Distribution of subjects tested for multiple infection (non-specific urethritis) with bacteria associated with UTI.
1. Introduction
The Chlamydiae belongs to the order Chlamydiales with one family Chlamydiaceae one genus
The first
A mention of
Urinary tract infections (UTI) could be defined as the persistent presence within the urinary tract of actively multiplying microorganisms. UTI implies both microbial colonization of the urine and invasion of the lower or upper urinary tract by microorganisms (Reld and Spied, 1987). It is an infection with more than 100,000 organisms per millilitres in the mid-stream samples of urine (Macleod et al., 1984).
Urinary tract infection is the most common disease of the urinary tract and it is a major cause of morbidity in both the hospital and the community (Hannan et al., 1993). The most common cause of UTI are bacteria, and less often viruses, yeasts or other intracellular microorganisms (Cattell, 1985). According to Bohnson (1986), bacteriuria may be completely asymptomatic or remain localised in the bladder without the development of renal infection. Urine secreted by normal kidney is sterile and remain so while it travels to the bladder, however, normal urine is known to have a microbial flora and any voided urine in normal persons may therefore contain thousands of bacteria per millilitre derived from this normal flora. In other to differentiate this smaller number of microorganisms from the larger number of microorganisms commonly found in infections of the urinary tract, it is essential to count the number of bacteria present in fresh properly collected specimens by appropriate methods (Schroeder, et al., 1990).
In Nigeria, UTI is prevalent among men and women, but more common among women, especially during pregnancy (Eke et al., 1987). Unrecognised UTI in infancy and childhood may have serious long-term effects and chronic pyelonephritis may occur in adults. However, the infection occurs in all persons regardless of sex or age with particular impact on the young and the very elderly (Rubin et. al., 1986). Sexually active females are also predisposed to UTI than their male counterparts (Wiswell and Smith, 1985; Johnson et al., 1995). In later life, UTI is more among men until the age of prostatic hypertrophy (above 40 years of age) (Schroeder et al., 1990).
For many years, pathogens associated with uncomplicated UTI have remained constant, with
In women, signs can include unusual vaginal discharge or bleeding, burning during urination or lower abdominal pain. Men like women, may in addition to pain during urination develop swellings in the testicles. Without treatment 40% of infected women develop pelvic inflammatory disease (PID) which affects the fallopian tubes and causes damage to the ovaries (Delpiano et al. 1994).
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10-15 | 10 | 15 | 2 (8) | 6 (24) | 8 (32) |
16-21 | 72 | 108 | 49 (27.2) | 69 (38.3) | 118 (65.6) |
22-27 | 56 | 99 | 52 (35.5) | 54 (34.8) | 106 (68.4) |
28-33 | 49 | 71 | 33 (27.5) | 40 (33.3) | 73 (60.8) |
34-39 | 40 | 71 | 23 (20.7) | 40 (36) | 63 (56.8) |
40-45 | 42 | 66 | 25 (23.1) | 37 (34.3) | 62 (57.4) |
46-51 | 32 | 59 | 20 (22) | 26 (28.6) | 46 (50.5) |
52-57 | 29 | 42 | 19 (26.8) | 24 (33.8) | 43 (60.6) |
58-63 | 36 | 38 | 22 (29.7) | 23 (31.1) | 45 (60.8) |
64-69 | 29 | 40 | 18 (26.1) | 19 (27.5) | 37 (53.6) |
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This study sought to establish the involvement of
2. Materials and methods
2.1. Sample collection
Mid urine samples (1004) were collected from both male (467) and females (537) as well as urethral swabs were from males and endocervical and high vaginal swabs from females visiting various clinics for cases of urethritis. Blood samples were also collected from all the patients. The blood samples were aseptically collected into sterile vacutaniers, centrifuged at 3000 rpm (hetituch), sera separated, collected into sterile vials and stored at -20oC until used. The endocervical swab and the urethral swabs were collected into modified Ringer’s solution as transport medium. Ringer’s solution has been modified by the addition of calf serum and addition of vancomycin, streptomycin and nystatin. The samples were then transported to the laboratory. Clinical information of the patients sampled were collected which included pain during urination, penal and vaginal discharge, urethral and vaginal itching, foul vaginal smell and urethral irritation. Only those samples that gave a growth of more than one bacteria were further screened for
2.2. Procedure
The urine samples were immediately cultured onto, Nutrient agar, McConkey agar, Blood agar, Chocolate agar, Mannitol salt agar, Thayer Martins media and CLED agar plates (Oxoid). All the samples were cultured in duplicates and incubated both aerobically an anaerobically at 370C (Gallenkamp, UK) for 24 hours. Bacterial count and identification were done according to the standard methods of
3. Results
Of the 1004 mid stream urine samples collected from patients with symptoms of urethritis in Nigeria and tested for bacteria involved in urethritis, only 601 were positive for multiple infections with UTI organisms. This included 56 samples positive for
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10-15 | 2 | 5 | 7 |
16-21 | 33 | 56 | 89 |
22-27 | 50 | 47 | 97 |
28-33 | 31 | 46 | 77 |
34-39 | 30 | 45 | 75 |
40-45 | 17 | 30 | 47 |
46-51 | 16 | 26 | 38 |
52-57 | 17 | 24 | 41 |
58-63 | 17 | 25 | 42 |
64-69 | 14 | 14 | 28 |
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Antibody titeration shows that 66% of the subjects positive to CCFA had antibody titre higher than 1:16. Age group 16-21 had the highest number of subjects with anti body titre higher than 1:16 Culture of samples into chicken’s embryonated eggs shows that 499 of the total samples positive to CCFA were positive to
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1:8 | 1:16 | 1:32 | 1:64 | 1:128 | 1:256 | 1:512 | 1:1024 | Total | |
10-15 | - | 2 | 2 | 2 | 1 | - | - | - | 7 |
16-21 | 20 | 20 | 13 | 11 | 9 | 10 | 6 | - | 69 |
22-27 | 31 | 19 | 42 | - | - | - | 5 | - | 66 |
28-33 | 11 | 29 | 17 | 5 | 5 | 5 | - | 5 | 66 |
34-39 | 21 | 18 | 13 | 3 | 10 | 5 | 5 | - | 54 |
40-45 | 5 | 5 | 10 | 11 | 13 | 1 | - | 2 | 42 |
46-51 | 3 | 8 | 8 | 5 | 5 | 4 | 4 | 1 | 35 |
52-57 | 21 | 9 | 10 | 10 | - | - | - | - | 30 |
58-63 | 5 | 32 | 3 | - | 1 | 1 | - | - | 37 |
64-69 | 3 | 3 | 3 | 1 | 6 | 6 | 6 | - | 25 |
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10-15 | 7 | 6 | 7 |
16-21 | 89 | 80 | 82 |
22-27 | 97 | 89 | 91 |
28-33 | 77 | 66 | 69 |
34-39 | 75 | 67 | 71 |
40-45 | 47 | 47 | 47 |
46-51 | 38 | 38 | 38 |
52-57 | 41 | 38 | 39 |
58-63 | 42 | 40 | 40 |
64-69 | 28 | 28 | 28 |
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4. Discussion
Infection of the genital with
The lack of treatment of
Model | Mono | CFT | Culture | ||
1 | Correlations | Mono | 1.000 | -.823 | -.907 |
CFT | -.823 | 1.000 | .508 | ||
Culture | -.907 | .508 | 1.000 | ||
Covariances | Mono | 24.033 | -8.743 | -14.912 | |
CFT | -8.743 | 4.700 | 3.695 | ||
Culture | -14.912 | 3.695 | 11.235 | ||
aDependent Variable: Total positiveKey: Mono=Monoclonal antibody test |
Age is a factor to UTI especially as it involves the early age groups with lesser number as well as lower percentage of individuals with UTI and also non-specific urethritis involving
Unstandardized Coefficients | Standardized Coefficients | t | Sig. | 95.0% Confidence Interval for B | |||
B | Std. Error | P | Lower Bound | Upper Bound | |||
(Constant) | .895 | 8.048 | .111 | .915 | -18.797 | 20.587 | |
CFT | 2.549 | 2.168 | 2.245 | 1.176 | .284 | -2.756 | 7.854 |
Culture | 8.080 | 3.352 | 6.228 | 2.410 | .053 | -.122 | 16.282 |
Mono | -9.420 | 4.902 | -7.518 | -1.921 | .103 | -21.415 | 2.576 |
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