Bladder - Acute cystitis

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Bladder

Cystitis

Acute cystitis

Reviewer: Anil Parwani, M.D., University of Pittsburgh Medical Center (see Reviewers page)
Revised: 13 May 2011, last major update April 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
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● A clinical diagnosis, usually with a triad of frequency, lower abdominal pain and dysuria (pain or burning during urination)
● There is usually no surgical specimen for acute cystitis, although it may be a finding in a specimen obtained for other purposes, or at autopsy

Terminology
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● Also called acute bladder infection, acute bacterial cystitis

Epidemiology
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● Common in young women of reproductive age; also older men and women

Sites
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● Bladder or lower urinary tract (urethra)

Etiology
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● Most common bacterial agents are E. coli, Proteus, Klebsiella, Enterobacter
● Also due to Candida or Cryptococcus in immunocompromised, Schistosoma haematobium in Egypt; also adenovirus, chlamydia, mycoplasma
● Noninfectious causes are chemotherapy, radiation therapy and trauma
● For E. coli infections, the host's fecal flora (and in women, vaginal flora) is the most common immediate source for the infecting strain
● The E. coli strain may represent the most prevalent fecal/vaginal E. coli clones of the individual (the prevalence hypothesis) or a distinctive, highly selected subset of the fecal/vaginal E. coli population with enhanced virulence potential (the special-pathogenicity hypothesis, J Clin Microbiol 2008;46:2529)

Clinical features
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● Patients may be asymptomatic
● May also be caused by obstruction, cystocele or diverticula
● May lead to pyelonephritis
● Uncomplicated: occurs in otherwise healthy nonpregnant adult women
● Complicated: associated with conditions that increase the risk of therapy failure, such as an upper tract infection or drug resistant pathogen; a broader spectrum antimicrobial is recommended in these cases
● Excellent prognosis; symptoms usually resolve within 1-2 days after treatment

Treatment
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● Suggested clinical algorithm: treat empirically with antibiotics if 2 of 3 variables present: dysuria, urine WBC > trace, urine nitrites); otherwise obtain culture and wait for results (Arch Intern Med 2007;167:2201)
● Complicated cases require a broader spectrum antibiotic for a longer period of time

Gross description
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● The bladder may show no gross abnormalities
● Occasionally, the mucosa may be hyperemic with variable exudate

Gross images
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Hyperemic mucosa

Fibrinopurulent exudate on mucosa

Purulent and ulcerative bladder

Micro description
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● Usually neutrophils

Micro images
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Acute and chronic cystitis: The inflammatory cells in the lamina propria are mixed mononuclear and neutrophils

End of Bladder > Cystitis > Acute cystitis

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