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Cystitis

Disease Details

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Description: Cystitis is an inflammation of the bladder, often caused by a bacterial infection, resulting in symptoms such as frequent, painful urination and lower abdominal pain.
Type: Cystitis is an infection or inflammation of the bladder. It is typically not a genetic condition and does not have a type of genetic transmission. Instead, it is often caused by bacterial infections, particularly Escherichia coli (E. coli), enter the urinary tract.
Signs And Symptoms: Lower urinary tract infection is also referred to as a bladder infection. The most common symptoms are burning with urination and having to urinate frequently (or an urge to urinate) in the absence of vaginal discharge and significant pain. These symptoms may vary from mild to severe and in healthy women last an average of six days. Some pain above the pubic bone or in the lower back may be present. People experiencing an upper urinary tract infection, or pyelonephritis, may experience flank pain, fever, or nausea and vomiting in addition to the classic symptoms of a lower urinary tract infection. Rarely, the urine may appear bloody or contain visible pus in the urine.UTIs have been associated with onset or worsening of delirium, dementia, and neuropsychiatric disorders such as depression and psychosis. However, there is insufficient evidence to determine whether UTI causes confusion. The reasons for this are unknown, but may involve a UTI-mediated systemic inflammatory response which affects the brain. Cytokines such as interleukin-6 produced as part of the inflammatory response may produce neuroinflammation, in turn affecting dopaminergic and/or glutamatergic neurotransmission as well as brain glucose metabolism.
Prognosis: With treatment, symptoms generally improve within 36 hours. Up to 42% of uncomplicated infections may resolve on their own within a few days or weeks.15–25% of adults and children have chronic symptomatic UTIs including recurrent infections, persistent infections (infection with the same pathogen), a re-infection (new pathogen), or a relapsed infection (the same pathogen causes a new infection after it was completely gone). Recurrent urinary tract infections are defined as at least two infections (episodes) in a six-month time period or three infections in twelve months, can occur in adults and in children.Cystitis refers to a urinary tract infection that involves the lower urinary tract (bladder). An upper urinary tract infection which involves the kidney is called pyelonephritis. About 10–20% of pyelonephritis will go on and develop scarring of the affected kidney. Then, 10–20% of those develop scarring will have increased risk of hypertension in later life.
Onset: Cystitis onset is typically acute, developing over a period of hours to days. Symptoms that might indicate the onset of cystitis include a frequent urge to urinate, burning sensation during urination, cloudy or strong-smelling urine, and pelvic discomfort.
Prevalence: Cystitis is a common condition, particularly affecting women. It is estimated that about 50-60% of women will experience at least one episode of cystitis in their lifetime. The condition is significantly less common in men.
Epidemiology: Urinary tract infections are the most frequent bacterial infection in women. They occur most frequently between the ages of 16 and 35 years, with 10% of women getting an infection yearly and more than 40–60% having an infection at some point in their lives. Recurrences are common, with nearly half of people getting a second infection within a year. Urinary tract infections occur four times more frequently in females than males. Pyelonephritis occurs between 20 and 30 times less frequently. They are the most common cause of hospital-acquired infections accounting for approximately 40%. Rates of asymptomatic bacteria in the urine increase with age from two to seven percent in women of child-bearing age to as high as 50% in elderly women in care homes. Rates of asymptomatic bacteria in the urine among men over 75 are between 7–10%. 2–10% of pregnant women have asymptomatic bacteria in the urine and higher rates are reported in women who live in some underdeveloped countries.Urinary tract infections may affect 10% of people during childhood. Among children, urinary tract infections are most common in uncircumcised males less than three months of age, followed by females less than one year. Estimates of frequency among children, however, vary widely. In a group of children with a fever, ranging in age between birth and two years, 2–20% were diagnosed with a UTI.
Intractability: Cystitis, particularly its acute form, is generally not considered intractable. Most cases of acute cystitis, often caused by bacterial infections such as Escherichia coli, can be effectively treated with antibiotics. However, chronic cystitis or interstitial cystitis might present more treatment challenges and could be considered more intractable due to their persistent and recurrent nature. Treatment for these chronic conditions usually involves a combination of medications, lifestyle changes, and sometimes procedures to manage symptoms.
Disease Severity: Cystitis is typically mild to moderate in severity. Most cases, especially acute uncomplicated cystitis, can be treated effectively with antibiotics and result in full recovery without complications. However, if left untreated or if it occurs in individuals with weakened immune systems or underlying health conditions, it can lead to more severe outcomes such as kidney infections.
Healthcare Professionals: Disease Ontology ID - DOID:1679
Pathophysiology: Cystitis is the inflammation of the bladder, commonly caused by a bacterial infection. The pathophysiology of cystitis typically involves the following steps:

1. **Bacterial Entry**: Uropathogenic bacteria, often Escherichia coli (E. coli), enter the urinary tract via the urethra.
2. **Adherence**: Bacteria adhere to the urothelial cells lining the bladder using fimbriae or adhesins.
3. **Invasion and Colonization**: They invade the bladder epithelium and multiply, evading the host immune response.
4. **Inflammatory Response**: The invasion triggers an immune response, leading to the recruitment of inflammatory cells and the release of cytokines.
5. **Symptoms**: This inflammatory process results in the clinical symptoms of cystitis, such as dysuria (painful urination), increased urinary frequency, urgency, and suprapubic pain.
6. **Resolution or Persistence**: If untreated or inadequately treated, the infection can ascend to involve the ureters and kidneys, leading to more serious conditions such as pyelonephritis. Effective treatment usually resolves the inflammation and infection, restoring normal bladder function.
Carrier Status: Cystitis is an inflammation of the bladder, often caused by a bacterial infection. Carrier status is not applicable as cystitis is not a hereditary or genetic condition.
Mechanism: Cystitis is an inflammation of the bladder, most commonly caused by a bacterial infection. Here's an overview of its mechanism and molecular mechanisms:

**Mechanism:**
1. **Infection Process**: The bladder becomes infected when bacteria, most commonly Escherichia coli (E. coli) from the gastrointestinal tract, enter the urethra and multiply in the bladder.
2. **Inflammatory Response**: The presence of bacteria triggers the body's immune response, leading to inflammation and symptoms like a frequent urge to urinate, burning sensation during urination, and lower abdominal pain.

**Molecular Mechanisms:**
1. **Bacterial Adhesion**: E. coli uses fimbriae, like type 1 fimbriae and P fimbriae, to adhere to the urothelial cells of the bladder. Fimbriae interact with receptors on the urothelial surface, facilitating bacterial colonization and infection.

2. **Toxin Production**: E. coli produces various toxins, such as Hemolysin, which can damage the bladder's epithelial cells and contribute to inflammation.

3. **Immune Activation**: The infection activates the host's innate immune system. Urothelial cells recognize bacterial components through pattern recognition receptors (PRRs) like Toll-like receptors (TLRs), specifically TLR4 for lipopolysaccharides from gram-negative bacteria.

4. **Cytokine Release**: Activation of TLRs leads to the production of pro-inflammatory cytokines (e.g., IL-1β, IL-6, and TNF-α) and chemokines (e.g., IL-8), which recruit immune cells like neutrophils to the site of infection to clear the bacteria.

Understanding these mechanisms is essential to the development of effective treatments and prevention strategies for cystitis.
Treatment: The mainstay of treatment is antibiotics. Phenazopyridine is occasionally prescribed during the first few days in addition to antibiotics to help with the burning and urgency sometimes felt during a bladder infection. However, it is not routinely recommended due to safety concerns with its use, specifically an elevated risk of methemoglobinemia (higher than normal level of methemoglobin in the blood). Paracetamol may be used for fevers. There is no good evidence for the use of cranberry products for treating current infections.Fosfomycin can be used as an effective treatment for both UTIs and complicated UTIs including acute pyelonephritis. The standard regimen for complicated UTIs is an oral 3g dose administered once every 48 or 72 hours for a total of 3 doses or a 6 grams every 8 hours for 7 days to 14 days when fosfomycin is given in IV form.
Compassionate Use Treatment: Compassionate use treatments and off-label or experimental treatments for cystitis are generally considered when standard treatments are not effective or suitable. Here are some approaches that might be used:

1. **Compassionate Use Treatments**:
- **Intravesical Therapy**: This involves directly instilling medication into the bladder. An example includes the use of heparin or lidocaine to provide symptom relief, particularly in cases of interstitial cystitis (IC).

2. **Off-label or Experimental Treatments**:
- **Dimethyl Sulfoxide (DMSO)**: Although primarily used for interstitial cystitis, DMSO can be instilled into the bladder to reduce inflammation and pain.
- **Hyaluronic Acid**: This is used intravesically to help restore the bladder's mucosal lining.
- **Antibiotics**: Some antibiotics might be used off-label for specific types of bacterial cystitis that do not respond to standard treatment protocols.
- **Botulinum Toxin (Botox)**: Injections into the bladder may help reduce symptoms of interstitial cystitis by calming overactive bladder nerves.
- **Probiotics**: Experimental studies are exploring the use of probiotics to balance the urinary tract's microbiome and alleviate cystitis symptoms.
- **Regenerative Medicine**: Research is ongoing into the use of stem cells and growth factors to repair damaged bladder tissue in chronic cases.

These treatments should be conducted under medical supervision and typically reserved for cases where conventional treatments have failed.
Lifestyle Recommendations: For cystitis, lifestyle recommendations include:

1. **Hydration:** Drink plenty of water to help flush bacteria from the urinary tract.
2. **Hygiene:** Practice good personal hygiene, including wiping from front to back after using the toilet.
3. **Urination Habits:** Urinate frequently and do not hold in urine for long periods. Also, try to urinate soon after intercourse.
4. **Avoid Irritants:** Reduce the use of irritants such as bubble baths, scented hygiene products, and harsh soaps around the genital area.
5. **Diet:** Cranberry juice or supplements might help prevent recurrent infections, though evidence is mixed. Avoid excessive alcohol and caffeine, as they can irritate the bladder.
6. **Clothing:** Wear loose-fitting clothing and cotton underwear to allow air circulation and prevent moisture buildup, which can promote bacterial growth.
Medication: For those with recurrent infections, taking a short course of antibiotics when each infection occurs is associated with the lowest antibiotic use. A prolonged course of daily antibiotics is also effective. Medications frequently used include nitrofurantoin and trimethoprim/sulfamethoxazole. Some recommend against prolonged use due to concerns of antibiotic resistance. Methenamine is another agent used for this purpose as in the bladder where the acidity is low it produces formaldehyde to which resistance does not develop. A UK study showed that methenamine is as effective daily low-dose antibiotics at preventing UTIs among women who experience recurrent UTIs. As methenamine is an antiseptic, it may avoid the issue of antibiotic resistance.In cases where infections are related to intercourse, taking antibiotics afterwards may be useful. In post-menopausal women, topical vaginal estrogen has been found to reduce recurrence. As opposed to topical creams, the use of vaginal estrogen from pessaries has not been as useful as low dose antibiotics. Antibiotics following short term urinary catheterization decreases the subsequent risk of a bladder infection. A number of vaccines are in development as of 2018.
Repurposable Drugs: Repurposable drugs for cystitis include:

1. **Methenamine**: Typically used as a urinary antiseptic.
2. **Fosfomycin**: An antibiotic that can be used for various bacterial infections and is approved for uncomplicated cystitis.
3. **Doxycycline**: An antibiotic that has been used for other infections but can be repurposed for bladder infections under certain circumstances.
4. **Nitrofurantoin**: Commonly used for urinary tract infections, including cystitis.

Always consult a healthcare professional before starting any repurposed medications.
Metabolites: Cystitis, an inflammation of the bladder often caused by a bacterial infection, can be associated with various metabolites as markers or indicators of the condition. Some key metabolites include:

1. **Nitrites:** Produced by certain bacteria, nitrites in the urine can indicate infection.
2. **Leukocyte esterase:** An enzyme found in white blood cells, its presence in urine often signifies an inflammatory response or infection.
3. **Proteins:** Elevated levels of proteins in urine, though less specific, can indicate inflammation.
4. **Blood (Hematuria):** Microscopic or visible blood can be a sign of cystitis.

Diagnosis and treatment should be overseen by healthcare professionals.
Nutraceuticals: Nutraceuticals that might help manage cystitis include:

1. **Cranberry Extract**: Contains proanthocyanidins that can prevent bacteria from adhering to the bladder wall.
2. **D-Mannose**: A type of sugar that can inhibit E. coli bacteria from sticking to the urinary tract.
3. **Probiotics**: Specifically Lactobacillus strains can help maintain healthy urinary tract flora.
4. **Vitamin C**: Can acidify urine, creating a less favorable environment for bacterial growth.

Always consult a healthcare provider before starting any new supplements.
Peptides: For cystitis:

**Peptides:** Antimicrobial peptides (AMPs) have shown potential in treating cystitis due to their ability to combat bacterial infections and reduce inflammation in the urinary tract.

**Nanotechnology (nan):** Nanoparticles can be engineered to deliver targeted antibiotics or other therapeutic agents directly to the site of infection in the bladder, potentially improving treatment efficacy and reducing side effects.

Both approaches are under research and show promise in enhancing the treatment of cystitis.