Urinary Track Infection Susceptibility Among Women With Blood Group B

Description

ABSTRACT

The urinary tract is one of the most common places for the occurrence of bacterial infections, especially in women. Urinary infection can be defined as an infection of the urinary tract structures which occurs, generally, as a consequence of the presence or colonization of bacteria, like Escherichia coli (E.coli) and other Enterobacteriaceae. The aim of this study was to evaluate the vulnerability of  urinary tract infections (UTIs) among women with blood group B and women with other blood group. The population of this study consisted of 307 patients (83 old women and 224 young women) from the General Hospital Ughelli, delta state. The blood groups were determined through a gel-test methodology. The microorganisms identification was made using the VITEK^® 2 Compact equipment. In a total of 307 patients, the most common pathogen was E. coli with 48.4%, followed by Klebsiella pneumoniae, with 17%. Infection by E. coli was significantly more common in patients with A blood group phenotypes (p<0.0005). A statistically higher risk for developing urinary tract infections in women compared to males (p<0.001) was found. The results suggest that E. coli was the main pathogen causing urinary tract infections, and we found statistically significant association between B blood group phenotypes and this infection. These results might be useful for describing an individual’s risk for a higher predisposition in developing urinary tract infections.

CHAPTER ONE

INTRODUCTION

BACKGROUND OF THE STUDY

Urinary Tract Infections (UTIs) are of the most common diseases worldwide affecting all age groups, and can be defined as an inflammation of the tubular  or parenchymal structures(Souza, 2009; Heilberg and Schor, 2003; Martins et al., 2010). The colonization of the urinary tract may occur due to the ascension of intestinal bacteria from the anus to the urinary opening, causing invasion of the urethra, bladder and ureters, and may even harm kidney function(Moura and Fernandes, 2010). Adult females are the most affected, and this fact is related to mechanical factors, such as the female urethra being shorter and closer to the anus (Heilberg and Schor, 2003; Martins et al., 2010; Moura and Fernandes, 2010; Lopes and Tavares, 2005; Costa et al., 2010). There are also other factors that may contribute to this high rate of urinary infections, such as sexually active young women, pregnancy, menopause, diabetes and urinary catheters (Souza, 2009; Heilberg and Schor, 2003; Moura and Fernandes). In men, UTI usually appears at older ages and commonly associated with anatomical abnormality or a decrease in the prostatic bactericidal activity (Moura and Fernandes, 2010).

UTIs can be classified according to their anatomical origin, in two groups: inferior or cystitis and superior or pyelonephritis. The main symptoms which help to diagnose and distinguish UTIs are dysuria, pollakiuria, hematuria and suprapubic or lower back pain. Some of the microorganisms involved in UTIs are Escherichia coli (E. coli), Klebsiella sp., Staphylococcus saprophyticus, Pseudomonas aeruginosa and Enterococcus faecalis, which are the main etiological agents(Souza, 2009; Martins et al., 2010).

Uropathogenic E. coli (UPEC) is the primary agent of UTIs, having different virulence factors that increase its ability to colonize the urogenital tract (Schilling et al., 2001; Finer and Landau, 2004). The uroepithelial surface binding is one of the factors that prevent “washout” through urination, and starts the bacterial invasion(Finer and Landau, 2004). The two fimbriae types most commonly found in UPEC isolates are the Type 1 fimbriae (mannose-sensitive) and P fimbriae (mannose-resistant) which are morphologically similar, but differ in the ability to mediate the hemagglutination in the presence of mannose(Connell et al., 1996; Santo et al., 2006). According to several authors the fim gene that encodes the Ttype 1 fimbriae, is characterized as the main virulence factor (Connell et al., 1996). These fimbriae consist of helical filaments composed of repeated subunits of the fimA structural protein, attached to fimH adhesion structures (Eto et al., 2007). The fimH adhesion binding to mannosylated receptors present on the uroepithelium is essential for the bladder colonization (Thankavel et al., 1997). The pap gene codifies for P fimbriae, which contain four subunits, a larger subunit, PapA, which constitutes the fimbriae structure and three smaller subunits (PapE, PapF and PapG) located at the end of the fimbriae extremity(Santo et al., 2006; Johnson, 1991).The binding of PapF and PapE to the receptors in Galα (Souza, 2009; Heilberg and Schor, 2003; Martins et al., 2010; Moura and Fernandes, 2010) uroepithelial cells prevents the elimination of bacteria from the bladder, breaks the mucosal barrier and encourages the immune response of the host (Bergsten et al., 2004).

In turn, the pathogenicity of Klebisella sp. is also due to virulence factors such as fimbriae or adhesins that bind ABH glycol conjugates expressed in host tissues, the production of urease, the presence of flagellum or “H” antigen (responsible for its mobility) and also capsular antigens (that confer resistance to phagocytosis)( Cao et al., 2011; Tarkkanen et al., 1997). The adhesion property is mediated by different types of filamentous projections, the fimbriae, each with their specific receptor. Thus, there are four types of adhesins involved in the adhesion process; however there are two predominant types. Its principal abilities are based  on the fact that they can agglutinate erythrocytes of different animal species (Tarkkanen et al., 1997, Podschun and Ullmann, 1998). Depending on whether or not the reaction is inhibited by D-mannose, these adhesins are designated as mannose-sensitive or mannose-resistant (MSHA and MRHA respectively)( Podschun and Ullmann, 1998). Type 1 fimbriae (MSHA), encoded by the gene cluster fim, seem to recognize the mannose glycoproteins present in various tissues of the host( Rosen et al., 2008). This fimbriae is involved in pyelonephritis scenarios, where they bind to proximal tubular cells. In contrast, Type 3 fimbriae mediate bacterial adhesion in tubular basal membranes, Bowman’s capsule and renal vessels, requiring 6 mrk genes, in which mrkA encodes the main subunit and mrkD the adhesion subunit( Tarkkanen et al., 1997).

Thus, some studies have pointed out the relationship between an individual’s susceptibility to infection according to their blood phenotype (AB0, Rh). Among these studies the identification of the fimbriae previously described stands out( Tarkkanen et al., 1997). The AB0 phenotype of an individual is due to the ABH genes which encode glycosyltransferases(enzymes) that add specific sugars to  a carbohydrate chain precursor the H substance(Yamamoto and McNeill, 1996). When this substance is added to an L-fucose, an 0 group is formed, the addition of an N-acetyl D galactosamine forms the A group and the addition of a D-galactose forms the B group (Yamamoto and McNeill, 1996; Yamamoto and Hakomori, 1990). The chains that carry the AB0 antigens can be glycoproteins, glycolipids or glycosphingolipids (Yang et al., 1994).

Several studies have been developed over the last few years, but the relationship between UTIs by different bacteria and the expression of AB0 and Rh antigens is not yet fully clarified. Therefore, the present study aims to associate the expression of these antigens and bacteria involved in UTIs.

1.2                                                 PROBLEM STATEMENT

A urinary tract infection (UTI) is an infection in any part of your urinary system — your kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract — the bladder and the urethra. Women are at greater risk of developing a UTI than are men. Infection limited to your bladder can be painful and annoying. In women, there is this belief and argument that women with blood group B are prone to urinary tract infection than women with other type of blood group. This study was introduced to investigate this argument which at the end of the work the result will end the argument.

1.3                                                    AIM OF THE STUDY

The aim of this study was to evaluate the level of vulnerability of urinary tract infections (UTIs) among women with blood group B and women with other blood group.

1.4                                             OBJECTIVES OF THE STUDY

At the end of this work, student involved shall be able to:

1. Study the urinary tract infection in full
2. Study the cause, symptom and cure for urinary tract infection

• Study different types of blood group

1. Investigate the vulnerability of urinary tract infection in different types of blood group.

1.5                                               PURPOSE OF THE STUDY

The purpose of this work is to understand the vulnerability of urinary tract infection in blood group B in women.

1.6                                                  SCOPE OF THE STUDY

Blood group antigens represent polymorphic traits inherited among individuals and populations. At present, there are 34 recognized human blood groups and hundreds of individual blood group antigens and alleles. Differences in blood group antigen expression can increase or decrease host susceptibility to many infections. Blood groups can play a direct role in infection by serving as receptors and/or coreceptors for microorganisms, parasites, and viruses. In addition, many blood group antigens facilitate intracellular uptake, signal transduction, or adhesion through the organization of membrane microdomains. Several blood groups can modify the innate immune response to infection.

1.7                                          SIGNIFICANCE OF THE STUDY

This study help the reader to understand that blood groups are frequent targets in epidemiological investigations since they are genetically determined traits with known polymorphic expression among individuals and populations. Many blood groups are receptors for toxins, parasites, and bacteria, where they can facilitate colonization or invasion or evade host clearance mechanisms. Blood groups can also serve as false receptors, preventing binding to target tissue. Finally, bacteria can stimulate antibodies against blood group antigens.

1.8                                                 DEFINITION OF TERMS

URINARY TRACT INFECTION (UTI):  is an infection in any part of your urinary system

ACUTE PYELONEPHRITIS: A bacterial infection of the upper urinary tract causing inflammation of the kidney(s).

ACUTE SECTOR: Hospital-based health services which are provided on an inpatient, day case or outpatient basis.

ACUTE TRUST: A trust is an NHS organisation responsible for providing a group of healthcare services.

APPRAISAL OF EVIDENCE: Formal assessment of the quality of research evidence and its relevance to the clinical question or guideline under consideration, according to predetermined criteria.

ASYMPTOMATIC BACTERIURIA: The presence of bacteria in the urine without the presentation of symptoms specific to the disease.

BACTERIURIA: The presence of bacteria in the urine with or without consequent urinary tract infection.

1.9                                                  RESEARCH QUESTION

1. How do u know if you have a urinary tract infection?
2. What is a urine infection?

• What is best antibiotic for urinary tract infection?

1. How long does a UTI last?
2. How do u know if you have a urinary tract infection?
3. What are the causes of urinary tract infection?

• Can a UTI go away on its own?
• What is the best thing to do for a urinary tract infection?

1. Which blood group is most prone to urinary tract infection?

1.10                                                      PROJECT ORGANISATION

The work is organized as follows: chapter one discuses the introductory part of the work,   chapter two presents the literature review of the study,  chapter three describes the methods applied,  chapter four discusses the results of the work, chapter five summarizes the research outcomes and the recommendations.