Bacteriuria and primary biliary cirrhosis.

Abstract

Patients with primary biliary cirrhosis have marked disturbances of humoral and cellular immunity, but an increased susceptibility to infection has not been described previously. We have observed, however, that patients with primary biliary cirrhosis have a high incidence of bacteriuria. This increased susceptibility to urinary infection has been studied and our findings are repoated. Methods PATIENTSPatients with primary biliary cirrhosis were diagnosed by the usual criteria,1 and classified into prefibrotic (stage 1 and 2) and fibrotic disease (stage 3 and 4). Women with other forms of chronic liver disease (non-primary biliary cirrhosis) confirmed by liver biopsy, and women with rheumatoid arthritis,

An exploratory population-based case-control study of primary biliary cirrhosis

“…Two previous case-control studies came to differing conclusions about the link between PBC and the prevalence of bacteruria as verified by a urine test 9,16 : it was suggested that the lack of matching for age distribution, other risk factors for UTI like cirrhosis, and technical problems may have explained this. We investigated whether subjects remembered ever having, or being treated for UTI, and our results did not show a strong association between past UTI and PBC.…”

“…Only one of these used healthy age-matched controls 10 comparing 87 PBC cases with controls (healthy hospital staff and patients with liver disease) to study the frequency of D&C and hysterectomy. Two studies compared UTIs in 89 cases 9 and 160 cases 16 of PBC with unmatched controls with other liver diseases. The final study examined miscarriage in 38 cases using hospital inpatients as controls.…”

“…There are four relevant case-control studies, but only one of them used healthy age-matched controls, and none used comprehensive methods to identify all PBC cases. [9][10][11]16 The strengths of our study are that it has a known population base for both cases and controls, which were matched for age and sex, and the cases cover a broad clinical range (symptomatic and asymptomatic), because of the intensive case finding methods used.…”

“…[5][6][7] The uneven geographical distribution of PBC suggests that one or more extrinsic factors may play an important part in the cause of the disease, possibly in genetically susceptible individuals. Earlier studies reported associations with viral infections 8 ; urinary tract infection (UTI) with Escherichia coli species 9 ; menorrhagia, dilatation and uterine curettage (D&C), and hysterectomy 10 ; and miscarriage. 11 Treatment with various drugs including chlorpromazine, prochlorperazine, and estrogens has also been linked anecdotally with PBC.…”

Experimental evidence on the immunopathogenesis of primary biliary cirrhosis

“…Urinary tract infections have been reported by several authors to be more frequent in patients with PBC than in controls, with Escherichia coli being the main etiological agent. [36][37][38] More recently, our 2005 epidemiological study on 1032 patients with PBC and 1041 rigorously matched controls 9 confirmed the association of an increased risk of PBC not only with urinary tract infections but also with vaginal infections, lifestyle factors such as smoking, and previous pregnancies. We also showed that frequent use of nail polish was associated with a slightly increased risk of having PBC.…”