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Role of urease in pyelonephritis resulting from urinary tract infection with Proteus.

The role of urease in induction of pyelonephritis was studied by treatment of proteus-infected rats with acetohydroxamic acid, a potent inhibitor of urease. Infection was produced by introduction of Proteus mirabilis into the bladder along with a zinc disk. Controls were treated identically but received no acetohydroxamic acid. The number of bacteria per milliliter of urine was the same in both groups. The number of bacteria in the kidneys and the extent of renal damage was much greater in controls. Common enterobacteraceal antigen was not detected in the renal parenchyma of rats treated with acetohydroxamic acid. Treatment with acetohydroxamic acid thus prevented invasion of and damage to kidney tissue without reduction of urinary infection. Thus new evidence was found that the invasive properties of Proteus in the urinary tract are dependent on alkalinization of urine by urease and the resulting damage to the renal epithelium.

Acute Disease

[Impairments of lipid metabolism in liver, kidney and heart tissues of mice infected with Proteus vulgaris].

Intraperitoneal administration of Proteus vulgaris living culture of various age (12 hrs and one day) caused impairments in lipid metabolism in mice liver, kidney and heart tissues. The one day-old culture was more toxic. The impairment in lipid metabolism was manifested as distinct increase in cholesterol content in liver tissue and kidney and a decrease in phospholipid content in liver, kidney and heart tissues. These changes were accompanied by an increase in content of sialic acids in liver tissue.

Animals

Proteus rettgeri infections: a review.

Proteus rettgeri is an aerobic gram-negative bacillus that displays marked resistance against most of the antibiotics presently available. This organism causes infections usually confined to the urinary tract of certain types of compromised patients. Occasionally, it is recovered from soft tissue abscesses, and rarely from the blood and respiratory tract. Proteus rettgeri is notorious for causing nosocomial outbreaks of urinary tract infections in urological and physical medicine wards. Our experience with a patient who had bacteremia with a multi-drug resistant strain of Proteus rettgeri prompted a review of the literature concerning infections with this organism. The salient features of these reports are discussed and summarized. Data on the antibiotic sensitivity of 15 other strains of Proteus rettgeri are included.

Adolescent

Ultrastructure of Proteus mirabilis swarmer cell rafts and role of swarming in catheter-associated urinary tract infection.

Proteus mirabilis is a common cause of catheter-associated urinary tract infection (C-UTI). It blocks indwelling urethral catheters through the formation of extensive crystalline biofilms. The obstruction of urine flow can induce episodes of pyelonephritis, septicemia, and shock. P. mirabilis exhibits a type of motility referred to as swarming, in which multicellular rafts of elongated, hyperflagellated swarmer cells form and move rapidly in concert over solid surfaces. It has been suggested that swarming is important in the pathogenesis of C-UTI. In this study we generated a set of stable transposon mutants deficient in swarming and used them to assess the role of swarming in the migration of P. mirabilis over urinary catheters. Swarming was found to be essential for migration over all-silicone catheters. Swarming-deficient mutants were attenuated in migration over hydrogel-coated latex catheters, but those capable of swimming motility were able to move over and infect these surfaces. A novel vapor fixation technique for the preparation of specimens and scanning electron microscopy were used to resolve the ultrastructure of P. mirabilis multicellular rafts. The flagellar filaments of P. mirabilis were found to be highly organized during raft migration and were interwoven in phase to form helical connections between adjacent swarmer cells. Mutants lacking these novel organized structures failed to swarm successfully. We suggest that these structures are important for migration and formation of multicellular rafts. In addition, the highly organized structure of multicellular rafts enables P. mirabilis to initiate C-UTI by migration over catheter surfaces from the urethral meatus into the bladder.

DNA Transposable Elements

[Investigations made to test the demarcation line method (DLM) after Dienes for its suitability in the epidemiology of Proteus mirabilis (author's transl)].

In 1946, DIENES observed that non-identical Proteus-strains, when swarming towards each other, were froming distinctly demarcated lines ("DIENES' phenomenon", demarcation (=AGL) phenomenon). Strains of the same origin were amalgamating without demarcation. In 1970, STURDZA studied this phenomenon and commented on its relevance for the epidemiology of nosocomial Proteus-infections. An increased number of Proteus-infections in Berlin was the reason that this procedure was tested for epidemiological purposes. Approx. 300 Proteus mirabilis-strains, tested on normal meat fluid agar, could be divided into 52 AGL-groups. When tested by several investigators, the coordination to any AGL-group seemed to be very subjective. Consequently, a DNase-agar with o-toluidinblue as an indicator, as had been mentioned by CHAMBERS in 1975, was used in order to give a more exact demonstration of AGL. This resulted in a reduction from 52 to 42 AGL-groups. Another 140 newly isolated Proteus-strains belonged to the 42 known as well as to another 42 new AGL-groups. Whether these 84 AGL-groups possess the constancy which is imperative for practical purposes, is however, still rather doubtful.

Agar

Cross-protection of mice provided by active and passive immunization against experimental infections with virulent Proteus rettgeri and Providencia bacteria.

Immunization with Providencia and Proteus rettgeri Formalin-treated bacterial suspensions produced high levels of protection in mice against homologous and heterologous challenge. Mice were also cross-protected, but less effectively, by passive administration of rabbit type-specific antisera. The protective activity appeared to be due to an antigen common to strains of different O-serotypes. It was not detectable in agglutination reactions, and preliminary results indicate that it is thermostable, not being inactivated in its antibody binding capacity at 121 degrees C for 1 h.

Animals

Micrococcal urinary-tract infections in young women.

In a prospective study in young women, novobiocin-resistant subgroup-3 micrococci were the second commonest cause, after Escherichia coli; of acute urinary infections. Proteus mirabilis was the only other causative organism. Symptoms, pyuria, or possible aetiological factors were the same in micrococcal and coliform infections. The infecting micrococcus "biotype" was only rarely found among the normal flora of the genitourinary tract of young women, though other micrococci and staphylococci were commonly present. Evidently, the infecting micrococci are selectively pathogenic in the urinary tract. Micrococcal infections, like coliform infections; commonly followed sexual intercourse, but there was no evidence that the micrococci were sexually transmitted. The infecting biotype was rarely found in the male urethra or prepuce.

Drug Resistance, Microbial

Proteus species isolated from human eyes.

Of 34 species of Proteus isolated from human eyes, 29 (85%) were P. mirabilis and five (15%) were P. morganii. In vitro antibiotic sensitivity studies showed that gentamicin best controlled both P. mirabilis and P. morganii of all the antibiotics tested. In vivo tests on experimental Proteus infections of rabbit coreas, treated with gentamicin and tobramycin, yielded comparable clinical results, but gentamicin was more effective in eliminating the organism from the experimental lesions.

Animals

Beta-lactam antibiotics alone or in combination with gentamicin for therapy of gram-negative bacillary infections in neutropenic patients.

This study was initiated to determine whether antibiotic combinations are superior to single antibiotics for the treatment of gram-negative bacillary infections in neutropenic patients. Twenty-six patients with Pseudomonas and Proteus infections received either carbenicillin or carbenicillin, plus gentamicin. The cure rates were 83 and 93 per cent, respectively. Twenty-three patients with infections caused by other gram-negative bacilli received either cephalothin plus gentamicin. The cure rates were 64 and 67 per cent, respectively. Superinfection occurred in 26 per cent of the patients who received a single antibiotic compared to 15 per cent of the patients who received a combination. Four of the 26 patients who received gentamicin developed transient azotemia. Combination therapy may be superior to single antibiotic therapy, but this study demonstrated no statistically significant differences.

Adolescent

Protection against Gram-negative infection by 'super-active' antigen.

'Super-active' antigens modified antigens released from bacteria which had been phagocytosed and killed by human leucocytes, were found to induce protective responses in mice within 24 h of immunization. At the earliest time (24 h) when immunized mice were protected against lethal intrapertoneal (i.p.) challenge by the bacteria from which which the 'super-active' antigens were made (Proteus mirabilis) the leucocytes of peripheral blood from immunized mice showed enhanced phagocytosis and killing of autologous bacteria and there was an increase in the number of lymphocytes producing anti-proteus antibody. Another mouse protective factor inducing transient protection lasting 1-2 days against lethal i.p. challenge by P. mirabilis was found in preparations of lysed heman leucocytes not engaged in phagocytosis. Burned mice, immunized with 'super-active' antigen preparations were protected against lethal invasive proteus infection, inoculated on to the burn surface, 2 h after burning and immunization.

Animals

Urease. The primary cause of infection-induced urinary stones.

Previous reports have suggested that urease-producing bacteria play a prominent role in the formation of infection-induced urinary stones. We have carried out crystalization experiments in vitro which show that bacterial urease alkalinizes urine, thereby causing: (i) supersaturation with respect to struvite and calcium phosphate; and (ii) formation of struvite and apatite crystals. Growth of Proteus in urea-free urine or in urine which contained a urease inhibitor did not cause alkalinization, supersaturation, or crystallization of struvite and apatite. Growth of Klebsiella, Escherichia coli, or Pseudomonas was not associated with significant alkalinization, supersaturation, or crystallization. Struvite and apatite crystals dissolved in Proteus-infected urine in which undersaturation was maintained by urease inhibition. Similar results in all experiments were obtained using human urine and a synthetic urine which was devoid of matrix, pyrophosphate, or other undefined solutes. Urease-induced supersaturation appears to be the primary cause of infection-induced urinary stones.

Bacteria

[Chemotherapy of experimental lactational mastitis in mice].

More severe mastitis on infection with Proteus was shown on a standardized model of experimental lactation mastitis of mice caused by Staphylococcus, Proteus and their mixture. Significant differences in the morphological pictures of the staphylococcal and Proteus mastitis were noted. A pronounced effect was observed with the use of kanamycin in combination with fuzidin in treatment of experimental mastitis of various etiology.

Animals