Doctors in Kentucky have detailed a uncommon case by which an aged girl’s urine turned deep purple because of a bladder an infection complication.
The 76-year-old unnamed affected person affected by coronary heart failure, kidney failure, and bladder most cancers was hospitalized and hooked as much as a catheter to hold away her urine.
An an infection in her urinary tract prompted a biochemical response yielding blue and pink pigments in her pee that, when oxidized within the catheter bag, turned darkish purple.
Doctors issued the uncommon prognosis of purple urine bag syndrome (PUBS), which happens in as many as 42 p.c of sufferers hooked as much as catheters for a very long time.
A chemical response within the liver yields an indigo pigment and indirubin, a pink pigment. Those pigments are mixed and oxidized to show purple within the urinary bag.
Purple urine bag syndrome (PUBS) is often a complication of urinary tract infections (UTIs), as is the case on this 76-year-old girl, the place catheter baggage and tubing flip purple. While it’s virtually at all times benign, the violent shade of purple may be alarming for sufferers, households, and clinicians
Doctors from the University of Pikeville in Kentucky revealed the case within the journal Oxford Medical Case Reports.
Writing within the report, they stated: ‘Elderly and bedridden sufferers with a number of comorbidities extra usually require long-term indwelling catheters which improve their threat of UTIs.
‘Such sufferers usually tend to be contaminated by the rarer micro organism which may go on to trigger PUBS.’
The affected person had an extended historical past of extreme medical points, together with congestive coronary heart failure, persistent kidney illness and bladder most cancers.
She went to the hospital for shortness of breath linked to her cardiovascular points.
To drain her bladder, medical doctors linked the lady to a catheter after which handled her with IV remedy to scale back swelling linked to congestive coronary heart failure.
After 4 days within the hospital, the affected person’s urinary bag took on a violent purple hue.
Dipstick testing discovered that her urine was extraordinarily alkaline with a pH of 8.5, a symptom of her kidneys working improperly.
She additionally had excessive concentrations of the micro organism Proteus mirabilis, a standard trigger for sophisticated urinary tract infections.
PUBS was first described clinically in 1978.
The situation is sort of at all times benign, however it may be alarming to sufferers and their family members.
As nicely as age and frailty, being feminine and in kidney failure, having alkaline urine and constipation are additionally major threat elements.
The phenomenon is a results of a multi-step organic course of within the intestine.
Bacteria aids within the breakdown of the amino acid tryptophan, which turns into a compound known as indole within the intestine, the place it’s then taken to the liver and become indoxyl sulfate.
Indoxyl sulphate is metabolized to indoxyl within the urine with assist from micro organism, which produce phosphatase and sulphatase.
Indoxyl turns into indigo, the blue colour, and indirubin, the pink colour, in alkaline urine, and these colours then combine to type a purple colour.
Purple urine usually alerts to medical doctors that the affected person has a urinary tract an infection, although not at all times.
Chronic constipation is usually related to an overgrowth of micro organism within the colon, which will increase the conversion of tryptophan into indole.
Most individuals who expertise PUBS can be okay, however immunocompromised sufferers are prone to extreme illness, the medical doctors stated. Fournier’s gangrene, as an illustration, can come up because of urinary tract illness. It is a uncommon, life-threatening bacterial an infection within the scrotum (which incorporates the testicles), penis, or perineum that causes physique tissue to die and slough off.
The medical doctors stated: ‘Medical administration of PUBS requires altering the catheter and administering acceptable antimicrobial remedy to deal with the underlying bacterial an infection.
‘Her constipation resolved, and a 5-day course of antibiotics was accomplished. The affected person was discharged to a nursing facility with suggestions to comply with up together with her nephrologist and urologist as an outpatient.’
WHAT IS PURPLE URINARY BAG SYNDROME?
Doctors say the bluish discolouration of urine is triggered by a collection of chemical reactions within the physique.
Bacteria accountable for the UTI breakdown metabolites of tryptophan – an amino acid present in meals.
This produces indole, which turns into indoxl sulfate, which then oxidises into blue-coloured indigo and the reddish indirubin.
Doctors on the King George’s Medical University in Lucknow, India, wrote within the British Medical Journal Case Reports final yr: ‘The mixture of indigo and indirubin offers a purple hue to the urine assortment bag.’
However, the discolouration is totally benign, and infrequently the underlying UTI is taken into account extra regarding to medics.
Women face a better threat of growing PUBS as a result of they’ve a shorter urethra, which leaves them extra susceptible to catching UTIs.
Constipation can even enhance the chances as a result of it offers micro organism extra time to interrupt down tryptophan metabolites within the physique.
It is unclear how widespread PUBS is, nevertheless it has been described as an ‘unusual phenomenon’.
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