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Pneumonia and Bladder Disease Linked

A lung bacteria could increase a woman's risk of severe urinary inflammation

FRIDAY, June 1 , 2001 (HealthDayNews) -- New evidence has linked a specific type of pneumonia with a baffling form of urinary inflammation that affects only women.

In a small but significant study, doctors at Vanderbilt University School of Medicine found a peculiarly high incidence of the microorganism Chlamydia pneumoniae in the urine and bladders of women who suffer from a chronic, extremely painful urinary tract condition called interstitial cystitis (IC). Doctors don't know either the cause of the disease or its cure.

"We are trying hard not to take enormous leaps of faiths here and just look at the information that we have, but that information does suggest a correlation between C. pneumoniae infection and interstitial cystitis," says study author Dr. Jenny J. Franke, an assistant professor of urologic surgery at Vanderbilt.

Despite the research, however, other medical professionals don't think the link exists.

"It would be nice if that's what it is, and then we could get somewhere. But I have a feeling it's not going to be repeated," says Dr. Suzanne Frye, a urologist and IC specialist at New York Hospital-Weill Cornell Medical Center.

IC is a condition marked by urinary frequency, urgency and, most prominently, inflammation that causes extreme pain every time the bladder fills. The premise for the study came about when research at numerous medical centers -- including not only Vanderbilt, but also Johns Hopkins and the Mayo Clinic -- began noting that C. pneumoniae was being diagnosed in patients who had other unexplainable inflammatory conditions, including multiple sclerosis, rheumatoid arthritis and even coronary artery disease.

"We began to suspect that it might be behind the inflammation seen in IC, as well," says Franke.

A newly discovered organism that was isolated in 1988, C. pneumoniae is a cousin to the sexually transmitted bug that results in the infection chlamydia. But unlike the sexually transmitted form, which resides primarily in the genital tract, C. pneumoniae is usually present only in the lungs. An infection begins the same way as other forms of pneumonia -- by breathing in the germs that linger in the air after someone infected with the disease coughs.

But how does it get from the lungs to the bladder?

"Our hypothesis is that it enters the lung, causing an inflammatory response there first," says Franke. From there it invades certain immune cells, where it lies dormant until those cells are called upon to fight inflammation elsewhere in the body. When those cells rush to the site of an inflammation, they carry along the C. pneumoniae organism. If the area of inflammation happens to be in or near the bladder, researchers believe C. pneumoniae organisms can once again be activated, causing the syndrome known as IC.

"The [immune] cells can rush to the pelvis after a simple urinary tract infection or even after a hysterectomy -- the infection is essentially transported to whatever area the white blood cells are called to," says Franke. Often, IC appears to develop after some trauma to the urogenital system, like an infection or surgery.

Completing the circle, say researchers, is a genetic susceptibility or congenital weakness in the bladder that allows the C. pneumoniae to take hold and, eventually, cause IC.

The research involved only 23 women: 17 had been diagnosed with IC, six had no urinary tract problems. Testing for C. pneumoniae, doctors found more than 80 percent of the patients with IC were positive, compared to only one woman in the control group.

Taking the study one step further, the women underwent bladder biopsies to check for the organism in tissue cells. The result: the numbers were virtually identical.

"We now need to look further into the possibility that this organism either causes IC or is very intimately involved in the patho-physiology of the disease. And we need to see if symptoms improve after appropriate therapy, and if the organisms are eradicated," says Franke.

That therapy, she adds, is likely to include long-term use of antibiotics -- a regimen that many doctors now believe is what is needed to fully eradicate C. pneumoniae in the lungs.

Frye, however, is doubtful this approach will help women with IC.

"There have been other studies with IC patients on long-term antibiotic treatments, and it hasn't worked. I remain hopeful, but very, very skeptical," she says.

What To Do

Although doctors are encouraged by the findings, no one is prepared to advocate long-term antibiotic therapy for IC patients just yet. However, if you have been diagnosed with IC and can recall having had a pneumonia-type illness months -- or even years -- before developing your urinary symptoms, you might want to talk to your doctor about urine testing for the C. pneumoniae organism.

For more information on IC, visit the Interstitial Cystitis Association here.

You can also click here to find a complete list of IC symptoms and other treatment options.

For more HealthDay stories on bladder disorders, click here.

SOURCES: Interviews with Jenny B. Franke, M.D., study author, assistant professor of urologic surgery, Vanderbilt University Medical Center, Nashville, Tenn.; Suzanne Frye, M.D., professor of urology, IC specialist, New York Hospital-Weill Cornell Medical Center, New York City; study presentation, American Urological Association 2001 Annual Meeting, Anaheim, Calif.
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