1
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Murray K, Patel K, Espinosa J, Lucerna A. A Case of Purple Urine Bag Syndrome (PUBS) in a Patient With a Chronic Indwelling Foley Catheter. Cureus 2024; 16:e67731. [PMID: 39318926 PMCID: PMC11421484 DOI: 10.7759/cureus.67731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2024] [Indexed: 09/26/2024] Open
Abstract
Purple urine bag syndrome (PUBS) is a medical condition characterized by the appearance of purple discoloration in the urine collection bag of patients who use catheters for urinary drainage. PUBS is primarily seen in elderly, female, and institutionalized patients who have chronic indwelling catheters. The discoloration occurs due to the presence of certain bacteria that can produce indigo (which has a blue hue) and indirubin (with a red hue) leading to the formation of a purple color. PUBS may also indicate an underlying urinary tract infection or other medical conditions that require immediate attention. This case report provides an overview of PUBS, including its etiology, pathogenesis, clinical manifestations, and management. Early identification and appropriate management of PUBS can significantly improve patient outcomes, decrease healthcare costs, and enhance the overall quality of care provided to patients.
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Affiliation(s)
- Kelsey Murray
- Emergency Medicine, Jefferson Health, Stratford, USA
| | - Kishan Patel
- Emergency Medicine, Jefferson Health, Stratford, USA
| | | | - Alan Lucerna
- Emergency Medicine, Jefferson Health, Stratford, USA
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2
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Julião M, Cruz M. The color purple: Purple urine bag syndrome: Identifying the phenomenon to ease unnecessary anxiety, fear, and distress. Palliat Support Care 2024; 22:424-426. [PMID: 37435644 DOI: 10.1017/s1478951523000949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
OBJECTIVES Purple urine bag syndrome (PUBS) is a condition that causes an intense purple discoloration of the urine, predominately in frail, dependent, and bedridden persons who are chronically catheterized and have urinary tract infections. Despite being considered a benign syndrome, PUBS can cause great anxiety, fear, and distress in health professionals, chronically ill persons, and caregivers or family members who provide care. METHODS We report the case of a 98-year-old institutionalized woman with Alzheimer's dementia with a long-term urinary catheter who developed PUBS. RESULTS Although alarming and distressing for the resident and the health-care team, PUBS was resolved by treating the underlying urinary tract infection and applying good genital hygiene and catheter replacement. SIGNIFICANCE OF RESULTS Identifying PUBS and its clinical features and management proved to be significantly helpful in ameliorating the anxiety, fear, and distress around the phenomenon.
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Affiliation(s)
- Miguel Julião
- Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, Sintra, Portugal
- Inválidos do Comércio IPSS, Lisboa, Portugal
| | - Mário Cruz
- Inválidos do Comércio IPSS, Lisboa, Portugal
- Escola de Psicologia e Ciências da Vida, Universidade Lusófona, Lisboa, Portugal
- USF Tapada, ACeS Sintra, Sintra, Portugal
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3
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Faia J, Martins AS, Martins M. Purple Urine Bag Syndrome: A Peculiar Presentation of a Urinary Tract Infection. Cureus 2023; 15:e49804. [PMID: 38161563 PMCID: PMC10757859 DOI: 10.7759/cureus.49804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/03/2024] Open
Abstract
Purple urine bag syndrome (PUBS) is a peculiar phenomenon and corresponds to the appearance of purplish-colored urine. It is associated with urinary tract infections occurring mainly in debilitated elderly women with constipation and long-term indwelling urinary catheters. We share a case involving PUBS in an 87-year-old female patient, explore the pathophysiology, and discuss potential management options for this uncommon syndrome.
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Affiliation(s)
- João Faia
- Internal Medicine, Centro Hospitalar do Baixo Vouga E.P.E, Aveiro, PRT
| | - Ana S Martins
- Internal Medicine, Centro Hospitalar do Baixo Vouga E.P.E, Aveiro, PRT
| | - Miguel Martins
- Internal Medicine, Centro Hospitalar do Baixo Vouga E.P.E, Aveiro, PRT
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4
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Antoci V, Ferrari V, Dacrema A. What is happening in that urinary catheter bag? EMERGENCY CARE JOURNAL 2022. [DOI: 10.4081/ecj.2022.10990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
An 86-year-old nursing home woman with an indwelling urinary catheter presented to our emergency department for abdominal pain, nausea, hyporexia after nine days of stubborn constipation despite the use of laxatives, on a background of IV stage Chronic Kidney Disease (CKD), type 2 diabetes, hypothyroidism, and bed rest syndrome with chronic pain treated with fentanyl transdermal patch. Blood tests showed a worsening of renal function (creatinine 5.7 mg/dL, nv 0.6-1; azotemia 177 mg/dL, nv 10-50), and increased C reactive protein value (5 mg/dL, nv < 0.5). Glucose and serum electrolytes were normal. Abdomen X-ray was unremarkable, and PoCUS excluded hydronephrosis and bladder globe. The urine drainage bag was purple with smelly urine.
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5
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Popoola M, Hillier M. Purple Urine Bag Syndrome as the Primary Presenting Feature of a Urinary Tract Infection. Cureus 2022; 14:e23970. [PMID: 35541297 PMCID: PMC9081951 DOI: 10.7759/cureus.23970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 11/27/2022] Open
Abstract
Purple urine bag syndrome (PUBS) is a curious condition that manifests with purple discoloration of a urinary catheter bag as a result of a urinary tract infection (UTI). This syndrome is produced through a reaction between urinary by-products and the components of a plastic urinary catheter bag. Predisposing factors include old age, long-term catheterization, chronic constipation, and limited mobility. We describe a case of a UTI in a 90-year-old woman in which the initial presentation was PUBS. Here, late recognition of PUBS led to delayed treatment of the associated UTI. Despite being a simple spot diagnosis, knowledge about this uncommon syndrome is lacking amongst clinicians and this may have implications on patient outcomes.
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6
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Mohib O, Roland T, Fontaine M, Laurent F, Rossi C. Purple urine bag syndrome is a rare manifestation of bacteriuria on bladder catheter: case report. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00191-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Purple urine bag syndrome (PUBS) is a complication of bacterial colonisation of bladder catheters in which urine turns purple in the tubing, as well as in the catheter bag. This rare phenomenon can be very worrisome and stressful for the patients and their families, as well as for the healthcare team taking care of them. Recognising this complication is essential in order to avoid misdiagnosis and erroneous treatment. We report a case of PUBS in a 71-year-old female patient.
Case presentation
A 71-year-old woman with previous medical history of schizophrenia was admitted to the emergency department for anorexia and suspicion of psychotic decompensation. Acute urine retention and rectal faecal impaction were clinically suspected and confirmed by bladder ultrasound and rectal examination, respectively. The patient underwent bladder catheterisation as well as a rectal enema. The day after her admission, our medical team was approached by the nurse in charge of the patient because of purple urine in her catheter bag and tubing. The diagnosis of PUBS was made with the help of the Oxford urine chart. A dipstick urinalysis revealed alkaline urine (pH = 8), and the urine culture was subsequently positive for Proteus mirabilis, which is sensitive to quinolones, beta-lactams and nitrofurantoin. The bladder catheter was changed. The patient received empiric antibiotic therapy with Levofloxacin 500 mg once daily. After obtaining the antibiogram, the targeted antibiotic therapy was adapted with oral Cefuroxime 500 mg three times a day for a total duration of seven days of antibiotic therapy. There was no recurrence of purple urine.
Conclusion
PUBS is a rare complication of bacteriuria, which induces a purple colouration of the tubing as well as the catheter bag. It is a simple spot diagnosis, as there is no other known cause of purple urine. This is why we believe that the Oxford urine chart represents a very interesting and easily accessible tool to help clinicians to investigate any abnormal urine colour.
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7
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Saraireh M, Gharaibeh S, Araydah M, Al Sharie S, Haddad F, Alrababah A. Violet discoloration of urine: A case report and a literature review. Ann Med Surg (Lond) 2021; 68:102570. [PMID: 34354830 PMCID: PMC8321942 DOI: 10.1016/j.amsu.2021.102570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Purple Urine Bag Syndrome (PUBS) is an uncommon event that can be described as purple discoloration of urine due to a series of chemical reactions induced by Urinary Tract Infections (UTIs). PUBS has been reported in the past but still remains unrecognized by healthcare givers leading to misdiagnosis and inappropriate management. We report our case alongside a literature review of previously published cases. CASE PRESENTATION We present the first case report of Purple Urine Bag Syndrome in Jordan of a catheterized 80-year-old wheel-chaired female with a history of type 2 Diabetes Mellitus (DM), stage 5 Chronic Kidney Disease (CDK), Hypertension, and ischemic stroke. Her condition was initially misdiagnosed for hematuria but later on was correctly diagnosed with PUBS. She was treated with a course of appropriate antibiotic and by changing her urinary catheter and bag. The patient returned for a follow up visit and her problem resolved with the color of her urine in the urine bag returning back to normal. CLINICAL DISCUSSION PUBS is an uncommon event that occurs in association with UTIs. Such cases are mostly seen in elderly catheterized patients with other risk factors. CONCLUSION Purple Urine Bag Syndrome can be managed by changing urinary catheter, and by the administration of appropriate antibiotics. Such event can be easily misdiagnosed thus leading to unnecessary and consuming measures. Creating a better awareness of this condition among physicians and healthcare givers is essential for better patient outcomes.
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Affiliation(s)
| | | | | | | | - Fadi Haddad
- Faculty of Medicine, Yarmouk University, Irbid, Jordan
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8
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Sabanis N, Paschou E, Papanikolaou P, Zagkotsis G. Purple Urine Bag Syndrome: More Than Eyes Can See. Curr Urol 2019; 13:125-132. [PMID: 31933590 PMCID: PMC6944938 DOI: 10.1159/000499281] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/26/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Purple urine bag syndrome (PUBS) is an uncommon clinical entity characterized by purple urine discoloration in the setting of urinary tract infections. Pa-thophysiology of PUBS has been correlated to aberrant metabolism of tryptophan. Multiple predisposing factors have been recognized, namely: female gender, advanced age, constipation, institutionalization, long-term catheter-ization, dementia and chronic kidney disease. Herein, we present a comprehensive review of all PUBS cases reported in PubMed, focusing on the predisposing factors and the microorganisms related to PUBS. METHODS We performed a search in PubMed database for articles referring to PUBS, published in English, French, Spanish and German from January 1978 until November 2017. The literature recruitment strategy was based on several keywords and Medical Subject Heading combination such as "purple urine bag syndrome" or PUBS or "urine discoloration". The finally selected articles were categorized into case reports/series (88 articles including 112 patients) and studies (10 articles including 134 patients). Demographical data as well as predisposing factors were recorded and further analyzed. RESULTS According to our findings, mean age of PUBS patients was 78.9 ± 12.3 years, 70.7% were female while 90.1% were suffering from constipation, 76.1% were in a bedridden situation, 45.1% were experiencing long-term catheterization, 42.8% had been diagnosed with dementia, 14.3% had recurrent urinary tract infections and 14.1% were chronic kidney disease patients. 91.3% of patients presenting with PUBS alkaline urine were observed while the most common microbe in urine cultures was E. coli. CONCLUSIONS PUBS is considered benign process in the majority of catheterized patients. Clinicians should be aware of the syndrome that may indicate serious comorbidities.
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Affiliation(s)
| | - Eleni Paschou
- Department of General Practice & Family Medicine, General Hospital of Livadeia, Voiotia, Greece
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9
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Su YJ, Yang HW. Risk factors of mortality in patients with purple urine bag syndrome. J Drug Assess 2019. [PMID: 30834162 DOI: 10.1080/21556660.2019.1579727.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022] Open
Abstract
Aim: Purple urine bag syndrome (PUBS) is rarely seen in clinical practice. Several studies have reported that PUBS is relatively benign in its clinical course, but this study aimed to identify risk factors for mortality related to PUBS. Materials and methods: In a PubMed search from October 1980 to August 2016, using the search term "Purple urine bag syndrome (PUBS)", 106 articles (n = 174 cases) were identified. This study excluded 58 cases. Among them, 14 cases did not include information on patient sex and four cases did not include information on patient age. Thirty-seven cases did not report the white blood cell (WBC) count, shock, fever, or etiology. Three cases did not report patient survival. This study considered 116 PUBS cases. Chi-square tests were used to compare the survival and mortality groups. Results: In relative risk analysis, uremia (17.8), shock (14.4), diabetes (4.8), leukocytosis (1.1), and female sex (1.1) were significant risk factors for mortality after PUBS. However, it is possible that PUBS cases are under-reported worldwide. Conclusions: PUBS is a warning sign of a urinary tract infection, and it often follows a relatively benign clinical course. This study found that female sex, leukocytosis, shock at presentation, comorbidity with diabetes, and uremia are risk factors for mortality associated with PUBS.
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Affiliation(s)
- Yu-Jang Su
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Oral Hygiene College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Yuanpei University of Medical Technology, Hsinchu City, Taiwan
| | - Hsiu-Wu Yang
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
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10
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Worku DA. Purple urine bag syndrome: An unusual but important manifestation of urinary tract infection. Case report and literature review. SAGE Open Med Case Rep 2019; 7:2050313X18823105. [PMID: 30719299 PMCID: PMC6349982 DOI: 10.1177/2050313x18823105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 12/13/2018] [Indexed: 11/16/2022] Open
Abstract
Purple urine bag syndrome is a rare albeit alarming purple discolouration of the urine typically seen in elderly ladies with constipation, urinary tract infection and concurrent urinary catheterisation. In this concise review, we report the pathophysiology of this condition and the case of one patient who developed this interesting phenomenon.
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11
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Su YJ, Yang HW. Risk factors of mortality in patients with purple urine bag syndrome. J Drug Assess 2019; 8:21-24. [PMID: 30834162 PMCID: PMC6394334 DOI: 10.1080/21556660.2019.1579727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 02/02/2019] [Indexed: 02/07/2023] Open
Abstract
Aim: Purple urine bag syndrome (PUBS) is rarely seen in clinical practice. Several studies have reported that PUBS is relatively benign in its clinical course, but this study aimed to identify risk factors for mortality related to PUBS. Materials and methods: In a PubMed search from October 1980 to August 2016, using the search term "Purple urine bag syndrome (PUBS)", 106 articles (n = 174 cases) were identified. This study excluded 58 cases. Among them, 14 cases did not include information on patient sex and four cases did not include information on patient age. Thirty-seven cases did not report the white blood cell (WBC) count, shock, fever, or etiology. Three cases did not report patient survival. This study considered 116 PUBS cases. Chi-square tests were used to compare the survival and mortality groups. Results: In relative risk analysis, uremia (17.8), shock (14.4), diabetes (4.8), leukocytosis (1.1), and female sex (1.1) were significant risk factors for mortality after PUBS. However, it is possible that PUBS cases are under-reported worldwide. Conclusions: PUBS is a warning sign of a urinary tract infection, and it often follows a relatively benign clinical course. This study found that female sex, leukocytosis, shock at presentation, comorbidity with diabetes, and uremia are risk factors for mortality associated with PUBS.
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Affiliation(s)
- Yu-Jang Su
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan;
- Department of Oral Hygiene College of Oral Medicine, Taipei Medical University, Taipei, Taiwan;
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan;
- Yuanpei University of Medical Technology, Hsinchu City, Taiwan
- CONTACT Yu-Jang Su Department of Emergency Medicine, Mackay Memorial Hospital, No.92 Sec 2 Chung-Shan N Rd, Taipei10449, Taiwan
| | - Hsiu-Wu Yang
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan;
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan;
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12
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Le Mouel JP, Fumery M. Purple urine bag syndrome. Eur J Intern Med 2018; 55:e1-e2. [PMID: 29496315 DOI: 10.1016/j.ejim.2018.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/22/2018] [Indexed: 10/17/2022]
Affiliation(s)
| | - Mathurin Fumery
- Gastroenterology Department, Amiens University Hospital, Amiens, France
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13
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Yang HW, Su YJ. Purple Urine Bag Syndrome in the Elderly. INT J GERONTOL 2018. [DOI: 10.1016/j.ijge.2018.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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14
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Karray O, Batti R, Talbi E, Ayed H, Chakroun M, Ouarda MA, Bouzouita A, Cherif M, Ben Slama MR, Amel M, Abdelmoula J, Derouiche A, Chebil M. Purple urine bag syndrome, a disturbing urine discoloration. Urol Case Rep 2018; 20:57-59. [PMID: 29992092 PMCID: PMC6034577 DOI: 10.1016/j.eucr.2018.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 06/19/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Omar Karray
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Rym Batti
- Oncology Department, Salah Azaiez Institute, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Emna Talbi
- Biochemistry Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Haroun Ayed
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Marouene Chakroun
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Mouna Ayadi Ouarda
- Oncology Department, Salah Azaiez Institute, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Abderrazek Bouzouita
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Mohamed Cherif
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Mohamed Riadh Ben Slama
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Mezlini Amel
- Oncology Department, Salah Azaiez Institute, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Jouida Abdelmoula
- Biochemistry Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Amine Derouiche
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Mohamed Chebil
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
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15
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Yang HW, Su YJ. Trends in the epidemiology of purple urine bag syndrome: A systematic review. Biomed Rep 2018. [PMID: 29564123 DOI: 10.3892/br.2018.1046.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purple urine bag syndrome (PUBS) is rarely observed in clinical practice. The present study aimed to identify the epidemiological trends in PUBS in recent decades. A search of PubMed articles published between 1980 October and 2016 August was conducted, in which 106 articles (174 cases) described PUBS. Of these cases, 58 cases were excluded: 14 cases without mention of gender, 4 cases without description of age, 37 cases without mention of white blood cell (WBC) count, shock status, fever status or description of etiology, and 3 cases without information on mortality. The remaining 116 PUBS cases were collected and analyzed in the present study. The articles were divided into three groups by publication year: 1991 to 2000, 2001 to 2010 and 2011 to 2016. The χ2 test was used for statistical analysis, with P<0.05 (two-tailed) defined as the threshold for significance. Of the total enrolled cases, there were 47 men (40.5%) and 69 women (59.5%), with a mean age ± standard deviation of 75.6±12.8 years. Of these, 98 cases (84.5%) were elderly (≥65 years old). A total of 93.1% of cases had a urine pH >7 while 6.9% of cases had acidic urine (pH <7). Furthermore, although WBC count elevated progressively, the mortality rate of patients with PUBS decreased over subsequent decades. This necessitates the advancement of antibiotics and application of early goal-directed therapy. Additionally, the overall mortality rate of PUBS (1980-2016) was 6.8%, which decreased to 4.3% in the last 5 years (2011-2016). In conclusion, although PUBS has previously been considered a benign process in the majority of indwelling catheterized patients, emphasis is required on early examination and aggressive antibiotic administration.
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Affiliation(s)
- Hsiu-Wu Yang
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan
| | - Yu-Jang Su
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan.,Department of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan.,Mackay Junior College of Medicine, Nursing and Management, New Taipei City 25245, Taiwan
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16
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Yang HW, Su YJ. Trends in the epidemiology of purple urine bag syndrome: A systematic review. Biomed Rep 2018; 8:249-256. [PMID: 29564123 PMCID: PMC5854937 DOI: 10.3892/br.2018.1046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 01/23/2018] [Indexed: 02/07/2023] Open
Abstract
Purple urine bag syndrome (PUBS) is rarely observed in clinical practice. The present study aimed to identify the epidemiological trends in PUBS in recent decades. A search of PubMed articles published between 1980 October and 2016 August was conducted, in which 106 articles (174 cases) described PUBS. Of these cases, 58 cases were excluded: 14 cases without mention of gender, 4 cases without description of age, 37 cases without mention of white blood cell (WBC) count, shock status, fever status or description of etiology, and 3 cases without information on mortality. The remaining 116 PUBS cases were collected and analyzed in the present study. The articles were divided into three groups by publication year: 1991 to 2000, 2001 to 2010 and 2011 to 2016. The χ2 test was used for statistical analysis, with P<0.05 (two-tailed) defined as the threshold for significance. Of the total enrolled cases, there were 47 men (40.5%) and 69 women (59.5%), with a mean age ± standard deviation of 75.6±12.8 years. Of these, 98 cases (84.5%) were elderly (≥65 years old). A total of 93.1% of cases had a urine pH >7 while 6.9% of cases had acidic urine (pH <7). Furthermore, although WBC count elevated progressively, the mortality rate of patients with PUBS decreased over subsequent decades. This necessitates the advancement of antibiotics and application of early goal-directed therapy. Additionally, the overall mortality rate of PUBS (1980-2016) was 6.8%, which decreased to 4.3% in the last 5 years (2011-2016). In conclusion, although PUBS has previously been considered a benign process in the majority of indwelling catheterized patients, emphasis is required on early examination and aggressive antibiotic administration.
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Affiliation(s)
- Hsiu-Wu Yang
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan
| | - Yu-Jang Su
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan
- Department of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City 25245, Taiwan
- Correspondence to: Dr Yu-Jang Su, Department of Emergency Medicine, Mackay Memorial Hospital, 92 Section 2 Chung-Shan North Road, Taipei 10449, Taiwan, E-mail:
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17
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Dharmshaktu GS, Pangtey T. Purple urine bag as indicator of multidrug-resistant vulvar abscess: Lessons for primary caregivers. J Family Med Prim Care 2018; 7:484-485. [PMID: 30090805 PMCID: PMC6060925 DOI: 10.4103/jfmpc.jfmpc_230_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Tanuja Pangtey
- Department of Pathology, Government Medical College, Haldwani, Uttarakhand, India
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18
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Abstract
Purple urine bag syndrome is an uncommon condition that describes the purple discolouration of a catheter bag and tubing. It mainly affects patients with limited mobility who have long-term catheters. Although benign in nature per se, its presence can alarm both patient and practitioner unfamiliar with the syndrome. Here, we describe two cases of asymptomatic patients who both presented to outpatient clinic with the characteristic purple discolouration of their long-term catheters and tubing. The report discusses the pathophysiology of the syndrome and initial investigation and management. Although the syndrome is considered benign, it may signify occult urine tract infection. This should not be ignored even if the patient is asymptomatic, given the likely co-morbidities of the patients affected. Healthcare professionals - particularly urologists and geriatricians - need to be aware of this unusual syndrome so as to initiate appropriate investigation and possible treatment as soon as possible.
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Affiliation(s)
- H Rooney
- 1 Core Surgical Trainee, Monklands General Hospital, UK
| | - L Mokool
- 2 Urology Registrar, Monklands General Hospital, UK
| | - A Ramsay
- 3 Urology Consultant, Monklands General Hospital, UK
| | - S Nalagatla
- 3 Urology Consultant, Monklands General Hospital, UK
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Kayal A, Dhanuka S, Mukhopadhyay BC, Mandal TK, Bansal CL. Purple urine bag syndrome in benign prostatic hyperplasia patient. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-017-0134-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Llenas-García J, García-López M, Pérez-Bernabeu A, Cepeda J, Wikman-Jorgensen P. Purple urine bag syndrome: A systematic review with meta-analysis. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lin J, Hlafka M, Vargas O, Bhattarai M. Recurrent purple urine bag syndrome presenting with full spectrum of disease severity: case report and review of literature. CEN Case Rep 2017; 5:144-147. [PMID: 28508966 DOI: 10.1007/s13730-016-0213-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 01/07/2016] [Indexed: 11/24/2022] Open
Abstract
Purple urine bag syndrome (PUBS) is a unique phenomenon characterized by purple discoloration of the urinary catheter bag and tubing following urinary catheterization lasting for hours to days. The purple discoloration is a mixture of indirubin dissolved in plastic with indigo on its surface. PUBS is most commonly associated with urinary tract infection (UTI) caused by bacteria with indoxyl phosphatase/sulfatase activity. It occurs predominantly in chronically catheterized, constipated elderly female patients. It usually appears to be asymptomatic and harmless, but rarely it can present as a severe illness. We report on a 29-year-old female with urinary ileal diversion presenting with multiple episodes of PUBS each with an asymptomatic state of varying severity, symptomatic UTI and severe sepsis requiring intensive care. To our knowledge, this is the first report where a single young patient had recurrent PUBS which presented with a full spectrum of disease severity at different occasions.
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Affiliation(s)
- Junzhi Lin
- Department of Internal Medicine, Southern Illinois University School of Medicine, 751 N Rutledge, PO BOX 19636, Springfield, IL, 62794-9636, USA.
| | - Martha Hlafka
- Department of Internal Medicine, Southern Illinois University School of Medicine, 751 N Rutledge, PO BOX 19636, Springfield, IL, 62794-9636, USA
| | - Omar Vargas
- Department of Internal Medicine, Southern Illinois University School of Medicine, 751 N Rutledge, PO BOX 19636, Springfield, IL, 62794-9636, USA
| | - Mukul Bhattarai
- Department of Internal Medicine, Southern Illinois University School of Medicine, 751 N Rutledge, PO BOX 19636, Springfield, IL, 62794-9636, USA
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Faridi MS, Rahman MJ, Mibang N, Shantajit N, Somarendra K. Purple Urine Bag Syndrome- An Alarming Situation. J Clin Diagn Res 2016; 10:PD05-6. [PMID: 27042522 DOI: 10.7860/jcdr/2016/16622.7209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/11/2015] [Indexed: 11/24/2022]
Abstract
Purple urine bag syndrome (PUBS) is an uncommon condition that occurs mainly in chronically catheterized patient and associated with urinary tract infection. It is characterised by purple discolouration of urine bag which leads to significant stress and anxiety to patient, care takers and health workers, so awareness regarding this condition is of utmost importance. In our report, an old gentleman with Benign Prostate Hyperplasia (BPH) on per urethral catheter (PUC) with past history of recurrent urinary tract infection developed burning micturition of urine with purple discoloration of urine bag. After proper antibiotic and catheter changed, discoloration subsided. In India, as life expectancy and geriatric care is improving, more patients are on PUC for various diseases. So, the incidence of PUBS will increase and awareness is required about the condition and its management.
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Affiliation(s)
- M S Faridi
- Resident, Department of Urology, Regional Institute of Medical Sciences , Imphal, Manipur, India
| | - Md Jawaid Rahman
- Resident, Department of Urology, Regional Institute of Medical Sciences , Imphal, Manipur, India
| | - Naloh Mibang
- Resident, Department of Urology, Regional Institute of Medical Sciences , Imphal, Manipur, India
| | - N Shantajit
- Resident, Department of Urology, Regional Institute of Medical Sciences , Imphal, Manipur, India
| | - Khumukchum Somarendra
- Registrar, Department of Urology, Regional Institute of Medical Sciences , Imphal, Manipur, India
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Abstract
Purple urine bag syndrome occurs commonly in long-term catheterized patients causing significant stress for patients, care takers, and health care providers. This may lead to unwarranted investigation as well as treatment when not identified early. Demographic changes in Indian population with increasing geriatric care make it a case to increase awareness of this condition among health care providers in primary and secondary care settings.
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Affiliation(s)
- Reginald Alex
- Department of Community Health, GI Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Krishna Manjunath
- Department of Community Health, GI Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajan Srinivasan
- Department of Community Health, GI Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gopal Basu
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
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Purple urine bag syndrome may not be benign: a case report and brief review of the literature. Case Rep Infect Dis 2013; 2013:863853. [PMID: 23864970 PMCID: PMC3705812 DOI: 10.1155/2013/863853] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/10/2013] [Indexed: 11/18/2022] Open
Abstract
Purple urine bag syndrome (PUBS) is a rare condition in which there is purple discoloration of the urine with its collecting bag and associated tubing occurs. It is considered a benign condition. We report an unusual case of PUBS in an 87-year-old female from nursing home who had a history of recurrent UTI. She also had a history of ureteral obstruction requiring left nephrostomy tube. She was brought to emergency department with altered mental status which developed five days after the occurrence of purple discoloration of the urinary bag. Her urine culture grew vancomycin-resistant Enterococci (VRE) and Pseudomonas aeruginosa. She died within three days of hospitalization despite intensive care in tertiary center. This case highlights that PUBS may not always be benign and should be approached on a case-by-case basis because it may signal the underlying UTI which might be very difficult to treat. Failure of recognition of this peculiar color early could delay the appropriate intervention leading to fatal complication. This case also represents the rare occurrence of PUBS in the setting of nephrostomy tube.
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Abstract
Purple urine bag syndrome is characterized by the urinary drainage bag turning purple in patients on prolonged urinary catheterization, especially those in the bedridden state. It is associated with bacterial urinary tract infections caused by indigo-producing and indirubin-producing bacteria, usually affects women, and is associated with alkaline urine, constipation, and a high bacterial load in the urine. Almost all patients with purple urine bag syndrome are catheterized due to significant disability, and the urinary pH is 7.0 or more. In general, intensive treatment with antibiotics is not recommended. Purple urine bag syndrome per se almost always appears to be asymptomatic and harmless. However, caution is needed, because some cases have been reported to show progression to severe disease states, so further research into the morbidity and mortality of this infection is warranted.
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Affiliation(s)
- Yoshiro Hadano
- Department of General Internal Medicine and Infectious Diseases, Rakuwakai Otowa Hospital, Yamashina-ku, Kyoto, Japan
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Khan F, Chaudhry MA, Qureshi N, Cowley B. Purple urine bag syndrome: an alarming hue? A brief review of the literature. Int J Nephrol 2011; 2011:419213. [PMID: 21977321 PMCID: PMC3184437 DOI: 10.4061/2011/419213] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 08/09/2011] [Indexed: 11/20/2022] Open
Abstract
Purple urine bag syndrome (PUBS) is a unique disease entity characterized by an alarming purple discoloration of the urine secondary to recurrent urinary tract infections with indigo- and indirubin-producing bacteria. It is usually associated with prolonged urinary catheterization and chronic debilitated states. We hereby present a concise review of this rare phenomenon with historic perspectives, epidemiology, emphasizing on current concepts of etiology, pathogenesis, relevant clinical associations, treatment modalities, prognosis, and future directions in PUBS. In addition, we highlight an interesting occurrence of this intriguing phenomenon in a 39-year-old gentleman at our institution.
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Affiliation(s)
- Fahad Khan
- Section of Nephrology, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73126-0901, USA
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