Rocha Paulo N, Rehem Ana Paula, Santana Juliana F, Castro Neviton, Muniz Andre L, Salgado Katia, Rocha Heonir, Carvalho Edgar M
Immunology Service, University Hospital Professor Edgard Santos, Federal University of Bahia, Rua Joao das Botas, s/n, 40110-160 Salvador, BA, Brazil.
BMC Infect Dis. 2007 Mar 12;7:15. doi: 10.1186/1471-2334-7-15.
HTLV-I infected patients often complain of urinary symptomatology. Epidemiological studies have suggested that these individuals have a higher prevalence and incidence of urinary tract infection (UTI) than seronegative controls. However, the diagnosis of UTI in these studies relied only on patient information and did not require confirmation by urine culture. The purpose of this study was to investigate the role of urinary tract infection (UTI) as the cause of urinary symptoms in HTLV-I infected patients.
In this cross sectional study we interviewed, and cultured urine from, 157 HTLV-I seropositive individuals followed regularly at a specialized clinic. All patients were evaluated by a neurologist and classified according to the Expanded Disability Status Scale (EDSS). Urodynamic studies were performed at the discretion of the treating physician.
Sixty-four patients complained of at least one active urinary symptom but UTI was confirmed by a positive urine culture in only 12 of these patients (19%); the majority of symptomatic patients (81%) had negative urine cultures. To investigate the mechanism behind the urinary complaints in symptomatic individuals with negative urine cultures, we reviewed the results of urodynamic studies performed in 21 of these patients. Most of them (90.5%) had abnormal findings. The predominant abnormalities were detrusor sphincter hyperreflexia and dyssynergia, findings consistent with HTLV-I-induced neurogenic bladder. On a multivariate logistic regression, an abnormal EDSS score was the strongest predictor of urinary symptomatology (OR 9.87, 95% CI 3.465 to 28.116, P < 0.0001).
Urinary symptomatology suggestive of UTI is highly prevalent among HTLV-I seropositive individuals but true UTI is responsible for the minority of cases. We posit that the main cause of urinary symptoms in this population is neurogenic bladder. Our data imply that HLTV-I infected patients with urinary symptomatology should not be empirically treated for UTI but rather undergo urine culture; if a UTI is excluded, further investigation with urodynamic studies should be considered.
人类嗜T淋巴细胞病毒I型（HTLV-I）感染患者常诉说有泌尿系统症状。流行病学研究表明，这些个体尿路感染（UTI）的患病率和发病率高于血清学阴性对照者。然而，这些研究中UTI的诊断仅依赖患者信息，并不需要尿培养确诊。本研究的目的是调查尿路感染（UTI）作为HTLV-I感染患者泌尿系统症状病因的作用。
在这项横断面研究中，我们对一家专科诊所定期随访的157名HTLV-I血清阳性个体进行了访谈并采集尿液进行培养。所有患者均由神经科医生进行评估，并根据扩展残疾状态量表（EDSS）进行分类。尿动力学研究由主治医生酌情进行。
64名患者诉说至少有一种现发泌尿系统症状，但其中只有12名患者（19%）尿培养阳性确诊为UTI；大多数有症状的患者（81%）尿培养阴性。为了调查尿培养阴性的有症状个体泌尿系统症状背后的机制，我们回顾了其中21名患者的尿动力学研究结果。他们中的大多数（90.5%）有异常发现。主要异常为逼尿肌括约肌反射亢进和协同失调，这些发现与HTLV-I诱导的神经源性膀胱一致。在多因素逻辑回归分析中，EDSS评分异常是泌尿系统症状的最强预测因素（比值比9.87，95%可信区间3.465至28.116，P<0.0001）。
提示UTI的泌尿系统症状在HTLV-I血清阳性个体中非常普遍，但真正的UTI仅占少数病例。我们认为该人群泌尿系统症状的主要原因是神经源性膀胱。我们的数据表明，有泌尿系统症状的HTLV-I感染患者不应凭经验治疗UTI，而应进行尿培养；如果排除UTI，应考虑进一步进行尿动力学研究。
