamos studijos, kurių tikslas nustatyti elgesio ir funkcinių sutrikimų vertę ŠOI pasikartojimui, tačiau duomenys... [toliau žr. visą tekstą] / Urinary tract infection (UTI) is one of the most common bacterial diseases in childhood. Recurrent UTI occurs in 20 – 86% of children. Recurrent UTI is relatively frequent in girls. At the age of 7, the prevalence of recurrent UTI in boys population is 1%, in girls population – 5%. Nearly one of three women will have at least one episode of UTI requiring antimicrobial therapy by the age of 24 years. Almost half of all women will experience one UTI during their lifetime. It is known, that in the group of young children the most common reason of recurrent UTI is anatomic abnormalities, such as vesicoureteral reflux (VUR), hydronephrosis. However, not all recurrent UTI can be explained by anatomic abnormalities. The vast majority of school age children with recurrent UTI have anatomically normal urinary tract. We found changes in urodynamic investigation for 91.4% of children with recurrent urinary tract infection at the age of 5–18. Having a history of previous recurrent UTI is a strong risk factor for having subsequent UTI. Antibacterial characteristics of urine and other host defence mechanisms may be important signs associated with UTI risk, but have not been clearly shown to be associated with UTI in healthy persons. Recent studies discuss about the role of behavioural and functional abnormalities (inadequate fluid intake, stool retention, infrequent voiding, etc.) that can predispose recurrent urinary tract infections. Influence of some these abnormalities for recurrent... [to full text]

<p>Urinary tract infections (UTIs) are the second most common type of infection identified in the clinical setting and disproportionately afflict women. UTIs most frequently manifest in the form of infection of the lower urinary tract, involving the bladder. Uropathogens, particularly uropathogenic E. coli, progressively colonize the urethra and ascend to the bladder, where they initiate cystitis. In some cases, infection further ascends through the ureters and reaches the kidneys, where it causes pyelonephritis. Infection of both the upper and lower urinary tract can have serious ramifications for the host, and this is in large part due not to infection itself but to host-directed responses to bacterial insults. </p><p> In this thesis, I will describe and discuss two distinct aspects of UTIs. In the first study, in vivo work in a mouse model of urinary tract infection revealed a novel role for mast cells, which are tissue-resident granulated innate immune cells, in directing the detachment and death of epithelial cells during cystitis, facilitating the clearance of bacteria from the bladder. An ex vivo porcine bladder infection model suggested a specific role for mast cell granules and the proteases contained therein, which was corroborated with in vitro experiments utlizing isolated mast cell granules and human epithelial cells to demonstrate granule-induced exfoliation and cell death. From this work, it is clear that mast cells play a highly targeted role in modulating urothelial integrity during bladder infection by mediating host-directed epithelial loss.</p><p> In the second study described in this dissertation, the synergistic roles of both pyelonephritis and vesico-ureteric reflux (VUR), a congenital urinary tract defect that results in the improper backflow of urine from the bladder to the kidney, in the development of reflux nephropathy, a fibrotic host response characterized by renal scar formation, were elucidated in a series of in vivo experiments. Specifically, the C3H mouse, which is naturally susceptible to VUR, was utilized to characterize the dynamics of kidney infection and the onset of reflux nephropathy. Renal scarring was dependent on the presence of sustained kidney infection and the accompanying inflammatory response due to VUR, while neither transient infection nor reflux alone were sufficient to provoke nephropathy. Thus, the development of reflux nephropathy is dependent upon the confluence of both infection and VUR. </p><p> This body of work reveals the double-edged sword of the host inflammatory response to urinary tract infection. In the bladder, mast cell activation and degranulation leads to granule-induced epithelial exfoliation and consequently a reduction in the bacterial burden in the bladder. However, the sustained inflammatory response that accompanies pyelonephritis in vesico-ureteric reflux-affected individuals results in significant damage to the kidney without any accompanying reduction in infection. These findings highlight the dueling roles of the host inflammatory response to infection in the upper and lower urinary tract and strongly suggest that differential clinical approaches to cystitis and pyelonephritis are necessary to promote an effective mast cell in the bladder in the former and facilitate the clearance of renal infection while mitigating tissue damage in the latter.</p> / Dissertation

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 4 uppsatser.

INTRODUÇÃO: As infecções do trato urinário (ITU) feminino são muito prevalentes em mulheres. Em geral, elas dividem-se em cistites e pielonefrites de acordo com seu nível anatômico. Seu tratamento, apesar de simples, depende do conhecimento da flora bacteriana e do padrão de sensibilidade local, principalmente em tempos de aumento de resistência bacteriana. Este estudo avaliou e comparou a flora e o padrão de sensibilidade das bactérias causadoras de infecção não complicada do trato urinário feminino no período de 2007 a 2012. MÉTODOS: Analisamos retrospectivamente os resultados de 493 culturas de urina de pacientes com idade a partir de 14 anos e sintomas clínicos de cistite ou pielonefrite tratadas no Pronto-Socorro ou Ambulatório de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. As pacientes foram separadas em três grupos: 1- pacientes com cistite simples atendidas no Pronto-Socorro; 2- pacientes com cistite simples atendidas no Ambulatório; 3- pacientes com pielonefrite atendidas no Pronto-Socorro. As características demográficas como idade, presença de ITU de repetição, diabetes mellitus (DM) e outras comorbidades, e os resultados de flora bacteriana e padrão de sensibilidade foram analisados e comparados entre os grupos. RESULTADOS: A média de idade das pacientes nos três grupos foi 43,2, 55,0 e 36,0 anos, respectivamente. ITU de repetição esteve presente em 36,0%, 76,1% e 26,5% das pacientes dos grupos 1, 2 e 3, respectivamente, enquanto que 8,5%, 22,7% e 2,2% das pacientes nos grupos 1, 2 e 3, respectivamente, eram diabéticas. Escherichia coli (E. coli) foi a bactéria responsável por 75,1% das infecções no geral e 87,3% das pielonefrites. Staphylococcus saprophyticus foi o segundo agente etiológico mais frequente (6,7%), principalmente no grupo 1 (10,0%), enquanto que nas diabéticas, Enterococcus faecalis foi o segundo agente etiológico (15,6%). Ao avaliarmos todas as pacientes, o antibiograma demonstrou sensibilidade à amoxacilina/ácido clavulânico (AAC), ampicilina, ciprofloxacina, levofloxacina, nitrofurantoína, norfloxacina e sulfametoxazol/trimetoprima (SMT) de 85,8%, 46,5%, 82,0%, 83,3%, 88,3%, 83,3% e 65,7%, respectivamente. Nas pielonefrites, a sensibilidade geral à cefalotina, cefepime, ceftriaxone, ciprofloxacina e gentamicina foi de 67,0%, 95,5%, 94,3%, 81,8% e 98,0%, respectivamente. Ao analisarmos apenas as infecções por E. coli, os antibióticos orais com sensibilidade > 90% foram AAC (96,5%) e nitrofurantoína (98,8%). No geral, ao compararmos pacientes sem e com ITU de repetição, os antibióticos amicacina, gentamicina e nitrofurantoína foram os únicos que não apresentaram diminuição significativa de sensibilidade. Nas infecções de repetição por E. coli, os únicos antibióticos orais que mantiveram sensibilidade > 90% foram AAC e nitrofurantoína. Ao compararmos ITU por E. coli nas pacientes = 50 anos, os antimicrobianos orais que mantiveram sensibilidade > 90% em ambas faixas etárias foram AAC e nitrofurantoína. Nas pacientes diabéticas, houve diminuição estatística da sensibilidade ao ácido nalidíxico (80,5% x 61,5%), ciprofloxacina (84,8% x 65,1%), gentamicina (97,4% x 81,0%), levofloxacina (85,4% x 66,7%) e SMT (66,0% x 50%), respectivamente. As infecções por E. coli nas pacientes diabéticas também apresentaram diminuição estatística aos mesmos antibióticos; AAC e nitrofurantoína mantiveram sensibilidade > 95% nesta situação. Análise de regressão logística identificou aumento de chance de resistência ao ácido nalidíxico, ciprofloxacina e levofloxacina de 3,62, 4,72 e 5,27, respectivamente, quando há ITU de repetição, e à gentamicina de 5,38 quando há DM. CONCLUSÕES: Pielonefrites foram mais comuns em mulheres jovens em relação às cistites. E. coli foi o principal agente causador das infecções urinárias não complicadas, principalmente em pielonefrites. A nitrofurantoína manteve sensibilidade in vitro acima de 90% em diversas situações como no tratamento geral das cistites por E. coli, em casos de cistite de repetição, em mulheres > 50 anos e em diabéticas. AAC mostrou sensibilidade in vitro acima de 90% em algumas situações: ITU de repetição por E. coli, mulheres com idade >= 50 anos e diabéticas. A ceftriaxone apresentou sensibilidade in vitro suficiente para o tratamento empírico de pielonefrite. O histórico de infecção urinária de repetição aumentou a chance de resistência ao ácido nalidíxico, ciprofloxacina e levofloxacina e DM aumentou a chance de resistência à gentamicina. / INTRODUCTION: Uncomplicated urinary tract infections (UTIs) in women are common. Urinary tract infections are usually divided into cystitis or pyelonephritis, according to anatomical level. Although treatment of UTI is simple, it depends on knowledge of the local uropathogens and antimicrobial susceptibility patterns due to increasing antimicrobial resistance. This study analyzed the causative pathogens of UTIs in women and their susceptibility patterns between 2007 and 2012. METHODS: We conducted a retrospective analysis of 493 urine culture results of female patients aged 14 years and older with clinical diagnosis of cystitis or pyelonephritis who were treated at the urological emergency unit or urological outpatient clinic. Patients were divided into three groups: 1- simple cystitis attended to in the emergency unit; 2- simple cystitis attended to in the urological outpatient clinic; 3- pyelonephritis attended to in the emergency unit. Results of demographic data, such as age, history of recurrent UTI, diabetes mellitus (DM) and comorbidities, and those of the causative pathogens and their susceptibility patterns were analyzed and compared. RESULTS: The mean age for groups 1, 2 and 3 was 43.2, 55.0 and 36.0 years, respectively. Recurrent UTI was present in 36.0%, 76.1% and 26.5% of patients in groups 1, 2 and 3, respectively. DM was present in 8.5%, 22.7% and 2.2% of patients in group 1, 2 and 3, respectively. Escherichia coli (E. coli) was responsible for 75.1% of all UTIs and 87.3% of pyelonephritis. Staphylococcus saprophyticus was the second most common agent (6.7%), mainly in group 1 (10.0%), while Enterococcus faecalis was the second most common agent in diabetic patients (15.6%). General susceptibility rates to amoxicillin/clavulanate (A/C), ampicillin, ciprofloxacin, levofloxacin, nitrofurantoin, norfloxacin and sulfamethoxazole/trimethoprim (SMT) were 85.8%, 46.5%, 82.0%, 83.3%, 88.3%, 83.3% and 65.7%, respectively. For pyelonephritis, the general susceptibility rates to cephalothin, cefepime, ceftriaxone, ciprofloxacin and gentamicin were 67.0%, 95.5%, 94.3%, 81.8% and 98.0%, respectively. Analysis of the E.coli isolates showed that more than 90% of the strains were susceptible to A/C (96.5%) and nitrofurantoin (98.8%). There was a decrease in the susceptibility rates to all antimicrobials in patients with recurrent UTI, except for amikacin, gentamicin and nitrofurantoin. In cases of recurrent UTI by E. coli, susceptibility rates for oral nitrofurantoin and A/C were above 90%. In a comparison of patients below 50 years and those aged 50 and older diagnosed with E. coli UTI, only A/C and nitrofurantoin maintained susceptibility rates above 95% for all ages. Comparison between diabetic and non-diabetic patients showed a significant decrease in susceptibility rates for ciprofloxacin (84.8% x 65.1%), gentamicin (97.4% x 81.0%), levofloxacin (85.4% x 66.7%), nalidixic acid (80.5% x 61.5%) and SMT (66.0% x 50%), respectively. A similar susceptibility rate of E. coli was found in diabetic patients; however, A/C and nitrofurantoin maintained susceptibility rates above 95% in this situation. A multivariate analysis identified an increased odds of resistance to ciprofloxacin, levofloxacin and nalidixic acid (OR=4.72, 5.27 and 3.62, respectively) in the presence of recurrent UTI, while there was an increased probability for resistance to gentamicin (OR=5.38) in the presence of DM. CONCLUSIONS: Pyelonephritis was more common in young women than cystitis. E. coli was the main agent for uncomplicated UTI, particularly for pyelonephritis. Nitrofurantoin maintained in vitro susceptibility rates above 90% in many situations, such as E. coli infections, recurrent infections, women older than 50 years and diabetic patients. A/C maintained susceptibility rates above 90 % in some situations, such as recurring UTI caused by E. coli, women aged 50 years or older and diabetic patients. Ceftriaxone had a sufficient in vitro susceptibility profile to be indicated for empirical treatment of pyelonephritis. Recurrent UTI increased the odds of resistance to ciprofloxacin, levofloxacin and nalidixic acid, while DM increased the chance of resistance to gentamicin

INTRODUÇÃO: As infecções do trato urinário (ITU) feminino são muito prevalentes em mulheres. Em geral, elas dividem-se em cistites e pielonefrites de acordo com seu nível anatômico. Seu tratamento, apesar de simples, depende do conhecimento da flora bacteriana e do padrão de sensibilidade local, principalmente em tempos de aumento de resistência bacteriana. Este estudo avaliou e comparou a flora e o padrão de sensibilidade das bactérias causadoras de infecção não complicada do trato urinário feminino no período de 2007 a 2012. MÉTODOS: Analisamos retrospectivamente os resultados de 493 culturas de urina de pacientes com idade a partir de 14 anos e sintomas clínicos de cistite ou pielonefrite tratadas no Pronto-Socorro ou Ambulatório de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. As pacientes foram separadas em três grupos: 1- pacientes com cistite simples atendidas no Pronto-Socorro; 2- pacientes com cistite simples atendidas no Ambulatório; 3- pacientes com pielonefrite atendidas no Pronto-Socorro. As características demográficas como idade, presença de ITU de repetição, diabetes mellitus (DM) e outras comorbidades, e os resultados de flora bacteriana e padrão de sensibilidade foram analisados e comparados entre os grupos. RESULTADOS: A média de idade das pacientes nos três grupos foi 43,2, 55,0 e 36,0 anos, respectivamente. ITU de repetição esteve presente em 36,0%, 76,1% e 26,5% das pacientes dos grupos 1, 2 e 3, respectivamente, enquanto que 8,5%, 22,7% e 2,2% das pacientes nos grupos 1, 2 e 3, respectivamente, eram diabéticas. Escherichia coli (E. coli) foi a bactéria responsável por 75,1% das infecções no geral e 87,3% das pielonefrites. Staphylococcus saprophyticus foi o segundo agente etiológico mais frequente (6,7%), principalmente no grupo 1 (10,0%), enquanto que nas diabéticas, Enterococcus faecalis foi o segundo agente etiológico (15,6%). Ao avaliarmos todas as pacientes, o antibiograma demonstrou sensibilidade à amoxacilina/ácido clavulânico (AAC), ampicilina, ciprofloxacina, levofloxacina, nitrofurantoína, norfloxacina e sulfametoxazol/trimetoprima (SMT) de 85,8%, 46,5%, 82,0%, 83,3%, 88,3%, 83,3% e 65,7%, respectivamente. Nas pielonefrites, a sensibilidade geral à cefalotina, cefepime, ceftriaxone, ciprofloxacina e gentamicina foi de 67,0%, 95,5%, 94,3%, 81,8% e 98,0%, respectivamente. Ao analisarmos apenas as infecções por E. coli, os antibióticos orais com sensibilidade > 90% foram AAC (96,5%) e nitrofurantoína (98,8%). No geral, ao compararmos pacientes sem e com ITU de repetição, os antibióticos amicacina, gentamicina e nitrofurantoína foram os únicos que não apresentaram diminuição significativa de sensibilidade. Nas infecções de repetição por E. coli, os únicos antibióticos orais que mantiveram sensibilidade > 90% foram AAC e nitrofurantoína. Ao compararmos ITU por E. coli nas pacientes = 50 anos, os antimicrobianos orais que mantiveram sensibilidade > 90% em ambas faixas etárias foram AAC e nitrofurantoína. Nas pacientes diabéticas, houve diminuição estatística da sensibilidade ao ácido nalidíxico (80,5% x 61,5%), ciprofloxacina (84,8% x 65,1%), gentamicina (97,4% x 81,0%), levofloxacina (85,4% x 66,7%) e SMT (66,0% x 50%), respectivamente. As infecções por E. coli nas pacientes diabéticas também apresentaram diminuição estatística aos mesmos antibióticos; AAC e nitrofurantoína mantiveram sensibilidade > 95% nesta situação. Análise de regressão logística identificou aumento de chance de resistência ao ácido nalidíxico, ciprofloxacina e levofloxacina de 3,62, 4,72 e 5,27, respectivamente, quando há ITU de repetição, e à gentamicina de 5,38 quando há DM. CONCLUSÕES: Pielonefrites foram mais comuns em mulheres jovens em relação às cistites. E. coli foi o principal agente causador das infecções urinárias não complicadas, principalmente em pielonefrites. A nitrofurantoína manteve sensibilidade in vitro acima de 90% em diversas situações como no tratamento geral das cistites por E. coli, em casos de cistite de repetição, em mulheres > 50 anos e em diabéticas. AAC mostrou sensibilidade in vitro acima de 90% em algumas situações: ITU de repetição por E. coli, mulheres com idade >= 50 anos e diabéticas. A ceftriaxone apresentou sensibilidade in vitro suficiente para o tratamento empírico de pielonefrite. O histórico de infecção urinária de repetição aumentou a chance de resistência ao ácido nalidíxico, ciprofloxacina e levofloxacina e DM aumentou a chance de resistência à gentamicina. / INTRODUCTION: Uncomplicated urinary tract infections (UTIs) in women are common. Urinary tract infections are usually divided into cystitis or pyelonephritis, according to anatomical level. Although treatment of UTI is simple, it depends on knowledge of the local uropathogens and antimicrobial susceptibility patterns due to increasing antimicrobial resistance. This study analyzed the causative pathogens of UTIs in women and their susceptibility patterns between 2007 and 2012. METHODS: We conducted a retrospective analysis of 493 urine culture results of female patients aged 14 years and older with clinical diagnosis of cystitis or pyelonephritis who were treated at the urological emergency unit or urological outpatient clinic. Patients were divided into three groups: 1- simple cystitis attended to in the emergency unit; 2- simple cystitis attended to in the urological outpatient clinic; 3- pyelonephritis attended to in the emergency unit. Results of demographic data, such as age, history of recurrent UTI, diabetes mellitus (DM) and comorbidities, and those of the causative pathogens and their susceptibility patterns were analyzed and compared. RESULTS: The mean age for groups 1, 2 and 3 was 43.2, 55.0 and 36.0 years, respectively. Recurrent UTI was present in 36.0%, 76.1% and 26.5% of patients in groups 1, 2 and 3, respectively. DM was present in 8.5%, 22.7% and 2.2% of patients in group 1, 2 and 3, respectively. Escherichia coli (E. coli) was responsible for 75.1% of all UTIs and 87.3% of pyelonephritis. Staphylococcus saprophyticus was the second most common agent (6.7%), mainly in group 1 (10.0%), while Enterococcus faecalis was the second most common agent in diabetic patients (15.6%). General susceptibility rates to amoxicillin/clavulanate (A/C), ampicillin, ciprofloxacin, levofloxacin, nitrofurantoin, norfloxacin and sulfamethoxazole/trimethoprim (SMT) were 85.8%, 46.5%, 82.0%, 83.3%, 88.3%, 83.3% and 65.7%, respectively. For pyelonephritis, the general susceptibility rates to cephalothin, cefepime, ceftriaxone, ciprofloxacin and gentamicin were 67.0%, 95.5%, 94.3%, 81.8% and 98.0%, respectively. Analysis of the E.coli isolates showed that more than 90% of the strains were susceptible to A/C (96.5%) and nitrofurantoin (98.8%). There was a decrease in the susceptibility rates to all antimicrobials in patients with recurrent UTI, except for amikacin, gentamicin and nitrofurantoin. In cases of recurrent UTI by E. coli, susceptibility rates for oral nitrofurantoin and A/C were above 90%. In a comparison of patients below 50 years and those aged 50 and older diagnosed with E. coli UTI, only A/C and nitrofurantoin maintained susceptibility rates above 95% for all ages. Comparison between diabetic and non-diabetic patients showed a significant decrease in susceptibility rates for ciprofloxacin (84.8% x 65.1%), gentamicin (97.4% x 81.0%), levofloxacin (85.4% x 66.7%), nalidixic acid (80.5% x 61.5%) and SMT (66.0% x 50%), respectively. A similar susceptibility rate of E. coli was found in diabetic patients; however, A/C and nitrofurantoin maintained susceptibility rates above 95% in this situation. A multivariate analysis identified an increased odds of resistance to ciprofloxacin, levofloxacin and nalidixic acid (OR=4.72, 5.27 and 3.62, respectively) in the presence of recurrent UTI, while there was an increased probability for resistance to gentamicin (OR=5.38) in the presence of DM. CONCLUSIONS: Pyelonephritis was more common in young women than cystitis. E. coli was the main agent for uncomplicated UTI, particularly for pyelonephritis. Nitrofurantoin maintained in vitro susceptibility rates above 90% in many situations, such as E. coli infections, recurrent infections, women older than 50 years and diabetic patients. A/C maintained susceptibility rates above 90 % in some situations, such as recurring UTI caused by E. coli, women aged 50 years or older and diabetic patients. Ceftriaxone had a sufficient in vitro susceptibility profile to be indicated for empirical treatment of pyelonephritis. Recurrent UTI increased the odds of resistance to ciprofloxacin, levofloxacin and nalidixic acid, while DM increased the chance of resistance to gentamicin

Urinvägsinfektioner (UVI) är ett vanligt hälsoproblem som drabbar miljontals människor. Den allvarligaste formen, akut pyelonefrit (APN) kan ge svåra komplikationer. Urinvägspatogena Escherichia coli (UPEC) som orsakar APN uttrycker P fimbrier som specifikt binder till glykosphingolipider på ytan av uroepitelceller. Det sätter igång en toll-like receptor 4 (TLR4) beroende men LPS-oberoende immunreaktion. Den roll som interferon beta (IFN-β) spelar vid bakterieinfektioner är inte helt klarlagd men studier som gjorts på IFN-β knockoutmöss visade på en ökad infektionsbenägenhet och svåra njursymptom vid infektion med UPEC. IFN-β uttrycket i uroepitelceller som svar på bakterieinfektion undersöktes. För att ta reda på om uttrycket är P fimbrieberoende infekterades humana A498 njurcarcinomceller med den P fimbrieförsedda pyelonefritstammen CFT073 eller den icke-virulenta asymtomatisk bakterieuristammen E. coli 83972 och inkuberades i 1,5 respektive 4 timmar. Som kontroll användes celler som enbart behandlats med PBS. Uttrycket av IFN-β analyserades med immunofluorescens (IF) och konfokalmikroskopi, samt med Western blot. Resultaten från konfokalmikroskopi visade att celler som exponerats för CFT073 under 4 timmar uttryckte mest IFN-β medan cellerna som utsatts för E. coli 83972 visade på ett omvänt förhållande. Western blot visade på högst uttryck i de E. coli 83972-behandlade cellerna. IFN-β uttrycktes i alla celler, inklusive kontrollcellerna, i någon utsträckning. Det kan betyda att IFN-β även induceras på någon alternativ väg och/eller att det uttrycks konstitutivt av njurepitelceller. / Urinary tract infections (UTI) are a common health concern and affect millions of people. The most severe form of UTI, acute pyelonephritis (APN) is associated with serious complications. Uropathogenic Escherichia coli (UPEC) that cause APN express P fimbriae which specifically bind to glycosphingolipid molecules on the surface of urothelial cells. This triggers a toll-like receptor 4 (TLR4) mediated but LPS-independent innate immune response. The role of interferon beta (IFN-β) in bacterial infections is not well known but experiments with IFN-β knockout mice have shown an increased susceptibility and severe kidney pathology when infected with UPEC. IFN-β induction in urothelial cells in response to bacterial infection was investigated. To find out whether this response is P fimbriae dependent, A498 human kidney carcinoma epithelial cells were exposed to the P fimbriated CFT073 pyelonephritis strain or the non-virulent E. coli 83972 asymptomatic bacteriuria strain and incubated for 1.5 and 4 hours. For control, cells were treated with PBS alone. The IFN-β expression was analysed using immunofluorescence (IF) and confocal microscopy, and Western blot. Confocal microscopy results showed that the response to bacteria was both time- and dose-dependent. The highest IFN-β expression was detected in cells exposed to CFT073 for 4 hours, while cells exposed to E. coli 83972 showed an inverse relationship. Western blot analysis revealed that the highest expression was in the E. coli 83972 stimulated cells. IFN-β was expressed in all cells to some degree, including control cells. This could imply that IFN-β is induced by some other means and/or is constitutively expressed by kidney epithelial cells.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Made available in DSpace on 2014-12-17T14:46:54Z (GMT). No. of bitstreams: 1 MariaGPA_DISSERT.pdf: 2796113 bytes, checksum: d2967bb8bd56144b41ef8989cbf03470 (MD5) Previous issue date: 2011-05-30 / The Urinary Tract Infection (UTI) in pregnancy is important as a consequence of the high incidence during the gestation. It is the third most common clinical complication in pregnancy affecting 10-12% of women whether prevalence is increasing in the first trimester of pregnancy, it may also contribute to maternal and infant mortality. Due the relevance for the results of obstetric and neonatal complications from UTI, these complications must be prevented, because it can lead to health hazards to pregnant women and newborns, producing a direct effect on morbidity and perinatal mortality. On this basis, it was defined as objectives of this research the identification of the profile of nurses from the Family Health Strategy (FHS) in the East and West Health Districts from the city of Natal / RN before the women with UTI and to verify the nurse performance during prenatal consultations. This is an exploratory study with a quantitative approach using a sample of 40 nurses active workers during this survey, it was approved by the Research Ethics Committee of the Universidade Federal do Rio Grande do Norte Protocol n0 232/10 P-CEP/UFRN and opinion n0 080/2011. The tool for data collection was a structured interview. The data collected were organized into an electronic database application Microsoft ? Excel 2007, exported and analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0, and coded, tabulated and presented through tables and charts into their respective percentage distributions, using the descriptive and inferential statistical analysis, chi-square test and significance level of 5% (distribution in relative and absolute frequencies) in the independent variables. Therefore, it was observed from these results that the longer action of nurses in the FHS from the East and Weast health districts of the city of Natal/RN contributed to the development of a greater number of activities to control the incidence of UTI in women who are attended in the prenatal care service, proven by significance in statistics / A Infec??o do Trato Urin?rio (ITU) na gesta??o ? de import?ncia em fun??o da elevada incid?ncia nessa fase. ? a terceira intercorr?ncia cl?nica mais comum na gesta??o acometendo de 10 a 12% das gr?vidas sendo sua maior ocorr?ncia no primeiro trimestre, podendo contribuir tamb?m para a mortalidade materno-infantil. Devido ? relev?ncia para os resultados obst?tricos e neonatais das complica??es derivadas da ITU, as mesmas devem ser evitadas, visto causar preju?zos ? sa?de da gestante e do rec?m-nascido, produzindo efeito direto no ?ndice de morbidade e mortalidade perinatal. Com base nisso, definiu-se como objetivos deste trabalho, identificar o perfil dos enfermeiros na Estrat?gia Sa?de da Fam?lia (ESF) nos Distritos Sanit?rios Leste e Oeste no Munic?pio de Natal/RN frente ?s gestantes com ITU e verificar a conduta do enfermeiro frente a uma gestante com ITU durante as consultas no pr?natal. Trata-se de um estudo explorat?rio descritivo com abordagem quantitativa tendo-se uma amostra de 40 enfermeiros atuantes durante o per?odo da pesquisa, a qual teve parecer favor?vel do Comit? de ?tica em Pesquisa da Universidade Federal do Rio Grande do Norte com Protocolo de n0 232/10-P CEP/UFRN e Parecer de n0 080/2011. O instrumento de coleta de dados foi uma entrevista estruturada. Os dados coletados foram organizados em um banco de dados eletr?nico do aplicativo Microsoft? Excel 2007, exportados e analisados no programa Statistical Package for Social Sciences (SPSS) vers?o 17.0, sendo codificados, tabulados e apresentados em forma de tabela e quadro com suas respectivas distribui??es percentuais, empregando-se a an?lise estat?stica descritiva e inferencial, teste do Qui- Quadrado e n?vel de signific?ncia de 5% (distribui??o em frequ?ncias relativas e absolutas) nas vari?veis independentes. Portanto, observou-se com estes resultados que o maior tempo de atua??o dos enfermeiros na ESF dos Distritos Sanit?rios Leste e Oeste do Munic?pio de Natal/RN contribuiu para o desenvolvimento de um maior n?mero de condutas no controle da ITU em gestantes que frequentam um servi?o de pr?-natal, comprovado por meio de signific?ncia estat?stica

<p>Serum amyloid A protein (SAA) is an acute phase protein that has recently gained increasing interest as a potential marker for disease and treatment monitoring. We investigated SAA and CRP levels in (a) patients with various common infectious diseases (n=98), (b) patients with pyelonephritis (n=37) versus patients with cystitis (n=32), (c) healthy individuals of varying ages (n=231), (d) very immature newborn infants with or without nosocomial infections (NIs) (n=72) and (e) patients with bacterial infections treated with cefuroxime (n=81). </p><p>SAA significantly correlated with CRP in viral as well as in bacterial infections (for the total group: r²=0.757, p<0.0001) and showed a systemic inflammatory response in 90% of the patients with cystitis as compared with 23% for CRP. Equally high efficiencies (0.96 and 0.94 for SAA and CRP, respectively) were observed in discriminating between pyelonephritis and cystitis. SAA and high sensitive (hs) CRP were lower in umbilical cords (p<0.0001) and higher in elderly adults (p<0.0001-0.03) than in the other age groups; higher in immature newborn infants than in term infants; and higher in the NI group than in the non-NI group. Interindividual variabilities of the time course of the biomarkers SAA and CRP were considerable. Because of the smoothed distribution of SAA and CRP (i.e. elevations were both essentially unchanged during the first 3 days of cefuroxime treatment), these markers were not useful when deciding parenteral-oral switch of therapy, which occurred within this time period in most cases.</p><p>SAA is a sensitive systemic marker in cystitis. SAA and hsCRP in umbilical cord blood are close to the detection limit and increase with age. They increase in relation to NI in very immature newborn infants and might therefore be used in diagnosis and monitoring. Finally, SAA and CRP in adults with bacterial infections could not predict an early parenteral-oral switch of antimicrobial therapy.</p>

Serum amyloid A protein (SAA) is an acute phase protein that has recently gained increasing interest as a potential marker for disease and treatment monitoring. We investigated SAA and CRP levels in (a) patients with various common infectious diseases (n=98), (b) patients with pyelonephritis (n=37) versus patients with cystitis (n=32), (c) healthy individuals of varying ages (n=231), (d) very immature newborn infants with or without nosocomial infections (NIs) (n=72) and (e) patients with bacterial infections treated with cefuroxime (n=81). SAA significantly correlated with CRP in viral as well as in bacterial infections (for the total group: r2=0.757, p&lt;0.0001) and showed a systemic inflammatory response in 90% of the patients with cystitis as compared with 23% for CRP. Equally high efficiencies (0.96 and 0.94 for SAA and CRP, respectively) were observed in discriminating between pyelonephritis and cystitis. SAA and high sensitive (hs) CRP were lower in umbilical cords (p&lt;0.0001) and higher in elderly adults (p&lt;0.0001-0.03) than in the other age groups; higher in immature newborn infants than in term infants; and higher in the NI group than in the non-NI group. Interindividual variabilities of the time course of the biomarkers SAA and CRP were considerable. Because of the smoothed distribution of SAA and CRP (i.e. elevations were both essentially unchanged during the first 3 days of cefuroxime treatment), these markers were not useful when deciding parenteral-oral switch of therapy, which occurred within this time period in most cases. SAA is a sensitive systemic marker in cystitis. SAA and hsCRP in umbilical cord blood are close to the detection limit and increase with age. They increase in relation to NI in very immature newborn infants and might therefore be used in diagnosis and monitoring. Finally, SAA and CRP in adults with bacterial infections could not predict an early parenteral-oral switch of antimicrobial therapy.