Serum antibodies study in recurrent urinary tract infection

Correspondence Address:
Vidya N Acharya
Department-Division of Nephrology-Department of Medicine; K.E.M. Hospital, Bombay 400012
India

Source of Support: None, Conflict of Interest: None

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PMID: 501674

Serum antibodies were studied in 187 cases of Urinary Tract Infection (UTI) divided into two groups. Group I consisted of 126 patients with 128 infections who had significant bacteriuria. 90 (70.3%) of these infections were associated with significant anti­body response (> 1:320) at the beginning of the study. It was further observed that uropathogens of all kinds were capable of producing antibody titre response. In the follow up study of 105 infections, it was noted that in 40.9% of infections inspite o f nega­tive urine culture, elevated antibody response persisted even after 3 months. In Group II, 61 patients with history of recurrent UTI with or without evidence of pyelonephritis were studied for re­sponses again` various serotypes of E. coli which were found to be common uropathogens. In this group too, majority o f the patients manifested elevated antibody response even when they had sterile urine at the time o f the study.

:: Introduction

these workers in upper UTI and 1: 160 or less in lower UTI. However, further work over the years has resulted in, contradictory observations by some groups of workers who did not obtain such consistent results with antibody re­sponses. ^[1],[2] It was evident from the study of above literature that there was paucity of data on the antibody response with urinary pathogens other than E. coli. The present work was undertaken with a view (a) to find out the antibody responses with various urinary patho­gens and (b) further to study the signi­ficance of this in relation to the chronic sequelae following UTI.

:: Material And Methods

Over a period of two years (Nov. '75 to Oct. '77), a total of 187 cases were stu­died. These patients were divided into two groups.

Group I: It consisted of 126 patients who had significant bacteriuria (10⁵ organisms/ml) which was determined by Dip-Slide inoculum method ^[4] from 3 consecutive mid-stream urine samples or on obtaining any growth from a single sample of urine drawn by suprapubic bladder aspiration method or by sterile disposable plastic catheter. In this group the antibody titre was determined against patient's own organisms by using indirect haemagglutination method. ^[8] The follow up study was done for a variable period of 3 to 12 months in 77 patients from Group I having 105 infections. The pri­mary urinary pathogens were stored in a refrigerator and the subsequent antibody titres were determined against these pri­mary cultures as well as against reinfect­ing organisms, if isolated.

Group II: The remaining 61 patients who had sterile urine at the time of the study were included in this group. How­ever, this group of patients had several episodes of UTI over a period ranging from 1 to 10 years or were diagnosed to have chronic pyelonephritis, by the com­bined criteria established clinically, radiologically and histologically by kid­ney biopsy. In this group, the antibody titres were determined against E. coli serotypes 01,02,04,06, 07 and 09. These E. coli : strains were found to be the com­mon urinary pathogen in the city of Bombay. ^[6] 14 patients of this group were followed up for 3 to 12 months to detect antibody titre response against the E. coli serotypes

:: Results

Group I: Out of 126 patients, 124 had UTI with single organism and two patients had multiple organisms. The antibody titre response against these 128 urinary pathogens is shown in [Table 1]. It is evident that majority of the orga­nisms were able to produce significant levels of antibodies (> 1:320) in the serum indicating that the majority of uropathogens had antigenicity. Further­more, it is noted that infections due to E. coli, Proteus group, Pseudomonas aeruginosa, A-D group and Staphylococ­cus aureus were able to produce anti­bodies in a large proportion of patients right at the beginning of the infection.

The follow up results of 105 infections were classified into two categories as follows.

Category I: There was recovery of pri­mary infection with no relapse as judged by the conventional criteria of urine cul­ture becoming negative and remaining persistently negative. This occured in 88 (83.8%) infections. In this category the results of antibody titre could be grouped as mentioned below.

(i) In 21 infections (23.9%) the high antibody titre returned to insigni­ficant level.

(ii) Antibody titre remained elevated in 36 (40.9%) infections.

(iii) 31 infections (35.2%) were asso­ciated with insignificant level of antibody all throughout.

Category II: In this category, there were 17 infections (16.2%) which were persistent or were associated with relapse after initial recovery. In this category, the elevated antibody titres were found in 11 infections (64.8% ). [Figure 1] shows the over all results of 105 infections from follow up of 77 patients.

In group II, out of 61 patients, where cultures were sterile, the elevated anti­body titres were observed in 15 patients against E. coli serotype 01, in 21 patients against E. coli-02, in 16 patients against E. coli-04, in 17 patients against E. coli­ 06, in 28 patients against E. coli-07 and in 19 patients against E. coli-09. These re­sults revealed that several patients had elevation of antibodies against more than one serotype of E. coli. In this group 14 patients were followed up and majority of these patients had still persistent high antibody titres. The classical examples of two such patients, viz., (1) one patient (ZK) who had recurrent UTI but no evidence of pyelonephritis and (2) Se­cond patient (B.S.) who had recurrent UTI in the past but had proved to have pyelonephritis are shown in [Table 2] and [Table 3].

:: Discussion

The serum antibody response in UTI depends on the presence of specific anti­bodies in the patient's serum against the 0 antigen of their own infecting micro­organisms causing the UTI. The present study revealed that significant levels of antibody titres were obtained against majority of the urinary pathogens. These included infections due to E. coli, Pseu­domonas aeruginosa, Proteus group, A-D group and Staphylococcus aureus [Table­ 1]. Recently Johny et al [5] have studied the antibody titre responses in different clinical groups of UTIs which were caus­ed by a variety of Gram negative bacte­ria. They also obtained significant levels of antibodies in these groups of patients.

It was interesting to observe from the follow up results of 105 infections in Group I that 40.9% of the infections con­tinued to manifest elevated antibody levels over long periods of time even when primary infection had long cleared off. The same was also observed in 61 cases of Group II who had sterile urine, but high antibody titres were found against more than one strains of E. coli serotypes. The exact significance of these antibody elevation needs to be deci­phered. It could be attributed in certain patients, to the presence of intermittent bacteriuria as observed by Faireley et a1 ^[2] even after a period of years or by the presence of degraded bacterial forms as noted in 82% of cases with intractable symptoms and scarred kidneys. ^[3] Second­ly, the above observation of elevated anti­body titre in presence of sterile urine could be very enlightening on the basis of cross reacting antigen (lipopolysac­charide 0 antigens) in majority of urinary pathogens except Proteus and Pseudo­monas strains. However, this observation is quite contrary to the routine belief that elevated antibodies against an infec­tion is protective in nature as far as UTI is concerned. Is this the vulnerable group likely to develop sequelae of re­current UTI? This is quite likely and could be proved only on very long term follow up of cases of UTI.

:: Acknowledgements

We are grateful to the Seth G. S. Medi­cal College and K,E.M. Hospital Research Society for giving us a grant to carry out this work. We thank the Dean, Dr. C. K. Deshpande of Seth G.S. Medical College and K.E.M. Hospital for the permission to carry out the above study and to pub­lish this paper.

 

:: References

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Figures

  [Figure 1]
 
 

Tables

  [Table 1], [Table 2], [Table 3]

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