Corynebacterium urealyticum urinary tract infection in dogs and cats: 7 cases (1996-2003)

OBJECTIVE: To identify clinical features of Corynebacterium urealyticum urinary tract infection in dogs and cats and antimicrobial susceptibility patterns of C urealyticum isolates. DESIGN: Retrospective study. ANIMALS: 5 dogs and 2 cats. PROCEDURE: Medical records of dogs and cats for which C urealyticum was isolated from urine samples were reviewed. Isolates from clinical cases, along with previously lyophilized unsubtyped isolates of Corynebacterium spp collected between 1977 and 1995, were examined and, if subtyped as C urealyticum, tested for antimicrobial susceptibility. RESULTS: Signalment of infected animals was variable. Prior micturition disorders were common, and all animals had signs of lower urinary tract disease at the time C urealyticum infection was diagnosed. Median urine pH was 8.0; WBCs and bacteria were variably seen in urine sediment. In vitro antimicrobial susceptibility testing of 14 C urealyticum isolates revealed that all were susceptible or had intermediate susceptibility to chloramphenicol, tetracycline, and vancomycin and most were susceptible to enrofloxacin. Thickening of the bladder wall and accumulation of sediment were common ultrasonographic findings. Contrast radiography or cystoscopy revealed findings consistent with encrusting cystitis in 3 dogs. Infection resolved in 2 dogs following surgical debridement of bladder plaques and antimicrobial administration. In 2 other dogs and 1 cat treated with antimicrobials, infection with C urealyticum resolved, but urinary tract infection with a different bacterial species developed. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that preexisting urinary tract disorders are common in dogs and cats with C urealyticum infection. Treatment with appropriate antimicrobials in combination with surgical debridement might eliminate C urealyticum infection.     

Successful treatment of Corynebacterium urealyticum encrusting cystitis with systemic and intravesical antimicrobial therapy

A 6-year-old Saint Bernard dog was diagnosed with encrusting cystitis caused by Corynebacterium urealyticum. The infection persisted despite the prolonged use of antimicrobials and surgical debridement of the urinary bladder. Resolution occurred following intravenous vancomycin, urine acidification, and intravesical gentamicin. The challenges involved in the treatment of encrusting cystitis are described.     

Relationship of upper and lower urinary tract infection and bacterial invasion of uroepithelium to antibody-coated bacteria test results in female dogs

Urinary tract infection was demonstrated in 12 female dogs via bacteriologic culture of a specimen of bladder urine collected by antepubic cystocentesis. Escherichia coli was isolated in pure culture from the urine of 9 dogs. Urine specimens from 2 dogs contained E coli and alpha-streptococci and from 1 dog contained Streptococcus zymogenes in pure culture. In 6 dogs, urinary tract infection was limited to the urinary bladder, whereas 6 dogs had unilateral or bilateral culture-positive renal pelvic urine as well (specimens collected by percutaneous nephropyelostomy). An antibody-coated bacteria (ACB) test was conducted on a portion of the bladder urine specimen from each dog, and the urinary tissues from these 12 dogs and from 6 healthy, noninfected female dogs were examined at necropsy. Tissues were given a subjective score based on the severity of the lesions seen microscopically. Histologic scores, bacterial cultural results, and ACB test results were examined for significance. A significant difference was found in the histologic scores between infected and noninfected dogs (P less than 0.025), but comparisons among histologic scores, cultural results, and ACB test results were not significant among infected dogs. The ACB test could neither be used to localize bacterial infection within the urinary tract nor could it be used to indicate the presence of bacterial invasion of the uroepithelium in dogs.     

Urinary tract infection caused by Corynebacterium urealyticum in a dog

Urinary tract infection (UTI) caused by Corynebacterium urealyticum is a rarely recognised condition in veterinary medicine. This report describes a case in a 13-month-old dog which presented with a history of dysuria and haematuria. C urealyticum was identified as the cause of UTI. The clinical, radiological and ultrasonographic features and the results of urinalysis and urine bacteriological culture are described, as are the therapeutic challenges presented by this particular infection.     

Comparison of three techniques for the diagnosis of urinary tract infections in dogs with urolithiasis

OBJECTIVES: To identify an appropriate sampling technique(s) to accurately detect the bacteria causing urinary tract infections in dogs with urolithiasis. METHODS: Twenty-one dogs with urolithiasis were included in the study. Three types of samples were taken from each dog. Urine was collected by cystocentesis, and a urinary bladder mucosal biopsy and urolith were retrieved during cystotomy. The samples were then cultured on blood agar and MacConkey's agar to identify the bacteria associated with urinary tract infections. RESULTS: Bacterial urinary tract infection was found in 16 cases (76.19 per cent). The most prevalent bacteria found to cause urinary tract infection were Escherichia coli (n=7), followed by coagulase-positive Staphylococcus species (n=4), Klebsiella pneumoniae (n=2), Pseudomonas aeruginosa (n=2) and Proteus mirabilis (n=1). In the case of a positive urine culture, the same bacteria were also cultured from the urinary bladder mucosal biopsy alone or from both the urinary bladder mucosal biopsy and urolith. However, in the case of a negative urine culture, bacteria were found to be present in the urinary bladder mucosal biopsy or urolith cultures in 23.81 per cent of dogs. The uroliths that gave positive culture results were either infection-induced uroliths composed of struvite and calcium carbonate phosphate, ammonium acid urate only or metabolic uroliths composed of calcium oxalate and calcium phosphate, or calcium phosphate only. All the uroliths that gave negative culture results were metabolic uroliths composed of calcium oxalate and/or calcium phosphate, and uric acid and calcium phosphate. CLINICAL SIGNIFICANCE: When the culture from the urine obtained by cystocentesis is negative, cultures of urinary bladder mucosal biopsy and urolith are recommended in dogs with urolithiasis in order to accurately assess the microbiological status of the urinary tract.     

Encrusting cystitis in a cat secondary to Corynebacterium urealyticum infection

An 18-year-old male neutered domestic shorthair cat was presented for investigation of haematuria and lethargy. The cat had sustained a traumatic T3-L3 lesion 5 years prior resulting in upper motor neuron incontinence. On further investigation the cat was found to be hyperkalaemic, hypothermic and dehydrated. Ultrasonography of the bladder revealed a markedly hypoechoic, thickened bladder wall with an irregular, hyperechoic mucosal layer. The patient responded to symptomatic and supportive care and was discharged. Despite initial improvement, the patient returned 10 days after discharge with recurrence of haematuria and lethargy. Ultrasound-guided aspiration and culture of the material on the mucosal surface of the bladder confirmed diagnosis of UTI caused by Corynebacterium urealyticum. On post-mortem examination, gross and histopathological features were consistent with encrusting cystitis. This is the first case report of encrusting cystitis in a cat. C urealyticum, an uncommon urinary tract pathogen in small animals, should be considered in patients with predisposing conditions.     

Cystoscopy in cattle--a valuable additional tool for clinical examination

Based on the findings of physical examination and on laboratory findings the urinary bladder of 23 cows was examined endoscopically in order to investigate the application of cystoscopy in cattle. The endoscopic findings of all examined cows were compared with the findings of physical examination and the results of macroscopic and microscopic urinalysis and the bacteriological culture of the urine. By physical examination only 3 cows were diagnosed to have urinary tract disease, whereas all other cows were suspected of having an urinary tract disease. Bacteriological culture of the urine revealed Corynebacterium renale and Escherichia coli infection in 18 cows, while the remaining 5 cows were negative. By cystoscopy catarrhal cystitis was diagnosed in 2 cases, haemorrhagic cystitis in 5 cases, and fibrinous-purulent and fibrinous-haemorrhagic cystitis in 13 cases. Three cows showed no pathological changes of the urinary bladder mucosa by endoscopic examination. Cystoscopy facilitates diagnosis through the direct visualisation of mucosal lesions and makes it possible to give a more accurate prognosis based upon the findings.     

High Urine Concentrations of Basic Fibroblast Growth Factor in Dogs With Bladder Cancer

Because dogs with bladder cancer often have advanced disease at the time of diagnosis, the identification and use of a tumor marker that could facilitate earlier diagnosis is a valid approach to improve prognosis. The objective of this study was to determine if urine concentrations of the proan-giogenic peptide, basic fibroblast growth factor (bFGF), are high in dogs with bladder cancer compared with normal dogs and dogs with urinary tract infection. We used a commercially available enzyme-linked immunosorbent assay test kit to quantitate bFGF in the urine of 17 normal dogs, 10 dogs with urinary tract infection, and 7 dogs with locally active transitional cell carcinoma of the urinary bladder. In normal dogs, the median urine bFGF concentration was 2.23 ng/g creatinine (quartile range, 1.53 to 5.12 ng/g creatinine). The median urine bFGF concentration in dogs with urinary tract infection did not differ significantly from normal dogs. Dogs with bladder cancer had significantly higher urine bFGF concentrations than normal dogs ( P < .002) and dogs with infection ( P < .02). The median urine bFGF concentration in dogs with transitional cell carcinoma was 9.86 ng/g creatinine (quartile range, 7.40 to 21.63 ng/g creatinine). Six of 7 dogs with bladder cancer had urine bFGF concentrations that were up to 7.4 times the 90th percentile value for normal dogs. Only 1 of 10 dogs with infection had a urine bFGF concentration that exceeded the 90th percentile of normal. These data suggest that canine bladder cancers export bFGF, and that urine bFGF may be useful as a diagnostic tumor marker or noninvasive indicator of treatment response. J Vet Intern Med 1996;10:231–234. Copyright © 1996 by the American College of Veterinary Internal Medicine .     

Isolation of Nocardia asteroides from a dog with haemorrhagic cystitis

The clinical, clinicopathological, serial urinalysis, urinary bladder radiography and urine bacteriological culture results in a three-year-old male dog with haematuria of four days duration are presented. The dog had cystitis associated with suspected Nocardia asteroides infection. There was rapid resolution of clinical signs on institution of treatment with ampicillin.     

Modified "cup-patch" ileocystoplasty for urinary bladder reconstruction in a dog

Full-thickness wall necrosis involving 90 to 95% of the urinary bladder was diagnosed in a 6-month-old Golden Retriever 2 days after ovariohysterectomy. An isolated, vascularized segment of ileum denuded of mucosa was used to reconstruct the urinary bladder. Serial excretory urography over 1 year indicated gradual enlargement of the bladder, with development of a smooth mucosal surface. At 6 months after reconstructive surgery, the dog was voiding urine 2 to 3 times/d and was continent. Results of renal function testing, urinalysis, and bacteriologic culture of urine were all considered normal on follow-up examinations. The cause of bladder wall necrosis was never determined. Ileocystoplasty as described herein appears to be an effective urinary bladder reconstructive procedure in dogs whenever the bladder neck, proximal portion of the urethra, and their neurovascular supply can be spared.     

Evaluation of a method using Proteus mirabilis and Pseudomonas aeruginosa to experimentally induce dual infection of the urinary bladder in dogs

OBJECTIVE: To evaluate a method using Proteus mirabilis and Pseudomonas aeruginosa to experimentally induce dual infection of the urinary bladder in dogs. ANIMALS: 6 healthy mixed-breed dogs. PROCEDURE: Dogs were anesthetized, and cystitis was induced by infusing a solution of salicylic acid in ethanol into the bladder, followed by an inoculum containing field isolates of P. mirabilis and P. aeruginosa. Dogs were examined daily for 21 days after induction of cystitis. On day 21, dogs were euthanatized, and urinary bladder, renal pelvis, and prostate specimens were submitted for bacterial culture. RESULTS: After induction of cystitis, all dogs had evidence of thickening of the bladder wall, dysuria, tenesmus, and hematuria. Urinalysis revealed proteinuria, hematuria, and pyuria. All urine samples obtained on day 21 yielded growth of P. mirabilis, but P. aeruginosa was not cultured from any of these samples. Proteus mirabilis was isolated from bladder, renal pelvis, or prostate specimens from 4 dogs; P. aeruginosa was not isolated from any of the tissue specimens. CONCLUSION: Results suggest that the method used in the present study fails to induce dual infection of the urinary bladder with P. mirabilis and P. aeruginosa. The inability to establish a persistent dual infection with this method may have been a result of insufficient pathogenicity of the Pseudomonas isolate or an inadequacy of the experimental design.     

Polypoid cystitis in 17 dogs (1978-2001)

Polypoid cystitis is a rare disease of the urinary bladder in dogs characterized by inflammation, epithelial proliferation, and development of a polypoid mass or masses without histopathologic evidence of neoplasia. Medical records of 17 dogs with polypoid cystitis were reviewed to determine the clinical and laboratory features of this disorder and to assess treatment and outcome. Most affected dogs (15/17) were female and presented for evaluation of hematuria or recurrent urinary tract infection (UTI). Proteus spp were the most common bacterial isolates (12/52 or 23.1%) identified when all urine samples obtained for culture at any time during the course study were considered. Other commonly isolated organisms included Escherichia coli , Staphylococcus spp, and Enterococcus spp. Several dogs (7/17) also had cystic calculi at some time during the course of their disease. Most of the masses (11/14) were located cranioventrally in the bladder as opposed to transitional cell carcinoma, which has a predilection for the bladder neck or trigone area. It is unknown whether persistent or recurrent UTI predisposes to polyp formation or if polyps predispose to UTI. Surgery and removal of all polyps was the most efficacious treatment in dogs of this study. The question of whether or not polyps represent preneoplastic lesions remains unanswered and constitutes an area for future investigation.     

Absence of urinary tract infection in dogs with experimentally induced hyperadrenocorticism

Objectives of this study were to determine occurrence of urinary tract infection and describe results of urine analysis and urine culture in dogs with experimentally induced hyperadrenocorticism. Dogs were randomly assigned to receive either hydrocortisone (nine dogs) or placebo (eight dogs) for 49 consecutive days. Before and on day 49 of treatment, evaluation of dogs included physical examination, abdominal ultrasound, urine culture, urinalysis, adrenal function testing, and measurement of urine protein and creatinine and activity of serum alkaline phosphatase. All dogs in the experimental group had clinical and laboratory findings of hyperadrenocorticism. Urine specific gravity was significantly decreased and urine protein-to-creatinine ratio was significantly increased in dogs with hyperadrenocorticism. Urinary tract infection did not occur in any dogs. We conclude that administration of hydrocortisone created a model of hyperadrenocorticism; however, urinary tract infection did not occur. Additional evaluation is needed to determine association between urinary tract infection and hyperadrenocorticism.     

Clinicopathologic and pathologic findings of herpesvirus-induced urinary tract infection in conventionally reared cats

Clinicopathologic manifestations of induced infection of the feline lower urinary tract with bovid herpesvirus-4 (BHV-4, strain FCAHV) were characterized in 6 conventionally reared adult cats (2 sexually intact males, 2 castrated males, and 2 females). Two additional control cats were exposed with noninfected cell culture control inoculum. Clinical and radiographic signs of lower urinary tract disease were not observed in exposed or control cats. Microscopic hematuria was detected in urine samples collected by cystocentesis from 4 to 6 exposed cats and 1 of 2 control cats. Results of culture of urine for bacteria, mycoplasmas, ureaplasmas, and viruses were consistently negative. Low titer of serum BHV-4 (strain FCAHV)-neutralizing antibodies was detected in 4 of 6 exposed cats, but not in controls. Gross abnormalities of the urinary tract were not observed in any cat. Light microscopic examination of serial sections of the lower urinary tract revealed mild focal lymphoid cystitis in 2 of 6 exposed cats, one of which also had increased amounts of connective tissue and proliferation of blood vessels in the urinary bladder lamina propria. Ninety days after initial exposure, BHV-4 (strain FCAHV) was reisolated from explanted urinary bladder tissues of 5 of 6 exposed cats. Virus was not isolated from tissues of control cats. It was concluded that BHV-4 (strain FCAHV) establishes persistent urinary tract infection in conventionally reared adult male and female cats. However, persistent BHV-4 infection in cats may remain clinically inapparent.     

Presumptive pseudohypoaldosteronism secondary to chronic urinary tract obstruction from sloughed urinary bladder mucosa and urinary tract infection in a cat

Objective – To describe a case of presumptive secondary pseudohypoaldosteronism (PHA) in a cat with urinary tract infection and chronic urethral obstruction. The obstruction was believed to have resulted from sloughed urinary bladder mucosa secondary to pressure necrosis. Case Summary – A 5‐year‐old, 4 kg, castrated male Siamese cat presented for vomiting and stranguria. Medical history included a perineal urethrostomy for urethral obstruction. Physical examination revealed a large, painful, nonexpressible urinary bladder. Point‐of‐care testing demonstrated electrolyte derangements consistent with a postrenal azotemia and metabolic acidosis. Results of urine culture was positive for bacterial growth. Diagnostic imaging revealed presence of retroperitoneal fluid, marked urinary bladder wall thickening, bilateral hydroureter, mild bilateral pyelectasia, and small nephroliths. The patient was treated for a urinary tract obstruction and infection. In the 3 weeks following initial discharge, the patient was evaluated on multiple occasions for lethargy, intermittent vomiting, inappropriate urination, and progressive polyuria and polydipsia. Although the urinary bladder was easily expressed during repeat examinations, it was persistently distended and subjectively thickened upon palpation. Repeat ultrasound of the urinary tract showed evidence of sloughed tissue in the bladder lumen, likely secondary to chronic urethral obstruction and pressure necrosis. A cystotomy was performed to remove the necrotic tissue, and a revised perineal urethrostomy was done due to a partial urethral stricture. Bladder biopsies were obtained at this time. Postoperatively, the cat was reported by the owners to be urinating normally but continued to be polyuric and polydipsic in the week following discharge. One week after surgery, the cat presented in hypovolemic shock with laboratory findings consistent with a presumptive diagnosis of secondary PHA. New or Unique Information Provided – PHA has not been reported previously in a cat. This case report suggests that aldosterone resistance should be considered in cats with consistent laboratory findings and a history of documented obstructive uropathy and urinary tract infection.     

Pyelonephritis in cows: 15 cases (1982-1986)

Medical records of 15 adult cows with a final diagnosis of pyelonephritis were evaluated retrospectively. Only 3 cows had obvious clinical signs that indicated urinary tract disease. Physical examination, including rectal and vaginal examinations, and urine chemical reagent strip screening detected abnormalities in all 15 cows and allowed subsequent confirmation by culture results of urine samples obtained using a catheter. Bacteriologic cultures of urine revealed Corynebacterium renale infection in 6 cows and Escherichia coli infection in 9 cows. Long-term treatment with antimicrobial drugs resulted in recovery in 9 of 11 treated cows. Of these, 4 of 4 cows with C renale infection and 5 of 7 cows with E coli infection recovered; the remaining 2 cows with E coli infection died.     

Transitional cell carcinoma of the urinary bladder in a 14-year-old dog

A 14-year-old spayed female poodle-pekinese dog with a history of hematuria was tentatively diagnosed with non-radiopaque uroliths or urinary bladder neoplasia following temporary resolution of clinical signs after several rounds of antibiotic treatments, normal abdominal radiographs and no growth on urine culture. Abdominal ultrasound revealed a mass in the trigone area of the urinary bladder which was confirmed to be an invasive transitional cell carcinoma by histopathology following euthanasia.     

Pathophysiology,Clinical Importance,and Management of Neurogenic Lower Urinary Tract Dysfunction Caused by Suprasacral Spinal Cord Injury

Management of persistent lower urinary tract dysfunction resulting from severe thoracolumbar spinal cord injury can be challenging. Severe suprasacral spinal cord injury releases the spinal cord segmental micturition reflex from supraspinal modulation and increases nerve growth factor concentration in the bladder wall, lumbosacral spinal cord, and dorsal root ganglion, which subsequently activates hypermechanosensitive C‐fiber bladder wall afferents. Hyperexcitability of bladder afferents and detrusor overactivity can cause urine leaking during the storage phase. During urine voiding, the loss of supraspinal control that normally coordinates detrusor contraction with sphincter relaxation can lead to spinal cord segmental reflex‐mediated simultaneous detrusor and sphincter contractions or detrusor‐sphincter dyssynergia, resulting in inefficient urine voiding and high residual volume. These disease‐associated changes can impact on the quality of life and life expectancy of spinal‐injured animals. Here, we discuss the pathophysiology and management considerations of lower urinary tract dysfunction as the result of severe, acute, suprasacral spinal cord injury. In addition, drawing from experimental, preclinical, and clinical medicine, we introduce some treatment options for neurogenic lower urinary tract dysfunction that are designed to: (1) prevent urine leakage arising because of detrusor overactivity during bladder filling, (2) preserve upper urinary tract integrity and function by reducing intravesical pressure and subsequent vesicoureteral reflux, and (3) prevent urinary tract and systemic complications by treating and preventing urinary tract infections.     

Evaluation of methods for localization of urinary tract infection in the female dog.

Urinary tract infection (UTI) was induced in the left kidney of seven female dogs and in the urinary bladder of eight female dogs. Several methods advocated for localization of UTI in other species were tested in the infected dogs. Although fever, renal pain, and leukocytosis were detected in some dogs with renal infection, findings were transient. Radiographic changes in the kidneys and ureters were detected in some dogs with renal infection, but were absent in others. Bladder washout studies were not reliable for differentiating renal infection from bladder infection. Antibody coating studies were positive in dogs with bladder infection and in dogs with renal infection. The positive results from dogs with bladder infection may have been because of nonspecific binding of immunoglobulins to Staphylococcus aureus after leakage of serum immunoglobulins into urine. Studies of six dogs of both sexes with naturally occurring UTI indicated that their serum contained antibody against common urinary pathogens and that this antibody gained access to the urine in some dogs. It was concluded that the antibody coating test was unreliable for localization of UTI in the dog.     

Urethral infection of male monkeys by Mycoplasma hominis and Ureaplasma urealyticum

Seven male Macaca nemestrina, eight male Macaca mulatta and three male Papio hamadrias were infected with M. hominis or U. urealyticum separately or simultaneously into the urethra. Animals of the first two species exhibited moderate infection and mild clinical urethritis characterized by increased number of PMNL in the urethral discharge and colonization and lymphocytic infiltration of the mucous membrane of the urethra and urinary bladder. Animals of the third species proved to be less sensitive.