Sexual Acquisition of Acute Pyelonephritis in a Man

Synthesis of the pentasaccharide repeating unit of the O-antigen of E. coli O117:K98:H4

The pentasaccharide repeating unit of the O-antigen of E. coli O117:K98:H4 strain has been synthesized using a combination of sequential glycosylations and [3 + 2] block synthetic strategy from the suitably protected monosaccharide intermediates. Thioglycosides and glycosyl trichloroacetimidate derivatives have been used as glycosyl donors in the glycosylations.

Sexually transmitted Escherichia coli urethritis and orchiepididymitis

We describe herein a case of uropathogenic Escherichia coli urethritis and orchiepididymitis in a heterosexual man, which he had acquired sexually from his girlfriend. The identity of the genital isolates from both partners was confirmed by pulsed-field gel electrophoresis.

Escherichia coli colonization patterns among human household members and pets, with attention to acute urinary tract infection

BACKGROUND

Within-household transmission of Escherichia coli may promote urinary tract infection (UTI) but is poorly understood.

METHODS

Fecal samples from 228 individuals (152 humans [5 with acute UTI] and 76 pets) in 63 households were extensively processed for unique E. coli clones, as defined by random-amplified polymorphic DNA analysis and pulsed-field gel electrophoresis. Patterns of strain sharing (presence of a clone in multiple individuals) were assessed.

RESULTS

Of 335 E. coli clones, 90 (27%) were recovered from multiple hosts (up to 11 per clone). Within-household strain sharing (1) involved 68% of households, including 3 of 5 households in which a member had a UTI; (2) was more frequent than across-household strain sharing (27% vs. 0.8% of potential sharing pairs; P< .001); (3) increased with household size (r2=0.93; P< .001); and (4) varied by host-pair type (pet-pet, 58%; human-human, 31%; human-pet, 17%). Sex partners shared strains more commonly than did other adults (31% vs. 7% of pairs; P= .08) but accounted for only 12% of within-household strain sharing.

CONCLUSIONS

Within-household sharing of E. coli, including in households in which a member has a UTI, is common and can involve any combination of humans and pets. Identification of the underlying mechanism(s) could lead to novel preventive measures against UTI.

Phylogenetic and pathotypic comparison of concurrent urine and rectal Escherichia coli isolates from men with febrile urinary tract infection

Among men with febrile urinary tract infection (FUTI), whether the host's fecal flora is the source for the urine strain ("fecal-urethral" hypothesis), and whether pathogenesis is driven by prevalence versus special pathogenicity, are unknown. Accordingly, pretherapy urine isolates from 65 men with FUTI were compared with concurrent rectal isolates from the same hosts according to serotype, genomic profile, phylogenetic group, and virulence genotype. The host's multiple rectal colonies included only the urine clone in 25% of subjects, the urine clone plus additional clones in 22%, and only nonurine clones in 54%. Compared with the 67 unique rectal clones, the 65 urine isolates were significantly enriched for phylogenetic group B2, virulence-associated serotypes, and specific virulence genes and contained more virulence genes (median, 10 versus 6: P < 0.001). In multivariable models, phylogenetic group B2, hlyD (hemolysin), cnf1 (cytotoxic necrotizing factor), iroN (siderophore receptor), ompT (outer membrane protease), and malX (pathogenicity island marker) most strongly predicted urine source. These findings challenge the fecal-urethral and prevalence hypotheses for FUTI pathogenesis and instead strongly support the possibility of alternate infection routes in some men and the special pathogenicity hypothesis. They also identify specific bacterial traits as potential targets for anti-FUTI interventions.

Concurrent fecal colonization with extraintestinal pathogenic Escherichia coli in a homosexual man with recurrent urinary tract infection and in his male sex partner

A 72-year-old homosexual man experienced frequent recurrences of symptomatic urinary tract infection (UTI) putatively due to the same strain of extraintestinal pathogenic Escherichia coli, despite receiving repeated courses of seemingly appropriate antibiotic therapy. Both the patient and his male sex partner were found to have fecal colonization with the strain recovered from the patient's urine, which exhibited characteristics of the E. coli O1/O2:K1:H7 clonal group (which is associated with urosepsis), whereas genetically distinct E. coli strains were recovered from a jar of petroleum jelly used by the couple during sexual activity.

Vaginal Escherichia coli share common virulence factor profiles, serotypes and phylogeny with other extraintestinal E. coli

Characteristics of Escherichia coli residing in the vagina and their role in extraintestinal infections are largely unknown. In this study, 88 vaginal E. coli (VEC) isolates from Japanese women were characterized by extraintestinal virulence factor (VF) profiling, O:H serotyping and phylogenetic analysis. The prevalence of papC, hlyA, cnfI, PAI, ibeA and K1 antigen among the VEC strains were 45, 22, 19, 78, 32 and 44%, respectively. Phylogenetic analysis identified 76, 16 and 8% of the VEC strains in groups B2, D and A, respectively. The VEC strains were distributed into 31 serotypes, including 8 common serotypes (O1:K1:H1, O1:K1:H7, O2:K1:H7, O4:H5, O6:H1, O18ac:K1:H7, O25:H1 and O75:HNM) that were identified in three or more isolates. Comparative analysis with 61 stool isolates from healthy Japanese men and women, and with data from previous studies, revealed that, although some geographical specificities do exist, the VEC strains shared common VF profiles, O:K:H serotypes and phylogeny with uropathogenic E. coli and E. coli of neonatal septicaemia and meningitis. This study provides additional evidence for a link among extraintestinal E. coli, supporting the concept that the VEC are a reservoir along the 'faecal-vaginal-urinary/neonatal' course of transmission in the extraintestinal E. coli infections.

Selective urological evaluation in men with febrile urinary tract infection

OBJECTIVE

To investigate the prevalence and clinical importance of urological abnormalities in men with community-acquired febrile urinary tract infection (UTI).

PATIENTS AND METHODS

In this prospective study, 85 men (median age 63 years, range 18--86) were followed for 1 year after an episode of febrile UTI. They were investigated by excretory urography, cysto-urethroscopy, uroflowmetry, digital rectal examination and measurement of postvoid residual urine volume by abdominal ultrasonography.

RESULTS

The radiological examination of the upper urinary tract in 83 patients revealed 22 abnormal findings in 19 men. Relevant clinical abnormalities leading to surgical intervention were found in only one patient who had renal calyceal stones. The lower urinary tract investigation disclosed 46 findings in 35 men. In all, surgically correctable disorders were found in 20 patients, of whom 15 had previously unrecognized abnormalities. All patients who required surgery were identified either by a history of voiding difficulties, acute urinary retention at the time of infection, the presence of microscopic haematuria at follow-up after one month, or early recurrent symptomatic UTI.

CONCLUSION

Routine imaging studies of the upper urinary tract seem dispensable in men with febrile UTI. To reveal abnormalities of clinical importance, any urological evaluation should primarily be focused on the lower urinary tract.

Pathogenesis of Urinary Tract Infection: the Role of Sexual Behavior and Sexual Transmission

Acute urinary tract infection (UTI) is an extremely common clinical entity that affects almost half of all women in the United States, and accounts for more than 7 million physician visits, annually, in this country. Sexual behavior and UTI history are the most important predictors of UTI risk among sexually active young women. Whether sexual behavior has similar impact on UTI risk in older women is unknown. Postcoital prophylaxis has been investigated as a strategy for the prevention of recurrent UTI in sexually active women. There are conflicting data regarding the role of voiding habits in relation to sexual intercourse and the risk of UTI. Finally, there are interesting epidemiologic studies suggesting that uropathogenic Escherichia coli may be transmitted between sex partners. We review the recent literature regarding these different areas, and comment on the potential role of sexual transmission in UTI.

The structure of the O-specific polysaccharide of Escherichia coli O117:K98:H4

The primary structure of the O-antigen of Escherichia coli O117 was shown by monosaccharide analysis, methylation analysis, and by 1D and 2D 1H and 13C NMR spectroscopy to be composed of linear pentasaccharide repeating units with the structure: -->3)-alpha-D-GalpNAc-(1-->4)-beta-D-GalpNAc-(1-->3)-alpha-L-Rhap- (1-->4)- alpha-D-Glcp-(1-->4)-beta-D-Galp-(1-->