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Psotta C, Nilsson EJ, Sjöberg T, Falk M. Bacteria-Infected Artificial Urine Characterization Based on a Combined Approach Using an Electronic Tongue Complemented with 1H-NMR and Flow Cytometry. BIOSENSORS 2023; 13:916. [PMID: 37887109 PMCID: PMC10605348 DOI: 10.3390/bios13100916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/22/2023] [Accepted: 10/04/2023] [Indexed: 10/28/2023]
Abstract
The prevailing form of bacterial infection is within the urinary tract, encompassing a wide array of bacteria that harness the urinary metabolome for their growth. Through their metabolic actions, the chemical composition of the growth medium undergoes modifications as the bacteria metabolize urine compounds, leading to the subsequent release of metabolites. These changes can indirectly indicate the existence and proliferation of bacterial organisms. Here, we investigate the use of an electronic tongue, a powerful analytical instrument based on a combination of non-selective chemical sensors with a partial specificity for data gathering combined with principal component analysis, to distinguish between infected and non-infected artificial urine samples. Three prevalent bacteria found in urinary tract infections were investigated, Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis. Furthermore, the electronic tongue analysis was supplemented with 1H NMR spectroscopy and flow cytometry. Bacteria-specific changes in compound consumption allowed for a qualitative differentiation between artificial urine medium and bacterial growth.
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Affiliation(s)
| | | | | | - Magnus Falk
- Biomedical Science, Faculty of Health and Society, and Biofilms Research Center, Malmö University, 205 06 Malmö, Sweden; (C.P.); (E.J.N.); (T.S.)
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2
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Pandey S, Tun MM, Htet SY, Chhetri B, K C N. Recurrent Non-cirrhotic Hyperammonemic Encephalopathy Due to Complicated Urinary Tract Infection: A Case Report. Cureus 2023; 15:e39579. [PMID: 37378248 PMCID: PMC10292922 DOI: 10.7759/cureus.39579] [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: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
Hyperammonemic encephalopathy (HE) can be broadly defined as an alteration in the level of consciousness due to elevated blood ammonia level. While hepatic cirrhosis is the most common cause of HE, non-hepatic causes like drugs, infections, and porto-systemic shunts can also lead to the presentation. In this case, we highlight an unusual occurrence of recurrent non-cirrhotic HE from obstructive urinary tract infection (UTI) with urea-splitting micro-organisms in an elderly male patient. The patient exhibited altered mentation, and elevated ammonia levels with normal hepatic function at presentation. Urine culture revealed Proteus mirabilis resistant to extended spectrum beta-lactamases (ESBL). Successful management of obstructive UTI was achieved through Foley's catheterization and intravenous (IV) antibiotics, resulting in the resolution of HE. This outcome further supports the significance of UTI as a potential cause of hyperammonemia. Thus, UTI as one of the non-hepatic causes of hyperammonemia should always be explored among elderly patients presenting with altered mentation.
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Affiliation(s)
- Sagar Pandey
- Internal Medicine, One Brooklyn Health/ Interfaith Medical Center, Brooklyn, USA
| | - Myo Myint Tun
- Internal Medicine, One Brooklyn Health/ Interfaith Medical Center, Brooklyn, USA
| | - Shwe Yee Htet
- Internal Medicine, One Brooklyn Health/ Interfaith Medical Center, Brooklyn, USA
| | - Bhawana Chhetri
- Internal Medicine, Nepal Medical College Teaching Hospital, Kathmandu, NPL
| | - Nabin K C
- Pulmonary and Critical Care Medicine, One Brooklyn Health/ Interfaith Medical Center, Brooklyn, USA
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3
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Skipina TM, Macbeth S, Cummer EL, Wells OL, Kalathoor S. Recurrent noncirrhotic hyperammonemia causing acute metabolic encephalopathy in a patient with a continent ileocecal pouch: a case report. J Med Case Rep 2021; 15:294. [PMID: 34020707 PMCID: PMC8140457 DOI: 10.1186/s13256-021-02842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/02/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Acute encephalopathy, while a common presentation in the emergency department, is typically caused by a variety of metabolic, vascular, infectious, structural, or psychiatric etiologies. Among metabolic causes, hyperammonemia is relatively common and typically occurs in the setting of cirrhosis or liver dysfunction. However, noncirrhotic hyperammonemia is a rare occurrence and poses unique challenges for clinicians. Case presentation Here we report a rare case of a 50-year-old Caucasian female with history of bladder cancer status post chemotherapy, radical cystectomy, and ileocecal diversion who presented to the emergency department with severe altered mental status, combativeness, and a 3-day history of decreased urine output. Her laboratory tests were notable for hyperammonemia up to 289 μmol/L, hypokalemia, and hyperchloremic nonanion gap metabolic acidosis; her liver function tests were normal. Urine cultures were positive for Enterococcus faecium. Computed tomography imaging showed an intact ileoceal urinary diversion with chronic ileolithiasis. Upon administration of appropriate antibiotics, lactulose, and potassium citrate, she experienced rapid resolution of her encephalopathy and a significant reduction in hyperammonemia. Her hyperchloremic metabolic acidosis persisted, but her hypokalemia had resolved. Conclusion This case is an example of one of the unique consequences of urinary diversions. Urothelial tissue is typically impermeable to urinary solutes. However, when bowel segments are used, abnormal absorption of solutes occurs, including exchange of urinary chloride for serum bicarbonate, leading to a persistent hyperchloremic nonanion gap metabolic acidosis. In addition, overproduction of ammonia from urea-producing organisms can lead to abnormal absorption into the blood and subsequent oversaturation of hepatic metabolic capacity with consequent hyperammonemic encephalopathy. Although this is a rare case, prompt identification and treatment of these metabolic abnormalities is critical to prevent severe central nervous system complications such as altered mental status, coma, and even death in patients with urinary diversions.
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Affiliation(s)
- T M Skipina
- Department of Internal Medicine, Wake Forest Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, USA.
| | - S Macbeth
- Department of Internal Medicine, Wake Forest Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, USA
| | - E L Cummer
- Department of Internal Medicine, Wake Forest Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, USA
| | - O L Wells
- Department of Internal Medicine, Wake Forest Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, USA
| | - S Kalathoor
- Department of Internal Medicine, Wake Forest Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, USA
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Novoselova V, Kumar V, Singh NN, Lacasse A. A case of anti-VGKC antibody encephalitis and prolonged encephalopathy despite spontaneous resolution of imaging abnormalities. J Community Hosp Intern Med Perspect 2020; 10:591-593. [PMID: 33194136 PMCID: PMC7599027 DOI: 10.1080/20009666.2020.1811068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Anti-voltage-gated potassium channel (anti-VGKC) antibody encephalitis is a common form of autoimmune encephalitis (AE). AE is usually associated with autoimmune diseases or paraneoplastic phenomena such as seen in small cell lung cancer. Clinical presentation can include memory impairment, seizures, and psychiatric symptoms. We report a case of a 72-year-old male with non-small lung cancer in remission who presented with erosive gastritis and acute severe encephalopathy. Anti-VGKC antibody limbic encephalitis was diagnosed. Spontaneous resolution of encephalitis-associated changes on brain Magnetic Resonance (MR) with concomitant decreased circulating antibody levels were observed despite lack of overall cognitive improvement. Abbreviations AE: autoimmune encephalitis; AMPAR: antibody limbic encephalitis - anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor encephalitis; Anti-VGKC encephalitis: anti-Voltage-gated potassium channel antibody encephalitis; CRP: c-reactive protein; CT: computed tomography; EEG: electroencephalography; ESR: erythrocyte sedimentation rate; GCS: Glasgow Coma Scale; MRImaging: Magnetic resonance imaging; NMDA-R encephalitis: Anti-N-methyl D-aspartate receptor encephalitis; PCR: polymerase chain reaction.
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Affiliation(s)
- Victoria Novoselova
- Department of Internal Medicine, SSM St. Mary's Hospital-St. Louis, St. Louis, MO, USA
| | - Vikas Kumar
- SSM Neurosciences Institute, SSM St. Mary's Hospital-St. Louis, St.Louis, MO, USA
| | - Niranjan N Singh
- SSM Neurosciences Institute, SSM St. Mary's Hospital-St. Louis, St.Louis, MO, USA
| | - Alexandre Lacasse
- Department of Internal Medicine, SSM St. Mary's Hospital-St. Louis, St. Louis, MO, USA
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Crawford AH, Cardy TJA. Is there a link between bacteriuria and a reversible encephalopathy in dogs and cats? J Small Anim Pract 2020; 61:467-474. [PMID: 32743843 DOI: 10.1111/jsap.13178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/02/2020] [Accepted: 04/21/2020] [Indexed: 11/29/2022]
Abstract
Bacteriuria has been associated with abnormal neurological status in humans, especially geriatric patients. In this report, we review 11 cases (seven dogs and four cats) that suggest an association between bacteriuria and abnormal neurological status in veterinary medicine. These cases showed diffuse forebrain signs with or without brainstem signs, but primary brain disease was excluded by MRI and cerebrospinal fluid analysis. Bacteriological culture of urine was positive in each animal and neurological deficits improved or resolved with initiation of antibiosis ± fluid therapy and levetiracetam. While further studies are needed to definitively confirm or refute the link between bacteriuria and a reversible encephalopathy, urine bacteriological culture should be considered in veterinary patients presented with acute onset forebrain neuro-anatomical localisation, even in the absence of clinical signs of lower urinary tract inflammation.
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Affiliation(s)
- A H Crawford
- Clinical Science and Services, Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - T J A Cardy
- Clinical Science and Services, Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
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Clericetti CM, Milani GP, Lava SAG, Bianchetti MG, Simonetti GD, Giannini O. Hyperammonemia associated with distal renal tubular acidosis or urinary tract infection: a systematic review. Pediatr Nephrol 2018; 33:485-491. [PMID: 29134448 DOI: 10.1007/s00467-017-3829-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/13/2017] [Accepted: 10/16/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Hyperammonemia usually results from an inborn error of metabolism or from an advanced liver disease. Individual case reports suggest that both distal renal tubular acidosis and urinary tract infection may also result in hyperammonemia. METHODS A systematic review of the literature on hyperammonemia secondary to distal renal tubular acidosis and urinary tract infection was conducted. RESULTS We identified 39 reports on distal renal tubular acidosis or urinary tract infections in association with hyperammonemia published between 1980 and 2017. Hyperammonemia was detected in 13 children with distal renal tubular acidosis and in one adult patient with distal renal tubular acidosis secondary to primary hyperparathyroidism. In these patients a negative relationship was observed between circulating ammonia and bicarbonate levels (P < 0.05). In 31 patients (19 children, 12 adults), an acute urinary tract infection was complicated by acute hyperammonemia and symptoms and signs of acute neuronal dysfunction, such as an altered level of consciousness, convulsions and asterixis, often associated with signs of brain edema, such as anorexia and vomiting. Urea-splitting bacteria were isolated in 28 of the 31 cases. The urinary tract was anatomically or functionally abnormal in 30 of these patients. CONCLUSIONS This study reveals that both altered distal renal tubular acidification and urinary tract infection may be associated with relevant hyperammonemia in both children and adults.
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Affiliation(s)
- Caterina M Clericetti
- Pediatric Department of Southern Switzerland, Bellinzona, Switzerland.,Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Sebastiano A G Lava
- University Children's Hospital, Inselspital - University of Bern, Bern, Switzerland
| | - Mario G Bianchetti
- Pediatric Department of Southern Switzerland, Bellinzona, Switzerland. .,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
| | - Giacomo D Simonetti
- Pediatric Department of Southern Switzerland, Bellinzona, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Olivier Giannini
- Department of Internal Medicine, Ente Ospedaliero Cantonale, Mendrisio, Switzerland
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Hassan AAI, Ibrahim W, Subahi A, Mohamed A. 'All that glitters is not gold': when hyperammonaemia is not from hepatic aetiology. BMJ Case Rep 2017; 2017:bcr-2017-219441. [PMID: 28536219 DOI: 10.1136/bcr-2017-219441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Hyperammonaemia is often caused by decompensated liver disease. However, non-hepatic causes can sometimes result in hyperammonaemia, severe enough to cause symptoms.We report a case of a 65-year-old man with a history of hypertension and bilateral peripelvic renal cyst who presented with acute confusion. Laboratory investigations revealed hyperammonaemia and normal liver function test. The abdominal ultrasound did not reveal any finding of liver disease or portal-systemic shunting but demonstrated bilateral peripelvic cysts with no hydronephrosis.Hyperammonaemia was attributed to urinary tract infection with a urea-splitting Escherichia coli bacterium.Antibiotic therapy and lactulose were administered. His neurological status rapidly normalised over the next 48 hours, concomitantly with a decrease in ammonia level. Clinician awareness of non-hepatic causes of hyperammonaemic encephalopathy like urinary tract infection can contribute to early diagnosis and timely initiation of appropriate and potentially life-saving treatment including antimicrobial therapy, alleviating urinary obstruction, if present, and lactulose.
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Affiliation(s)
| | - Walid Ibrahim
- Internal Medicine, Wayne State University, Detroit, Michigan, USA
| | - Ahmed Subahi
- Internal Medicine, Wayne State University, Detroit, Michigan, USA
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