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Bladder
Cystitis
Author: Nat Pernick, M.D. (see Authors page)
Revised: 18 December 2009, last major update - December 2009
Copyright: (c) 2002-2009, 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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Epidemiology
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● Common in young women of reproductive age; also older men and women
Sites
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Etiology
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● Due to E. coli, Proteus, Klebsiella or Enterobacter bacteria
● 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 (and, in women, vaginal) flora is the most common immediate source for the infecting E. coli 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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● May also be caused by obstruction, cystocele or diverticula
● May lead to pyelonephritis
● Uncomplicated: in otherwise healthy nonpregnant adult woman
● 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
Prognostic factors
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Case reports
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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
Clinical images
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Gross description (Macroscopy)
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● Hyperemic mucosa with variable exudate
Gross images
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Hyperemic mucosa, link
Fibrinopurulent exudate on mucosa, link
Purulent and ulcerative bladder, link
Micro description (Histopathology)
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● Usually neutrophils
Micro images
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Cytology description
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Cytology images
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Positive stains
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Negative stains
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Electron microscopy descriptions
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Electron microscopy images
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Molecular / cytogenetics description
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Molecular / cytogenetics images
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Differential Diagnosis
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● (link to topic)
Additional references
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End of Bladder > Cystitis > Acute cystitis
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