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Follicular cystitis in girls with untreated asymptomatic or covert bacteriuria
Insights
Nodular bladder changes, seen in children with urinary tract infections, are linked to recurrent infections. These changes are reversible and caused by bacteria, not a primary bladder issue.
Area of Science:
- Pediatric Urology
- Infectious Diseases
- Pathology
Background:
- Nodular changes of the bladder mucosa, including cystitis follicularis and cystitis cystica, occur in 2-9% of children with urinary tract infections (UTIs).
- These nodules consist of lymphoid aggregates, similar to intestinal Peyer's patches, and are associated with a poor short-term prognosis and recurrent infections in children.
- Asymptomatic bacteriuria is present in a small percentage of the female population without overt disease.
Purpose of the Study:
- To investigate the relationship between asymptomatic bacteriuria and nodular changes in the bladder mucosa.
- To determine if these nodular changes are a primary lesion or secondary to bacterial presence.
- To assess the reversibility of bladder mucosal nodularity.
Main Methods:
- Cystoscopic examination of 59 girls with untreated asymptomatic bacteriuria.
- Biopsy of nodular bladder mucosa in 22 girls to analyze histological features.
- Correlation of nodular changes with the presence or absence of bacteriuria.
Main Results:
- 52 out of 59 girls (88%) with asymptomatic bacteriuria exhibited nodular bladder mucosal changes.
- Biopsies revealed lymphocytic infiltration and follicular formation in a significant number of cases.
- Nodular changes persisted during bacteriuria and resolved upon becoming abacteriuric.
Conclusions:
- Bladder mucosal nodularity in the context of bacteriuria is a reversible condition.
- These findings strongly suggest that nodular changes are secondary to bacterial infection, not a primary pathological lesion.
- The study supports the hypothesis that bacterial presence triggers these lymphoid-based mucosal responses.
Abstract:
Nodular changes of the bladder mucosa, that is cystitis follicularis or cystitis cystica, are found in 2 to 9% of all children with urinary tract infections. The nodules are composed of lymphoid aggregates, resembling Peyer's patches in the intestine. Children with this finding are considered to have a poor short-term prognosis with a marked tendency for recurrent infections. Screening programs for bacteriuria have revealed that a few per cent of the female population are bacteriuric without symptoms of overt disease. Of 59 girls followed with untreated asymptomatic bacteriuria 52 had nodular changes of the bladder mucosa at cystoscopy. Biopsy was performed in 22 girls, and revealed lymphocytic infiltration in 19 and follicular formation in 11. The nodular changes persisted when bacteriuria continued but disappeared in patients who became abacteriuric. This finding demonstrates the reversibility of the changes, and supports the assumption that they are secondary to the presence of bacteria and not a primary lesion.