The urinary tract is a common site of infection. The complete mechanisms of urinary tract infection (UTI) are still unknown. In general, the strategies of the uropathogenic Escherichia coli are adherence, motility, iron acquisition, toxin, and evasion of host immunity. Host immune responses play a significant part in defense of UTI. Various antimicrobial peptides (AMPs) including defensins, cathelicidin, hepcidin, ribonuclease 7, lactoferrin, lipocalin, Tamm-Horsfall protein, and secretory leukocyte proteinase inhibitor help to prevent UTI by modulation of innate and adaptive immunity. Toll-like receptors (TLRs) play an important role of microorganism identification in innate immunity. Stimulation of TLRs on the cell membrane by ligand of bacteria triggers production of inflammatory chemokines, cytokines, and AMPs. These mechanisms are an attempt to defend the urinary tract against UTI.
Keywords: Urinary tract infections; Molecular biology
INTRODUCTIONUrinary tract infections (UTIs) are one of the most common infections that lead to out-patient and in-patient hospital visits. About 50% of women suffer from a UTI during their lifetime [1]. About 8 million female patients are treated annually for UTI alone in the United States and UTI recurs in about 30% of those who have normal function and anatomy of urinary tract [2]. UTI comprises acute uncomplicated cystitis and acute uncomplicated pyelonephritis. Acute uncomplicated cystitis results in dysuria, frequency, or urgency in healthy and non-pregnant women [3]. The diagnosis is aided by the presence of pyuria in voided urine and positive urine culture of at least 10 3 CFU/ml [3]. Acute uncomplicated pyelonephritis results in fever, costovertebral angle tenderness and flank pain in healthy and non-pregnant women and is similar to cystitis in lower urinary tract symptoms and laboratory analyses [4]. UTIs are commonly classified as uncomplicated and complicated. Complicated UTI occurs in patients with co-morbid illness or anatomic malformations of the urinary tract that can aggravate the risk of infection or therapeutic failure [5]. Complicating factors, for example, include the presence of catheter, obstructive uropathy, pregnancy, urinary stones, diabetes, and male gender. Most of them are main causes of pathogenesis in the host. Meanwhile, bacterial factors in UTI have been studied worldwide for decades with the main focus on Escherichia coli that is the most common pathogen in community acquired UTI [6]. Eighty percent to ninety percent of acute uncomplicated cystitis or acute uncomplicated pyelonephritis correspond to E. coli and the similar explanation applies to most complicated UTIs [7]. E. coli are classified into intestinal E. coli and extraintestinal E. coli. Most in vivo and clinical studies on extraintestinal E. coli related to UTI show that the specific adaptations of uropathogenic E. coli (UPEC)