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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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2
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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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3
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Matsubara H, Maeda K, Kaname S. Purple urine bag syndrome. Clin Exp Nephrol 2022; 26:1240-1241. [PMID: 36056981 DOI: 10.1007/s10157-022-02266-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 08/14/2022] [Indexed: 01/20/2023]
Affiliation(s)
- Hidehito Matsubara
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Keizo Maeda
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Shinya Kaname
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
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4
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Ahmed SI, Waheed MA, Shah S, Muhammad Shah SY, Mumtaz H. Purple urine bag syndrome: A case report. Int J Surg Case Rep 2022; 99:107721. [PMID: 36261954 PMCID: PMC9568877 DOI: 10.1016/j.ijscr.2022.107721] [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: 09/03/2022] [Revised: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Purple Urine Bag Syndrome (PUBS) is purple discoloration of urine and is common in bedridden patients with long-term urinary catheter. Although typically benign, the purple discoloration is alarming to both the patients and their attendants. CASE REPORT This case report presents an uncommon case of PUBS in a 74-year-old lady with hypertension, type II diabetes and ischemic stroke from last 2 years. She has neurogenic bladder and has been catheterized from last 2 years. Her last catheter was changed 15 days back. She presented to the emergency room with complaints of change in color of urine with low grade fever from last 1 week. on clinical examination there was one bed sore on lumbar region that was grade 1 with pus oozing from base of ulcer. CLINICAL DISCUSSION PUBS is generally associated with alkaline urine and in patients who was chronically catheterized as was observed in this patient, although it has also been reported in acidic urine. CONCLUSION PUBS is a rare manifestation of urinary tract infection with an alarming appearance and can be a source of anxiety for patients and their families. Being asymptomatic and comparatively benign, purple discoloration is simply an indicator of underlying bacteriuria and is of no prognostic value.
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Affiliation(s)
| | - Mir Abdul Waheed
- Emergency Medicine, Maroof International Hospital, Islamabad, Pakistan
| | - Sara Shah
- Emergency Medicine, Maroof International Hospital, Islamabad, Pakistan
| | | | - Hassan Mumtaz
- Maroof International Hospital, Islamabad, Pakistan,Health Services Academy, Islamabad, Pakistan,Corresponding author at: Maroof International Hospital, Islamabad, Pakistan.
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5
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Analysis of purple urine bag syndrome by low vacuum scanning electron microscopy. Med Mol Morphol 2022; 55:123-130. [PMID: 35122146 PMCID: PMC9132813 DOI: 10.1007/s00795-022-00313-0] [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: 12/17/2021] [Accepted: 01/19/2022] [Indexed: 11/18/2022]
Abstract
Purple urine bag syndrome (PUBS) is seen in the prolonged indwelling bladder catheters, and the mechanism of its onset was investigated using low vacuum scanning electron microscopy (LVSEM), which enables us to study the 3D structure of urinary sediments and urine bag walls. The urinary sediment and urine bags of 2 cases of PUBS were observed by LVSEM. The urine was brown turbid urine with a pH of 8.5, and magnesium phosphate stones and granules were observed in the urinary sediment together with Gram-positive and Gram-negative bacilli. Bacteria that moved by Brownian motion were observed with a dark-field microscope. LVSEM showed granular crystals around the bacilli, cocci, or mycelium that adhered to the walls of the bag. Granular crystals were dissolved in chloroform and presumed to be a mixture of the bacterial metabolites indigo blue and indirubin red. LVSEM also detected unusual tubular and honeycomb-like graphene in the urinary sediments, which were derived from the inner layer of the silicon elastomer-coated rubber catheter. LVSEM revealed purple crystals produced by bacteria or fungi attached to the urine bag that caused PUBS.
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6
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Gorvin CM. Genetic causes of neonatal and infantile hypercalcaemia. Pediatr Nephrol 2022; 37:289-301. [PMID: 33990852 PMCID: PMC8816529 DOI: 10.1007/s00467-021-05082-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/25/2021] [Accepted: 04/06/2021] [Indexed: 12/02/2022]
Abstract
The causes of hypercalcaemia in the neonate and infant are varied, and often distinct from those in older children and adults. Hypercalcaemia presents clinically with a range of symptoms including failure to thrive, poor feeding, constipation, polyuria, irritability, lethargy, seizures and hypotonia. When hypercalcaemia is suspected, an accurate diagnosis will require an evaluation of potential causes (e.g. family history) and assessment for physical features (such as dysmorphology, or subcutaneous fat deposits), as well as biochemical measurements, including total and ionised serum calcium, serum phosphate, creatinine and albumin, intact parathyroid hormone (PTH), vitamin D metabolites and urinary calcium, phosphate and creatinine. The causes of neonatal hypercalcaemia can be classified into high or low PTH disorders. Disorders associated with high serum PTH include neonatal severe hyperparathyroidism, familial hypocalciuric hypercalcaemia and Jansen's metaphyseal chondrodysplasia. Conditions associated with low serum PTH include idiopathic infantile hypercalcaemia, Williams-Beuren syndrome and inborn errors of metabolism, including hypophosphatasia. Maternal hypocalcaemia and dietary factors and several rare endocrine disorders can also influence neonatal serum calcium levels. This review will focus on the common causes of hypercalcaemia in neonates and young infants, considering maternal, dietary, and genetic causes of calcium dysregulation. The clinical presentation and treatment of patients with these disorders will be discussed.
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Affiliation(s)
- Caroline M. Gorvin
- Institute of Metabolism and Systems Research and Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, Birmingham, B15 2TT UK ,Centre of Membrane Proteins and Receptors (COMPARE), Universities of Birmingham and Nottingham, Birmingham, B15 2TT UK
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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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Kumar U, Singh A, Thami G, Agrawal N. Purple urine bag syndrome:A simple and rare spot diagnosis in Uroscopic rainbow. Urol Case Rep 2020; 35:101533. [PMID: 33384931 PMCID: PMC7770535 DOI: 10.1016/j.eucr.2020.101533] [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: 11/22/2020] [Revised: 12/10/2020] [Accepted: 12/13/2020] [Indexed: 10/31/2022] Open
Abstract
Purple urine bag syndrome (PUBS) is benign pathology but an alarming symptom to the patients and his/her relatives because of purple discoloration of urine in collecting bag and tubing. Colour of the urine is purple because of tryptophan metabolite named Indigo and Indirubin. In urinary tract infection, sulphatase and phosphatase producing bacteria involved in pathogenesis of PUBS. Here, we discuss a case of 60 year male patient with spinal cord injury with neurogenic bladder presented in surgical emergency with purple colour urine in urobag.
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Affiliation(s)
- Utkarsh Kumar
- Department of Surgery, Kalpana Chawla Government Medical College, C7, 7th Floor Apartment No 21, KCGMC Campus, Karnal, Haryana, 132001, India
| | - Anjali Singh
- Department of Otorhinolaryngology, Kalpana Chawla Government Medical College, Karnal, Haryana, 132001, India
| | - Gaurav Thami
- Department of Surgery, Kalpana Chawla Government Medical College, Karnal, Haryana, 132001, India
| | - Nivesh Agrawal
- Department of Surgery, Kalpana Chawla Government Medical College, Karnal, Haryana, 132001, India
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9
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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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10
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Ohm JY, Lee HJ. Purple urine bag syndrome. Postgrad Med J 2019; 95:453. [PMID: 31332024 DOI: 10.1136/postgradmedj-2019-136762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 05/30/2019] [Indexed: 11/03/2022]
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11
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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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12
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Shin KS, Kim MY, Kang HN. Purple Urine Bag Syndrome in Geriatric Hospital: A Report of 2 Cases. Ann Geriatr Med Res 2018; 22:151-153. [PMID: 32743265 PMCID: PMC7387583 DOI: 10.4235/agmr.2018.22.3.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 11/01/2022] Open
Abstract
Purple urine bag syndrome (PUBS) is a rare clinical condition that occurs in older women with a long-term urinary catheterization. Other risk factors include alkaline urine, constipation, renal disease, and immobility. It presents as purple discoloration of the urine bag and tubing and is a mixture of pigment that becomes purple. Patient with PUBS usually do not complain of any symptoms. The clinical course is generally benign, and intensive treatment is not usually needed. But awareness of this syndrome is necessary for doctor and nurse in geriatric hospital so as to adequately treat urinary tract infection and explain the clinical process to a caregiver. We present 2 cases of PUBS in a geriatric hospital.
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Affiliation(s)
- Kyung Su Shin
- Department of General Surgery, Yeosunoble Geriatric Hospital, Yeosu, Korea
| | - Mi Young Kim
- Department of Nursing, Yeosunoble Geriatric Hospital, Yeosu, Korea
| | - Hyo Nam Kang
- Department of Nursing, Yeosunoble Geriatric Hospital, Yeosu, Korea
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13
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Wong Y, Abdullah N. Purple urine bag syndrome: A startling phenomenon of purple urine in a urine drainage bag. A primary care approach and literature review. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2018; 13:42-44. [PMID: 30302185 PMCID: PMC6173963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Purple urine bag syndrome (PUBs) is a rare and startling phenomenon of purple discolouration in the urine or urinary catheter and bag. It is reported in chronically debilitated elderly patients, mostly in women on long-term urinary catheters. Its prevalence is strikingly more common in nursing home residents. Several factors contribute to the formation of indigo (blue) and indirubin (red) pigments from a breakdown of dietary tryptophan, which stains the urine purple. These factors include constipation, dysmotility of the bowel, bowel bacterial overgrowth, dehydration, and urinary tract infection. The presence of purple urine may cause undue alarm to both the patient and the doctor. Thus, we present this case report on an 86-year-old woman, a nursing home resident on a long-term urinary catheter, who presented to the primary care clinic. Her urine cleared after antibiotic therapy, replacement of her urinary catheter, and supportive management, which included hydration and nutrition. In addition to these measures, reducing the time between urinary catheter changes was recommended to prevent recurrence of this condition.
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Affiliation(s)
- Ywe Wong
- MBBS (MMMC), Department of Primary Care Medicine, University of Malaya Medical Centre (UMMC) Malaysia.
| | - N Abdullah
- MBBS (Mal), MMed (FamMed) (Mal), Department of Primary Care Medicine, University of Malaya Medical Centre (UMMC) Malaysia
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14
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Wattanapisit S, Wattanapisit A, Meepuakmak A, Rakkapan P. Purple urine bag syndrome in palliative care. BMJ Support Palliat Care 2018; 9:155-157. [PMID: 30045940 DOI: 10.1136/bmjspcare-2018-001601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/11/2018] [Indexed: 11/04/2022]
Abstract
Purple urine bag syndrome (PUBS) is a rare condition characterised by urine discolouration. The management of PUBS remains controversial. Four females (mean age 84.5±9.7 years) with palliative conditions (two cancer and two non-cancer cases) presenting PUBS were identified. Urine bags were changed in all cases. Urinary catheters were changed in three cases. Oral antibiotics were prescribed in two cases and used in one case. Urine discolouration was resolved in all cases. One patient (without antibiotic treatment) died on day 5 after presentation of PUBS. Three patients (one out of three cases used oral antibiotics) were clinically stable after the management of PUBS. There was no recurrence of PUBS. Caring for patients with PUBS should be based on clinical decisions, patient status and the goals of care. Palliative care teams should focus on the prevention of PUBS by shortening the duration of catheterisation and minimising modifiable risk factors for this condition.
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Affiliation(s)
| | - Apichai Wattanapisit
- School of Medicine, Walailak University, Thasala, Nakhon Si Thammarat, Thailand.,Walailak University Hospital, Thasala, Nakhon Si Thammarat, Thailand
| | - Anong Meepuakmak
- Palliative Care Unit, Thasala Hospital, Thasala, Nakhon Si Thammarat, Thailand
| | - Pornnipa Rakkapan
- Palliative Care Unit, Thasala Hospital, Thasala, Nakhon Si Thammarat, Thailand
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15
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Kamelamela N, Zalesne M, Morimoto J, Robbat A, Wolfe BE. Indigo- and indirubin-producing strains of Proteus and Psychrobacter are associated with purple rind defect in a surface-ripened cheese. Food Microbiol 2018; 76:543-552. [PMID: 30166186 DOI: 10.1016/j.fm.2018.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 06/17/2018] [Accepted: 07/19/2018] [Indexed: 01/28/2023]
Abstract
The rinds of surface-ripened cheeses have expected aesthetic properties, including distinct colors, that contribute to overall quality and consumer acceptance. Atypical rind pigments are frequently reported in small-scale cheese production, but the causes of these color defects are largely unknown. We provide a potential microbial explanation for a striking purple rind defect in a surface-ripened cheese. A cheese producer in the United States reported to us several batches of a raw-milk washed-rind cheese with a distinctly purple rind. We isolated a Proteus species from samples with purple rind defect, but not from samples with typical rind pigments, suggesting that this strain of Proteus could be causing the defect. When provided tryptophan, a precursor in the indigo and indirubin biosynthesis pathway, the isolated strain of Proteus secreted purple-red pigments. A Psychrobacter species isolated from both purple and normal rinds also secreted purple-red pigments. Using thin-layer chromatography and liquid chromatography-mass spectrometry, we confirmed that these bacteria produced indigo and indirubin from tryptophan just as closely related bacteria make these compounds in purple urine bag syndrome in medical settings. Experimental cheese communities with or without Proteus and Psychrobacter confirmed that these Proteobacteria cause purple pigmentation of cheese rinds. Reports of purple rinds in two other cheeses from Europe and the observation of pigment production by Proteus and Psychrobacter strains isolated from other cheese rinds suggest that purple rind defect has the potential to be widespread in surface-ripened cheeses.
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Affiliation(s)
- Noelani Kamelamela
- Department of Biology, Tufts University, 200 Boston Ave., Medford, MA, 02155, USA
| | - Michael Zalesne
- Department of Biology, Tufts University, 200 Boston Ave., Medford, MA, 02155, USA
| | - Joshua Morimoto
- Tufts University Sensory and Science Center, Tufts University, 200 Boston Ave., Medford, MA 02155, USA; Department of Chemistry, Tufts University, 62 Talbot Ave., Medford, MA, 02155, USA
| | - Albert Robbat
- Tufts University Sensory and Science Center, Tufts University, 200 Boston Ave., Medford, MA 02155, USA; Department of Chemistry, Tufts University, 62 Talbot Ave., Medford, MA, 02155, USA
| | - Benjamin E Wolfe
- Department of Biology, Tufts University, 200 Boston Ave., Medford, MA, 02155, USA; Tufts University Sensory and Science Center, Tufts University, 200 Boston Ave., Medford, MA 02155, USA.
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16
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Traynor BP, Pomeroy E, Niall D. Purple urine bag syndrome: a case report and review of the literature. Oxf Med Case Reports 2018; 2017:omx059. [PMID: 29744118 PMCID: PMC5934649 DOI: 10.1093/omcr/omx059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 07/04/2017] [Accepted: 07/22/2017] [Indexed: 11/13/2022] Open
Abstract
Purple urine bag syndrome (PUBS) is a rare and striking manifestation associated with urinary tract infection involving bright purple discoloration of the lining and tubing of a urinary catheter bag. We present the interesting case of a 90-year-old female patient who developed PUBS and include a review of the relevant literature to date. Uniquely, in this case, PUBS acts as an important clinical sign in supporting the diagnosis of urinary tract infection in a high-risk patient.
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Affiliation(s)
- Bryan P Traynor
- Department of Orthopaedic Surgery, Midland Regional Hospital at Tullamore, Tullamore, Co. Offaly, Ireland
| | - Eoghan Pomeroy
- Department of Orthopaedic Surgery, Midland Regional Hospital at Tullamore, Tullamore, Co. Offaly, Ireland
| | - Dorothy Niall
- Department of Orthopaedic Surgery, Midland Regional Hospital at Tullamore, Tullamore, Co. Offaly, Ireland
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17
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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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18
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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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19
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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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20
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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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21
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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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22
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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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23
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Agbor VN, Njim T, Oben HB, Aminde LN. Purple Urine Bag Syndrome in an 80-year-old Female Cameroonian. Niger Med J 2017; 58:119-121. [PMID: 29962654 PMCID: PMC6009141 DOI: 10.4103/nmj.nmj_173_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purple urine bag syndrome is a rare clinical entity commonly seen in elderly females with a long-term urinary catheterization. It presents as purple discoloration of the patient's plastic urine bag and tubing. We report the first case of this rare entity from Central Africa. We present the case of an 80-year-old female with purple urine associated with signs of urinary tract infection. Her symptoms resolved after 3 days of intravenous antibiotic treatment and diet modification. Purple urine bag syndrome remains rare, especially in African literature. Awareness of this benign syndrome is necessary for clinicians so as to adequately manage up to and including the associated anxiety.
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Affiliation(s)
| | - Tsi Njim
- Centre for Global Health and Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxfordshire, United Kingdom
| | - Helen Bessem Oben
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Leopold Ndemnge Aminde
- Clinical Research Education, Networking and Consultancy, Douala, Littoral, Cameroon.,School of Public Health, Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Australia
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24
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Demelo-Rodríguez P, Galán-Carrillo I, Del Toro-Cervera J. Purple urine bag syndrome. Eur J Intern Med 2016; 35:e3-e4. [PMID: 27225045 DOI: 10.1016/j.ejim.2016.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 05/09/2016] [Indexed: 11/19/2022]
Affiliation(s)
| | - I Galán-Carrillo
- Nephrology Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain
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25
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Koçoğlu H, Yıldırım B, Okuturlar Y, Hurşitoğlu M, Harmankaya Ö. Purple Urine Bag Syndrome in a Male Patient with Chronic Hemodialysis. Balkan Med J 2016; 33:717-718. [PMID: 27994934 DOI: 10.5152/balkanmedj.2016.151140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 02/24/2016] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hakan Koçoğlu
- Department of Internal Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Betül Yıldırım
- Department of Internal Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Yıldız Okuturlar
- Department of Internal Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Hurşitoğlu
- Department of Internal Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Özlem Harmankaya
- Department of Internal Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
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26
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Richardson-May J. Single case of purple urine bag syndrome in an elderly woman with stroke. BMJ Case Rep 2016; 2016:bcr2016215465. [PMID: 27489067 PMCID: PMC4985987 DOI: 10.1136/bcr-2016-215465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2016] [Indexed: 11/04/2022] Open
Abstract
Purple urine bag syndrome is an unusual condition that heralds an underlying urinary tract infection, in which certain bacteria produce a purple discolouration within the catheter bag of affected cases. It is most often seen in elderly women with constipation. While alarming, it can be resolved by treating the infection causing it. This report presents an elderly patient who developed the condition while an inpatient, and discusses the pathogenesis behind the condition.
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27
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Liu DX, Didier PJ, Plauche G, Pahar B. Septicemia in an Indian Rhesus Macaque (Macaca mulatta) associated with Providencia stuartii. J Med Primatol 2016; 45:330-332. [PMID: 27466784 DOI: 10.1111/jmp.12230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 11/30/2022]
Abstract
Providencia stuartii (P. stuartii) is an opportunistic pathogen and major concern in urinary catheter-related infections in human medicine. Here we report P. stuartii-induced septicemia in an eighteen-year-old, female India-origin Rhesus macaque with multiple traumatic wounds. The animal had neutrophilic leukocytosis, necrosuppurative meningoencephalitis, hypophysitis and bronchopneumonia with vasculitis, thrombosis, and clusters of extracellular Gram-negative bacilli. P. stuartii was isolated from the lesions of the brain and lung and confirmed by PCR and sequencing. To the authors' knowledge, this is the first case of septicemia associated with P. stuartii in a non-human primate.
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Affiliation(s)
- David X Liu
- The Division of Comparative Pathology, Tulane National Primate Research Center, Tulane University, Covington, LA, USA
| | - Peter J Didier
- The Division of Comparative Pathology, Tulane National Primate Research Center, Tulane University, Covington, LA, USA
| | - Gail Plauche
- The Division of Comparative Pathology, Tulane National Primate Research Center, Tulane University, Covington, LA, USA
| | - Bapi Pahar
- The Division of Comparative Pathology, Tulane National Primate Research Center, Tulane University, Covington, LA, USA
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28
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Aubert C, Alvarado Lavado F, Sánchez Calso A, González González J. Orina púrpura en bolsa. Semergen 2016; 42:e25-6. [DOI: 10.1016/j.semerg.2015.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 03/28/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
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Sriramnaveen P, Reddy YS, Sridhar A, Kishore CK, Manjusha Y, Sivakumar V. Purple urine bag syndrome in chronic kidney disease. Indian J Nephrol 2016; 26:67-8. [PMID: 26937089 PMCID: PMC4753752 DOI: 10.4103/0971-4065.172230] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- P Sriramnaveen
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Y S Reddy
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Avssn Sridhar
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - C K Kishore
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Y Manjusha
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - V Sivakumar
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
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30
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Karim A, Abed F, Bachuwa G. A unilateral purple urine bag syndrome in a patient with bilateral nephrostomy tubes. BMJ Case Rep 2015; 2015:bcr-2015-212913. [PMID: 26701992 DOI: 10.1136/bcr-2015-212913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A change in the colour of urine is always of clinical significance, and a source of concern for the patient and his physician. Among the different urine colours observed, purple is the least common. Although purple discolouration of a catheter and a urine bag is an uncommon finding, it was reported in the literature as early as 1978, by Barlow and Dickson. We present a unique case of purple urine bag syndrome in a patient with bilateral nephrostomy tubes (NT) and associated urine bags (UB) with only the left nephrostomy tube and urine bag exhibiting the purple colour, which resolved with a course of appropriate antibiotics eradicating the causative bacterial pathogen, and change of NT and UB.
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Affiliation(s)
- Adil Karim
- Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | - Firas Abed
- Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | - Ghassan Bachuwa
- Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
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31
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Purple Urine Bag Syndrome in Two Elderly Men with Urinary Tract Infection. Case Rep Nephrol 2015; 2015:746981. [PMID: 26351597 PMCID: PMC4553271 DOI: 10.1155/2015/746981] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 08/11/2015] [Indexed: 11/29/2022] Open
Abstract
Purple urine bag syndrome is a rare condition in which purple discoloration of urine inside its collection bag occurs. We describe two illustrative cases. The first patient is an 81-year-old man who was hospitalized for a newly diagnosed lymphoma with acute obstructive renal failure for which a nephrostomy procedure was performed. During the hospitalization, a sudden purple discoloration of the suprapubic catheter urine was noted, while the nephrostomy urine had a normal color. Urine culture from the suprapubic catheter was positive for Pseudomonas aeruginosa and Enterococcus faecalis; urine from the nephrostomy was sterile. The second case is an 80-year-old man who was admitted for heart failure with cardiorenal dilemma and who was started on intermittent hemodialysis. There was a sudden purple discoloration of the urine in the collection bag from his indwelling catheter. He was diagnosed with an E. coli urinary infection and treated with amoxicillin and removal of the indwelling catheter. These two cases illustrate the typical characteristics of purple urine bag syndrome.
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32
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Abubacker NRT, Jayaraman SMT, R K, Sivanesan MK, Mathew R. Purple Urine Bag Syndrome. J Clin Diagn Res 2015; 9:OD01-2. [PMID: 26435987 PMCID: PMC4576580 DOI: 10.7860/jcdr/2015/14736.6304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/23/2015] [Indexed: 11/24/2022]
Abstract
Purple urine bag syndrome (PUBS) is a rare disorder seen in elderly persons, wherein the urinary bag and the tubing turn in to purple colour. It is usually seen in patients who are on urinary catheters for a long time. Purple coloured urine occurs due to the accumulation of indigo and indirubin, which are the end products of tryptophan metabolism due to the action of sulfatases and phosphatases formed by bacteria like Providencia, Citrobacter, Enterobacter, Klebsiella etc. We present this interesting phenomenon of purple urine in a young male who was on prolonged urinary catheterization. The urine culture was positive for Providencia and constipation was an added risk factor for the purple urine. The urinary catheter and tubing was changed along with a course of antibiotics which lead to the normalization of the urine colour.
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Affiliation(s)
- Naufal Rizwan Taraganar Abubacker
- Assistant Professor, Department of General Medicine, Saveetha Medical College and Hospital, Saveetha University, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu, India
| | | | - Kannan R
- Associate Professor, Department of General Medicine, Saveetha Medical College and Hospital, Saveetha University, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu, India
| | - Magesh Kumar Sivanesan
- Professor, Department of General Medicine, Saveetha Medical College and Hospital, Saveetha University, Saveetha Nagar, Tamil Nadu, Chennai, Tamil Nadu, India
| | - Renu Mathew
- Professor, Department of Microbiology, Saveetha Medical College and Hospital, Saveetha University, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu, 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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35
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A PUBS Case in a Palliative Care Unit Experience. Case Rep Oncol Med 2014; 2014:169782. [PMID: 25317348 PMCID: PMC4181899 DOI: 10.1155/2014/169782] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 08/10/2014] [Indexed: 11/22/2022] Open
Abstract
Purple urine bag syndrome (PUBS) is a rare condition in which purple discoloration of the collecting bag and its associated tubing occurs. It is considered a benign condition. PUBS is usually associated with urinary tract infection occurring in elderly bedridden women, with chronic urinary catheterization. This syndrome is usually reported to occur in alkaline urine, but here we describe a rare case of PUBS involving acidic urine.
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Li ZJ, Njateng GSS, He WJ, Zhang HX, Gu JL, Chen SN, Du ZZ. Chemical composition and antimicrobial activity of the essential oil from the edible aromatic plant Aristolochia delavayi. Chem Biodivers 2014; 10:2032-41. [PMID: 24243612 DOI: 10.1002/cbdv.201300066] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Indexed: 01/11/2023]
Abstract
The essential oil obtained by hydrodistillation from the aerial parts of Aristolochia delavayi Franch. (Aristolochiaceae), a unique edible aromatic plant consumed by the Nakhi (Naxi) people in Yunnan, China, was investigated using GC/MS analysis. In total, 95 components, representing more than 95% of the oil composition, were identified, and the main constituents found were (E)-dec-2-enal (52.0%), (E)-dodec-2-enal (6.8%), dodecanal (3.35%), heptanal (2.88%), and decanal (2.63%). The essential oil showed strong inhibitory activity (96% reduction) of the production of bacterial volatile sulfide compounds (VSC) by Klebsiella pneumoniae, an effect that was comparable with that of the reference compound citral (91% reduction). Moreover, the antimicrobial activity of the essential oil and the isolated major compound against eight bacterial and six fungal strains were evaluated. The essential oil showed significant antibacterial activity against Providencia stuartii and Escherichia coli, with minimal inhibitory concentrations (MIC) ranging from 3.9 to 62.5 μg/ml. The oil also showed strong inhibitory activity against the fungal strains Trichophyton ajelloi, Trichophyton terrestre, Candida glabrata, Candida guilliermondii, and Cryptococcus neoformans, with MIC values ranging from 3.9 to 31.25 μg/ml, while (E)-dec-2-enal presented a lower antifungal activity than the essential oil.
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Affiliation(s)
- Zhi-Jian Li
- School of Life Sciences, Yunnan University, Kunming 650091, P. R. China; State Key Laboratory of Phytochemistry and Plant Resources of West China, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming 650201, P. R. China, (phone: +86-871-5223224; fax: +86-871-5216335)
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37
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Tür FÇ, Zafer N, Hocaoglu N. Purple urine bag syndrome. Emerg Med J 2014; 32:347. [PMID: 24876154 DOI: 10.1136/emermed-2014-203818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 04/25/2014] [Indexed: 11/04/2022]
Affiliation(s)
- Feriyde Çalişkan Tür
- Department of Emergency Medicine, S.B. Izmir Tepecik Research and Training Hospital, İzmir, Turkey
| | - Nur Zafer
- Department of Emergency Medicine, S.B. Izmir Tepecik Research and Training Hospital, İzmir, Turkey
| | - Nil Hocaoglu
- Department of Pharmacology, Dokuz Eylül University Medical School, Izmir, Turkey
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38
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Abstract
Purple urine bag syndrome (PUBS) is rare disease entity, occurs predominantly in constipated women, chronically catheterized and associated with bacterial urinary infections that produce sulphatase/phosphatase. The etiology is due to indigo (blue) and indirubin (red) or to their mixture that becomes purple. We present a case report of this rare phenomenon occurring in an 86-year-old woman.
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Affiliation(s)
- Ahmed Al Montasir
- Family Medicine Diploma, University of Science and Technology, Chittagong, Family Physician, Sofia Ismail Memorial Medical Centre, Bogra, Bangladesh
| | - Ahmed Al Mustaque
- Diploma in Orthopaedic Surgery University of Rajshahi, Consultant Orthopaedic Surgeon, Sofia Ismail Memorial Medical Centre, Bangladesh
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Agapakis DI, Massa E, Hantzis I, Paschoni E, Satsoglou E. Purple Urine Bag Syndrome: a case report of an alarming phenomenon. Hippokratia 2014; 18:92-94. [PMID: 25125964 PMCID: PMC4103055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Purple urine bag syndrome is an uncommon phenomenon where the plastic urinary catheter bag and tubing turn purple. It occurs in some elderly constipated chronic urinary catheterization patients. The phenomenon is attributed to the presence of metabolites of tryptophan in the presence of urinary tract infection.This urine discoloration may lead to misdiagnosis and also cause great concern to patients and their relatives. CASE REPORT We present the clinical case of a 83-year-old female patient with dementia and hypothyroidism, chronically catheterized, who presented with purple-color urine initially misdiagnosed as having haematuria.
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Affiliation(s)
- DI Agapakis
- Department of Internal Medicine, General Hospital of Goumenissa, Kilkis, Greece
| | - Ev Massa
- ICU, Hippokratio General Hospital, Thessaloniki, Greece
| | - I Hantzis
- Department of Internal Medicine, General Hospital of Goumenissa, Kilkis, Greece
| | - E Paschoni
- Department of Internal Medicine, General Hospital of Goumenissa, Kilkis, Greece
| | - E Satsoglou
- Department of Internal Medicine, General Hospital of Goumenissa, Kilkis, Greece
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40
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Mumoli N, Vitale J, Brondi B, Basile V, Cei M. Purple Urine‐Bag Syndrome in a Department of Medicine. J Am Geriatr Soc 2013; 61:2240-2241. [DOI: 10.1111/jgs.12577] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Nicola Mumoli
- Department of Internal Medicine Ospedale Civile Livorno Livorno Italy
| | - Josè Vitale
- Department of Internal Medicine Ospedale Civile Livorno Livorno Italy
| | - Barbara Brondi
- Department of Internal Medicine Ospedale Civile Livorno Livorno Italy
| | - Valentina Basile
- Department of Internal Medicine Ospedale Civile Livorno Livorno Italy
| | - Marco Cei
- Department of Internal Medicine Ospedale Civile Livorno Livorno Italy
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41
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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: 11] [Impact Index Per Article: 1.0] [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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Bocrie OJ, Bouchoir E, Camus A, Popitean L, Manckoundia P. Purple urine bag syndrome in an elderly subject. Braz J Infect Dis 2012; 16:597-8. [PMID: 23141971 DOI: 10.1016/j.bjid.2012.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 07/11/2012] [Indexed: 10/27/2022] Open
Affiliation(s)
- Olivier-Jacques Bocrie
- Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France
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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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Ciobanu CS, Iconaru SL, Le Coustumer P, Constantin LV, Predoi D. Antibacterial activity of silver-doped hydroxyapatite nanoparticles against gram-positive and gram-negative bacteria. NANOSCALE RESEARCH LETTERS 2012; 7:324. [PMID: 22721352 PMCID: PMC3422172 DOI: 10.1186/1556-276x-7-324] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 05/26/2012] [Indexed: 05/10/2023]
Abstract
Ag-doped nanocrystalline hydroxyapatite nanoparticles (Ag:HAp-NPs) (Ca10-xAgx(PO4)6(OH)2, xAg = 0.05, 0.2, and 0.3) with antibacterial properties are of great interest in the development of new products. Coprecipitation method is a promising route for obtaining nanocrystalline Ag:HAp with antibacterial properties. X-ray diffraction identified HAp as an unique crystalline phase in each sample. The calculated lattice constants of a = b = 9.435 Å, c = 6.876 Å for xAg = 0.05, a = b = 9.443 Å, c = 6.875 Å for xAg = 0.2, and a = b = 9.445 Å, c = 6.877 Å for xAg = 0.3 are in good agreement with the standard of a = b = 9.418 Å, c = 6.884 Å (space group P63/m). The Fourier transform infrared and Raman spectra of the sintered HAp show the absorption bands characteristic to hydroxyapatite. The Ag:HAp nanoparticles are evaluated for their antibacterial activity against Staphylococcus aureus, Klebsiella pneumoniae, Providencia stuartii, Citrobacter freundii and Serratia marcescens. The results showed that the antibacterial activity of these materials, regardless of the sample types, was greatest against S. aureus, K. pneumoniae, P. stuartii, and C. freundii. The results of qualitative antibacterial tests revealed that the tested Ag:HAp-NPs had an important inhibitory activity on P. stuartii and C. freundii. The absorbance values measured at 490 nm of the P. stuartii and C. freundii in the presence of Ag:HAp-NPs decreased compared with those of organic solvent used (DMSO) for all the samples (xAg = 0.05, 0.2, and 0.3). Antibacterial activity increased with the increase of xAg in the samples. The Ag:HAp-NP concentration had little influence on the bacterial growth (P. stuartii).
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Affiliation(s)
- Carmen Steluta Ciobanu
- National Institute of Materials Physics, 105 bis Atomistilor, P.O. Box MG 07, Magurele, Bucuresti, 077125, Romania
| | - Simona Liliana Iconaru
- National Institute of Materials Physics, 105 bis Atomistilor, P.O. Box MG 07, Magurele, Bucuresti, 077125, Romania
| | - Phillippe Le Coustumer
- University of Bordeaux, EA 4592 Géoressources & Environnement, EGID, 1 allée F. Daguin 18, Pessac Cedex, 33607, France
| | - Liliana Violeta Constantin
- Faculty of Physics, University of Bucharest, 405 Atomistilor, CP MG - 1, Magurele, Bucuresti, 077125, Romania
| | - Daniela Predoi
- National Institute of Materials Physics, 105 bis Atomistilor, P.O. Box MG 07, Magurele, Bucuresti, 077125, Romania
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Peters P, Merlo J, Beech N, Giles C, Boon B, Parker B, Dancer C, Munckhof W, Teng HS. The purple urine bag syndrome: a visually striking side effect of a highly alkaline urinary tract infection. Can Urol Assoc J 2011; 5:233-4. [PMID: 21801678 DOI: 10.5489/cuaj.10177] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Peter Peters
- Department of Urology, Ipswich General Hospital, Queensland, Australia; School of Medicine, Griffith University, Queensland, Australia
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