Acta path. microbiol. scand. Sect. B, 83: 10-16, 1975
THE OCCURRENCE OF MYCOPLASMAS IN T H E URINARY TRACT OF PATIENTS WITH CHRONIC PY ELONEPHRITIS A. C. TIIOMSEN The Institute of Medical Microbiology, University of Aarhus, Denmark, and Surgical University Clinic I, Aarhus Amtssygehus, Denmark, and Department of Urology, Aarhus Kommunehospital, Denmark
Thomsen, A. C. The occurrence of mycoplasmas in the urinary tract of patients with chronic pyelonephritis. Acta path. microbiol. scand. Sect. B, 83: 10-16, 1975. Two groups of patients, each consisting of 40, were investigated for the occurrence of mycoplasmas in the urethra, bladder and upper urinary tract. Mycoplasmas were isolated significantly more frequently from the bladder urine of patients with chronic pyelonephritis than from patients with non-infectious urinary tract diseases. Furthermore, mycoplasmas were isolated from the upper urinary tract of 5 patients with chronic pyelonephritis, while mycoplasmas could not be cultivated from the upper urinary tract of patients with non-infectious urinary tract diseases. Key words : Mycoplasmas ; urinary tract ; chronic pyelonephritis. A. C. Thomsen, The Institute of Medical Microbiology, University of Aarhus, DK-8000 Aarhus C , Denmark.
Received 30.iv.74
Accepted 2.viii.74
I n 1937 Dienes & Edsall (4) isolated mycoplasmas from an abscess in the Bartholin gland. Since then, the frequent occurrence in the lower urinary tract of both large-colony mycoplasmas and T-mycoplasmas (in the following referred to as Ureaplasma urealyticum (9) ), and their possible aetiological implication in non-gonococcal urethritis has attracted a great deal of interest. O n the other hand, only a few investigators have reported on the occurrence of mycoplasmas in the bladder and the upper urinary tract. Mdrdh et al. ( 6 ) isolated Mycoplasma hominis and U. urealyticum from urine collected by suprapubic aspiration of the bladder urine from patients with chronic pyelonephri10
tis. Using the same technique, Witzleb et al. ( 12) isolated mycoplasmas from urine specimens of patients with urinary tract infections. Mycoplasma saliuarium has been isolated from the kidney of a patient with focal glomerulonephritis and focal pyelonephritis ( 7 ) , and M . hominis and U . urealyticum from urine obtained through a ureteric catheter from a woman suffering from chronic pyelonephritis ( 1 2 ) . None of these studies provided anything but suggestive evidence, at best, for a pathogenic role of the mycoplasmas. A pathogenic effect of mycoplasmas in the upper urinary tract of rats has recently been demonstrated under experimental conditions. Acute pyelonephritis was produced by intracardial inoculation of Mycoplasma art hriti-
dis after ligature of the ureter (10). Moreover, the M . arthritidis infection was shown to aggravate the effect of secondary infection with Escherichia coli ( 11) . The purpose of the present investigation was to determine the occurrence of mycoplasmas in the urinary tract of patients with chronic pyelonephritis as compared to patients with non-infectious urinary tract disease.
MATERIAL AND METHODS
Group I . Patients with Non-Infectious Urinary Tract Disease Thirty women and 10 men were examined. 23 patients had concrements in the upper urinary tract, 5 had tumours, 7 malformations, and 5 suffered from diseases of the bladder (tumours, neurogenic bladder-diseases) . None of the patients revealed any signs of infection of the urinary tract such as elevated temperature or ESR, abnormal urine sediment, lumbar pain, dysuria or pollakisuria. The youngest patient was 19 and the oldest 7 8 years of age. Two of them had been treated with antibiotics (penicillin and nitrofurantoin) during the last month before collection of specimens, but none of the antibiotics used were mycoplasma inhibitors. The patients of this group were selected, to make them comparable with respect to age and sex to those of group I1 who were unselected. All selections were made before the results of cultivation were known. Group I I . Patients with Chronic Pyelonephritis Thirty women and 10 men were examined. The diagnosis of chronic pyelonephritis was based on the Occurrence of at least three of the following six criteria: 1) An anamnestic story of cystitis and attacks of acute pyelonephritis; 2 ) a urine sediment containing leucocytes; 3 ) significant bacteriuria; 4 ) a biopsy showing histological lesions of chronic pyelonephritis; 5 ) impaired function of the kidneys, and 6) the demonstration by X-ray examination of irregular shadow of the kidney and clubbing of the calyces. The age of the patients ranged from 22 to 85 years with an equal distribution throughout the group. Fourteen patients had been treated with antibiotics within the last month, although not with compounds known to possess mycoplasma inhibiting effects.
Sampling Group I . Specimens were taken from the urethra, bladder and the upper urinary tract. Specimens from the urethra were taken by rotating sterile cotton-tipped swabs in the external orificium. For sampling of urine, the patients were catheterized and a mid-portion of the urine (bladder urine) collected for cultivation. From the upper urinary tract, specimens were taken during operation; cotton-tipped swabs were rotated in the pelvis renis, or urine was collected from the pelvis through aspiration or through a catheter. Group II. According to the method of sampling this group was divided into three subgroups: a ) From 14 patients, specimens from the urethra, bladder and upper urinary tract were collected during operation as described for group I. From the remaining 26 patients, bladder urine was at first taken by catheterization and cultivated for mycoplasmas. b) Seven of these 26 patients had mycoplasmas in the bladder urine, and the examination was therefore extended to include specimens from the upper urinary tract and the urethra. Urine from the upper urinary tract was collected through bilateral ureteric catheterization, and the urine was divided into an initial-, a middle-, and a terminal portion. Specimens from the urethra were taken as described for group I. c ) Nineteen patients did apparently not harbour mycoplasmas in the bladder urine and no further examination was done in these cases. The p H of all urine specimens was determined. All samples were inoculated into growth media within one hour. Cultivation and Identification Large-colony Mycoplasmas The growth medium ( B ) used in the present study has been described earlier ( 5 ) . Solid medium was prepared by adding ionagar No. 2 (Oxoid), 1.2 per cent; and semisolid medium by adding 0.1 per cent of ionagar. Swabs were streaked onto solid medium and then deposited in semisolid medium. Cultures in semisolid medium were incubated in atmospheric air at 37" C and plating was performed after 3 days' incubation. Dublicate sets of plates were incubated at 37" C in candle jars and in an atmosphere of 95 per cent N, plus 5 per cent CO,. T h e plates were incubated for 4 days before examination for growth under a stereomicroscope. If no colonies were found, the plates were incubated for a further 4 days before repeated examination. Following a preliminary grouping according to biochemical properties (fermentation of glucose,
11
0
U . urealyticum
0 0
0 0
0
0
0 2 1
0 0
0 2
M . hominis
Upper urinary tract*
currence of Mycoplasmas in 40 Patients with non Infectious Urinary Tract Diseases and in 40 Patients with Chronic Pyelonephriti
C
b
a
13 0
66
69
1 6
11 0
3 6
7/2 1§
0 4
0 3§
1
40
0
1
6
30 0
10
M. hominis
1/2 1
Not investigated
0
0
11/21§
1 2
a
7/40§
1/40
0 0
0 0
0 4
0 0
1
0
0
0
0
tans
M . fermen-
3§
0
0
0
1
0
a
0
0
M . hominis
0
3
u.ticum
5
0
0
M* fermentans
alization
11/40$
0 0
2
1
a§
0
2
2
0
ticum
U . urealy-
M. hominis species
0
0
0
U . urealy-
3/2 1
0
0
0 2
2/2 1
0
6 10
1
Not investigated
2
0
0 1
0
0
0
ticum
M . hominis
Upper urinary tract*
1
act
30 0
he occurrence of a mycoplasmal species in more than one anatomical location refer throughout to the same patients. of M. hominis and U . urealyticum was found in three of these patients.
mycoplasmas/total
nic
ract
species
Bladder*
ticum
tans
Urethra*
Bladder* Urethra*
U . urealyM . fermenM . hominis
u.ticum
2
1 40
3 6 a
M* fermentans
0
0 0 3 0
2
0 0
0
0 0 0
0
0 3§
ic
11 0
1
5 0
a§
1 3§
a
0 0
a 0
2
0 0
0 4 1 2
0
calization
13 0
0
1 6
b
0 4
Not investigated
0 0 0 0 0 0 Not investigated
69 66 C
2/2 1 3/2 1 11/40$ 1/40 7/40§ 11/21§ 1/2 1
7/2 1§
ccurrence of Mycoplasmas in 40 Patients with non Infectious Urinary Tract Diseases and in 40 Patients with Chronic Pyelonephritis
e occurrence of a mycoplasmal species in more than one anatomical location refer throughout to the same patients. f M. hominis and U . urealyticum was found in three of these patients. ycoplasmas/total
hydrolysis of arginine, reduction of tetrazolium and production of phosphatase) , the mycoplasma isolates were identified by the indirect epi-immunofluorescence (8) and growth inhibition tests ( 3 ) .
U . urealyticum The medium of Shepard as modified by Black ( 2 ) , medium ( S ) , was used. For solid medium 1.2 per cent ionagar No. 2 (Oxoid) was added. The specimens were inoculated both into broth and onto solid medium. The broth was incubated at 37' C for 24 hours after which subcultivation onto plates was performed. A duplicate set of plates were incubated a t 37" C in 90 per cent atmospheric air plus 10 per cent CO, and in an atmosphere of 95 per cent N, plus 5 per cent CO,, respectively. Examination for growth was done on the third and the fifth day using a stereomicroscope. The isolates were tested for hydrolysis of urea, and isolates from patients harbouring U . urealyticum in the upper urinary tract were typed serologically by indirect epi-immunofluorescence ( 1 ) and by growth inhibition (2).
Quantitative Estimates The number of colonies appearing after streaking of the swabs on the agar plates were recorded as + + + for >loo, + + for 10-100 and + for 1-10 colonies. The number of colony forming units/ml (c.f.u./ml) of mycoplasmas in urine specimens were determined using a serial ten-fold dilution of the urine followed by plating with a calibrated loop (0.01 ml). Bacteria All specimens were cultivated for bacteria using blood agar, lactose bromthymol-blue agar and chocolate agar plates. The plates were incubated at 37" C aerobically and anaerobically.
RESULTS
Cultivation for Mycoplasmas Group I . Patients with Non-infectious Diseases of the Urinary Tract
Mycoplasmas were found in the urethra of 9, and in the bladder urine of two out of the 40 patients examined. Mycoplasmas were not recovered in any case from the upper urinary tract in this group of patients (Table 1).
Group ZZ. Patients with Chronic Pyelonephritis Subgroup a (specimens collected during operation). This subgroup included 3 male and 11 female patients. Mycoplasmas were not recovered from the male patients. From 9 female patients, mycoplasmas were cultivated from the urethra as well as from the bladder urine. From the upper urinary tract, mycoplasmas were isolated from three patients (Table l ). Subgroup b (specimens collected by ureteric catheterization). This subgroup included 1 male and 6 female patients. Mycoplasmas were isolated from the urethra and the bladder urine of the male patient. The six female patients harboured mycoplasmas in the urethra and the bladder urine. Two of these patients also harboured mycoplasmas in the upper urinary tract (Table 1) . Subgroup c (only bladder urine was investigated). Mycoplasmas were not isolated from any of the 6 male and 13 female patients in this subgroup (Table 1) . Altogether, mycoplasmas were recovered from the urethra of 16 out of 21, from the bladder urine of 16 out of 40, and from the upper urinary tract of 5 out of 21 patients examined. Mycoplasmas were the only isolates from the upper urinary tract of four of the patients and two of these, both harbouring M . hominis, revealed signs of an acute exacerbation (Table 2 and 3). No relationship between the p H of the urine and the occurrence of mycoplasmas was found in any group. Neither was the occurrence of mycoplasmas correlated to a certain age group. The occurrence of mycoplasmas did not seem to have special affinity to the occurrence of a certain species of bacteria or to a bacteria free urinary tract. Two patients from whom both M . hominis and U . urealyticum were isolated, had been treated with nitrofurantoin and ampicillin.
13
5
U.urealyticum
4
2
M . hominis E. coli S. albus M . hominis U . urealyticum S. albus
+
+++
++
++
++ ++
++
++ M . hominis
M . hominis
+
M . hominis E. coli S. albus
M . hominis colonies *No*Of
Bladder
U . urealyticum type 1 P. uulrraris M . hominis E. coli
Cultivation results
M . hominis
M . hominis E. coli
* Swabs: recorded as + + + for >loo, + + for 10-100, and Urine specimens: recorded as the number of c.f.u./ml.
+
colonies No.yf
lO5/ml type I11 S. albus
4 x lo5
M . hominis
M . hominis 0 0 M hominis M . hominis M . hominis
M . hominis E. coli M . hominis M hominis M . hominis E. coli 0 0
* Swabs: recorded as + + + for >loo, + + for 10-100, and Urine specimens: recorded as the number of c.f.u./ml.
5
M . hominis U . urealyticum S. albus
4
type I11 S. albus
+++
S. albus
U . urealyticum type I11
U. urealyticum type 1 P . vulrraris
M . hominis
U.urealyticum
+
U . urealyticum type 1 P. uulrraris
Bladder
Urethra
3
3
type I11 S. albus
2
+
colonies *No*Of
1
U. urealyticum type 1 P . vulrraris
Urethra
+
M . hominis E. coli M . hominis M hominis M . hominis E. coli 0 0 for 1-10 colonies.
5x103
< 105/ml
M . hominis 0 0 M hominis M . hominis M . hominis
4 x lo5
3 x 103
M . hominis
>lO5/ml
U . urealyticum
U . urealyticum type1
upper urinary tract
type I11 S. albus
2 x 102
105/ml) nor the occurrence of bacteria in the upper urinary tract could be demonstrated in any of the 40 patients examined. Group 11
Nineteen of the 40 patients examined had significant bacteriuria. The bacteria were identified as E. coli in 12 and as Proteus vulgaris in 7 of these cases. Four patients had E . coli and two P . vulgaris in the upper urinary tract as well. DISCUSSION
The patients included in the group with noninfectious urinary tract disease were selected so that they were comparable in respect to age and sex with the patients in the group with chronic pyelonephritis. This seemed
reasonable as it is well-known that the occurrence of mycoplasmas in the urogenital tract is correlated to age and sex. Mycoplasmas were isolated from 16 out of 40 specimens of the bladder urine (40 per cent) from patients with chronic pyelonephritis. From the bladder urine of 40 patients with non-infectious urinary tract disease, mycoplasmas were isolated only twice (5 per cent). This difference between the two groups of patients is significant (x = 14.05 p
THE OCCURRENCE OF MYCOPLASMAS IN T H E URINARY TRACT OF PATIENTS WITH CHRONIC PY ELONEPHRITIS A. C. TIIOMSEN The Institute of Medical Microbiology, University of Aarhus, Denmark, and Surgical University Clinic I, Aarhus Amtssygehus, Denmark, and Department of Urology, Aarhus Kommunehospital, Denmark
Thomsen, A. C. The occurrence of mycoplasmas in the urinary tract of patients with chronic pyelonephritis. Acta path. microbiol. scand. Sect. B, 83: 10-16, 1975. Two groups of patients, each consisting of 40, were investigated for the occurrence of mycoplasmas in the urethra, bladder and upper urinary tract. Mycoplasmas were isolated significantly more frequently from the bladder urine of patients with chronic pyelonephritis than from patients with non-infectious urinary tract diseases. Furthermore, mycoplasmas were isolated from the upper urinary tract of 5 patients with chronic pyelonephritis, while mycoplasmas could not be cultivated from the upper urinary tract of patients with non-infectious urinary tract diseases. Key words : Mycoplasmas ; urinary tract ; chronic pyelonephritis. A. C. Thomsen, The Institute of Medical Microbiology, University of Aarhus, DK-8000 Aarhus C , Denmark.
Received 30.iv.74
Accepted 2.viii.74
I n 1937 Dienes & Edsall (4) isolated mycoplasmas from an abscess in the Bartholin gland. Since then, the frequent occurrence in the lower urinary tract of both large-colony mycoplasmas and T-mycoplasmas (in the following referred to as Ureaplasma urealyticum (9) ), and their possible aetiological implication in non-gonococcal urethritis has attracted a great deal of interest. O n the other hand, only a few investigators have reported on the occurrence of mycoplasmas in the bladder and the upper urinary tract. Mdrdh et al. ( 6 ) isolated Mycoplasma hominis and U. urealyticum from urine collected by suprapubic aspiration of the bladder urine from patients with chronic pyelonephri10
tis. Using the same technique, Witzleb et al. ( 12) isolated mycoplasmas from urine specimens of patients with urinary tract infections. Mycoplasma saliuarium has been isolated from the kidney of a patient with focal glomerulonephritis and focal pyelonephritis ( 7 ) , and M . hominis and U . urealyticum from urine obtained through a ureteric catheter from a woman suffering from chronic pyelonephritis ( 1 2 ) . None of these studies provided anything but suggestive evidence, at best, for a pathogenic role of the mycoplasmas. A pathogenic effect of mycoplasmas in the upper urinary tract of rats has recently been demonstrated under experimental conditions. Acute pyelonephritis was produced by intracardial inoculation of Mycoplasma art hriti-
dis after ligature of the ureter (10). Moreover, the M . arthritidis infection was shown to aggravate the effect of secondary infection with Escherichia coli ( 11) . The purpose of the present investigation was to determine the occurrence of mycoplasmas in the urinary tract of patients with chronic pyelonephritis as compared to patients with non-infectious urinary tract disease.
MATERIAL AND METHODS
Group I . Patients with Non-Infectious Urinary Tract Disease Thirty women and 10 men were examined. 23 patients had concrements in the upper urinary tract, 5 had tumours, 7 malformations, and 5 suffered from diseases of the bladder (tumours, neurogenic bladder-diseases) . None of the patients revealed any signs of infection of the urinary tract such as elevated temperature or ESR, abnormal urine sediment, lumbar pain, dysuria or pollakisuria. The youngest patient was 19 and the oldest 7 8 years of age. Two of them had been treated with antibiotics (penicillin and nitrofurantoin) during the last month before collection of specimens, but none of the antibiotics used were mycoplasma inhibitors. The patients of this group were selected, to make them comparable with respect to age and sex to those of group I1 who were unselected. All selections were made before the results of cultivation were known. Group I I . Patients with Chronic Pyelonephritis Thirty women and 10 men were examined. The diagnosis of chronic pyelonephritis was based on the Occurrence of at least three of the following six criteria: 1) An anamnestic story of cystitis and attacks of acute pyelonephritis; 2 ) a urine sediment containing leucocytes; 3 ) significant bacteriuria; 4 ) a biopsy showing histological lesions of chronic pyelonephritis; 5 ) impaired function of the kidneys, and 6) the demonstration by X-ray examination of irregular shadow of the kidney and clubbing of the calyces. The age of the patients ranged from 22 to 85 years with an equal distribution throughout the group. Fourteen patients had been treated with antibiotics within the last month, although not with compounds known to possess mycoplasma inhibiting effects.
Sampling Group I . Specimens were taken from the urethra, bladder and the upper urinary tract. Specimens from the urethra were taken by rotating sterile cotton-tipped swabs in the external orificium. For sampling of urine, the patients were catheterized and a mid-portion of the urine (bladder urine) collected for cultivation. From the upper urinary tract, specimens were taken during operation; cotton-tipped swabs were rotated in the pelvis renis, or urine was collected from the pelvis through aspiration or through a catheter. Group II. According to the method of sampling this group was divided into three subgroups: a ) From 14 patients, specimens from the urethra, bladder and upper urinary tract were collected during operation as described for group I. From the remaining 26 patients, bladder urine was at first taken by catheterization and cultivated for mycoplasmas. b) Seven of these 26 patients had mycoplasmas in the bladder urine, and the examination was therefore extended to include specimens from the upper urinary tract and the urethra. Urine from the upper urinary tract was collected through bilateral ureteric catheterization, and the urine was divided into an initial-, a middle-, and a terminal portion. Specimens from the urethra were taken as described for group I. c ) Nineteen patients did apparently not harbour mycoplasmas in the bladder urine and no further examination was done in these cases. The p H of all urine specimens was determined. All samples were inoculated into growth media within one hour. Cultivation and Identification Large-colony Mycoplasmas The growth medium ( B ) used in the present study has been described earlier ( 5 ) . Solid medium was prepared by adding ionagar No. 2 (Oxoid), 1.2 per cent; and semisolid medium by adding 0.1 per cent of ionagar. Swabs were streaked onto solid medium and then deposited in semisolid medium. Cultures in semisolid medium were incubated in atmospheric air at 37" C and plating was performed after 3 days' incubation. Dublicate sets of plates were incubated at 37" C in candle jars and in an atmosphere of 95 per cent N, plus 5 per cent CO,. T h e plates were incubated for 4 days before examination for growth under a stereomicroscope. If no colonies were found, the plates were incubated for a further 4 days before repeated examination. Following a preliminary grouping according to biochemical properties (fermentation of glucose,
11
0
U . urealyticum
0 0
0 0
0
0
0 2 1
0 0
0 2
M . hominis
Upper urinary tract*
currence of Mycoplasmas in 40 Patients with non Infectious Urinary Tract Diseases and in 40 Patients with Chronic Pyelonephriti
C
b
a
13 0
66
69
1 6
11 0
3 6
7/2 1§
0 4
0 3§
1
40
0
1
6
30 0
10
M. hominis
1/2 1
Not investigated
0
0
11/21§
1 2
a
7/40§
1/40
0 0
0 0
0 4
0 0
1
0
0
0
0
tans
M . fermen-
3§
0
0
0
1
0
a
0
0
M . hominis
0
3
u.ticum
5
0
0
M* fermentans
alization
11/40$
0 0
2
1
a§
0
2
2
0
ticum
U . urealy-
M. hominis species
0
0
0
U . urealy-
3/2 1
0
0
0 2
2/2 1
0
6 10
1
Not investigated
2
0
0 1
0
0
0
ticum
M . hominis
Upper urinary tract*
1
act
30 0
he occurrence of a mycoplasmal species in more than one anatomical location refer throughout to the same patients. of M. hominis and U . urealyticum was found in three of these patients.
mycoplasmas/total
nic
ract
species
Bladder*
ticum
tans
Urethra*
Bladder* Urethra*
U . urealyM . fermenM . hominis
u.ticum
2
1 40
3 6 a
M* fermentans
0
0 0 3 0
2
0 0
0
0 0 0
0
0 3§
ic
11 0
1
5 0
a§
1 3§
a
0 0
a 0
2
0 0
0 4 1 2
0
calization
13 0
0
1 6
b
0 4
Not investigated
0 0 0 0 0 0 Not investigated
69 66 C
2/2 1 3/2 1 11/40$ 1/40 7/40§ 11/21§ 1/2 1
7/2 1§
ccurrence of Mycoplasmas in 40 Patients with non Infectious Urinary Tract Diseases and in 40 Patients with Chronic Pyelonephritis
e occurrence of a mycoplasmal species in more than one anatomical location refer throughout to the same patients. f M. hominis and U . urealyticum was found in three of these patients. ycoplasmas/total
hydrolysis of arginine, reduction of tetrazolium and production of phosphatase) , the mycoplasma isolates were identified by the indirect epi-immunofluorescence (8) and growth inhibition tests ( 3 ) .
U . urealyticum The medium of Shepard as modified by Black ( 2 ) , medium ( S ) , was used. For solid medium 1.2 per cent ionagar No. 2 (Oxoid) was added. The specimens were inoculated both into broth and onto solid medium. The broth was incubated at 37' C for 24 hours after which subcultivation onto plates was performed. A duplicate set of plates were incubated a t 37" C in 90 per cent atmospheric air plus 10 per cent CO, and in an atmosphere of 95 per cent N, plus 5 per cent CO,, respectively. Examination for growth was done on the third and the fifth day using a stereomicroscope. The isolates were tested for hydrolysis of urea, and isolates from patients harbouring U . urealyticum in the upper urinary tract were typed serologically by indirect epi-immunofluorescence ( 1 ) and by growth inhibition (2).
Quantitative Estimates The number of colonies appearing after streaking of the swabs on the agar plates were recorded as + + + for >loo, + + for 10-100 and + for 1-10 colonies. The number of colony forming units/ml (c.f.u./ml) of mycoplasmas in urine specimens were determined using a serial ten-fold dilution of the urine followed by plating with a calibrated loop (0.01 ml). Bacteria All specimens were cultivated for bacteria using blood agar, lactose bromthymol-blue agar and chocolate agar plates. The plates were incubated at 37" C aerobically and anaerobically.
RESULTS
Cultivation for Mycoplasmas Group I . Patients with Non-infectious Diseases of the Urinary Tract
Mycoplasmas were found in the urethra of 9, and in the bladder urine of two out of the 40 patients examined. Mycoplasmas were not recovered in any case from the upper urinary tract in this group of patients (Table 1).
Group ZZ. Patients with Chronic Pyelonephritis Subgroup a (specimens collected during operation). This subgroup included 3 male and 11 female patients. Mycoplasmas were not recovered from the male patients. From 9 female patients, mycoplasmas were cultivated from the urethra as well as from the bladder urine. From the upper urinary tract, mycoplasmas were isolated from three patients (Table l ). Subgroup b (specimens collected by ureteric catheterization). This subgroup included 1 male and 6 female patients. Mycoplasmas were isolated from the urethra and the bladder urine of the male patient. The six female patients harboured mycoplasmas in the urethra and the bladder urine. Two of these patients also harboured mycoplasmas in the upper urinary tract (Table 1) . Subgroup c (only bladder urine was investigated). Mycoplasmas were not isolated from any of the 6 male and 13 female patients in this subgroup (Table 1) . Altogether, mycoplasmas were recovered from the urethra of 16 out of 21, from the bladder urine of 16 out of 40, and from the upper urinary tract of 5 out of 21 patients examined. Mycoplasmas were the only isolates from the upper urinary tract of four of the patients and two of these, both harbouring M . hominis, revealed signs of an acute exacerbation (Table 2 and 3). No relationship between the p H of the urine and the occurrence of mycoplasmas was found in any group. Neither was the occurrence of mycoplasmas correlated to a certain age group. The occurrence of mycoplasmas did not seem to have special affinity to the occurrence of a certain species of bacteria or to a bacteria free urinary tract. Two patients from whom both M . hominis and U . urealyticum were isolated, had been treated with nitrofurantoin and ampicillin.
13
5
U.urealyticum
4
2
M . hominis E. coli S. albus M . hominis U . urealyticum S. albus
+
+++
++
++
++ ++
++
++ M . hominis
M . hominis
+
M . hominis E. coli S. albus
M . hominis colonies *No*Of
Bladder
U . urealyticum type 1 P. uulrraris M . hominis E. coli
Cultivation results
M . hominis
M . hominis E. coli
* Swabs: recorded as + + + for >loo, + + for 10-100, and Urine specimens: recorded as the number of c.f.u./ml.
+
colonies No.yf
lO5/ml type I11 S. albus
4 x lo5
M . hominis
M . hominis 0 0 M hominis M . hominis M . hominis
M . hominis E. coli M . hominis M hominis M . hominis E. coli 0 0
* Swabs: recorded as + + + for >loo, + + for 10-100, and Urine specimens: recorded as the number of c.f.u./ml.
5
M . hominis U . urealyticum S. albus
4
type I11 S. albus
+++
S. albus
U . urealyticum type I11
U. urealyticum type 1 P . vulrraris
M . hominis
U.urealyticum
+
U . urealyticum type 1 P. uulrraris
Bladder
Urethra
3
3
type I11 S. albus
2
+
colonies *No*Of
1
U. urealyticum type 1 P . vulrraris
Urethra
+
M . hominis E. coli M . hominis M hominis M . hominis E. coli 0 0 for 1-10 colonies.
5x103
< 105/ml
M . hominis 0 0 M hominis M . hominis M . hominis
4 x lo5
3 x 103
M . hominis
>lO5/ml
U . urealyticum
U . urealyticum type1
upper urinary tract
type I11 S. albus
2 x 102
105/ml) nor the occurrence of bacteria in the upper urinary tract could be demonstrated in any of the 40 patients examined. Group 11
Nineteen of the 40 patients examined had significant bacteriuria. The bacteria were identified as E. coli in 12 and as Proteus vulgaris in 7 of these cases. Four patients had E . coli and two P . vulgaris in the upper urinary tract as well. DISCUSSION
The patients included in the group with noninfectious urinary tract disease were selected so that they were comparable in respect to age and sex with the patients in the group with chronic pyelonephritis. This seemed
reasonable as it is well-known that the occurrence of mycoplasmas in the urogenital tract is correlated to age and sex. Mycoplasmas were isolated from 16 out of 40 specimens of the bladder urine (40 per cent) from patients with chronic pyelonephritis. From the bladder urine of 40 patients with non-infectious urinary tract disease, mycoplasmas were isolated only twice (5 per cent). This difference between the two groups of patients is significant (x = 14.05 p
