Mixed Acid Fermentation of Glucose as a Mechanism of Emphysematous Urinary Tract Infection

Abstract

Emphysematous pyelonephritis is a severe necrotizing infection that usually occurs in patients with diabetes mellitus or obstructive uropathy. Although glucose fermentation has been considered as the main cause of gas production the actual mechanism remains controversial. Compositions of gas samples from 2 patients with emphysematous pyelonephritis recently encountered were analyzed, and showed 15% hydrogen, 4.8% carbon dioxide, 60% nitrogen, 6.7% oxygen and some unknown gases in case 1, and 3.4% hydrogen, 22% carbon dioxide, 66% nitrogen and 9.8% oxygen in case 2. These results tend to implicate mixed acid fermentation of glucose as the pathway by which emphysematous urinary tract infections develop.

Emphysematous pyelonephritis presenting in acute respiratory distress syndrome: a case report

“…EPN due to Pseudomonas, Enterobacter, Candida and Citrobacter freundii have also been reported. [7][8][9] High levels of glucose in the vicinity of the renal tissue and impaired tissue perfusion serve as predisposing factors. 10,11 These organisms ferment sugars within the urine, thereby, producing gases like nitrogen, oxygen, hydrogen and carbon dioxide.…”

“…10,11 These organisms ferment sugars within the urine, thereby, producing gases like nitrogen, oxygen, hydrogen and carbon dioxide. 7 Ultrasonography and computerized tomography of the abdomen are the main diagnostic modalities, with 80% and 100% sensitivity respectively.…”

Emphysematous pyelonephritis with Dengue hemorrhagic fever: A successful medical management of a fatal scenario

“…These organisms ferment sugars within the urine and produce gases like oxygen, nitrogen, hydrogen and carbon dioxide. 7 Ultrasound study and computerized tomography scan are the main imaging modalities, with 80% and 100% sensitivity respectively. 8,9 The CT classification of EPN is as follows: • Class 1: Gas confined to the collecting system; • Class 2: Gas confined to renal parenchyma alone; • Class 3a: Perinephric extension of gas or abscess; • Class 3b: Extension of gas beyond the Gerota fascia; • Class 4: Bilateral EPN or unilateral EPN with a solitary kidney.…”

Cistitis enfisematosa: una inusual forma de presentación de la infección del tracto urinario bajo

“…Dependiendo si las burbujas están sometidas a presiones positivas o negativas se quedan en el lumen del órgano o pasan a la pared del mismo e incluso al torrente sanguíneo. El daño tisular por el gas y la microangiopatía causan acumulación de gas, que se ve potenciado por el déficit inmunitario y el mal control metabólico 8,9 . La presencia de gas en la infección del tracto urinario no es exclusiva de la vejiga y ha sido descrito con mayor frecuencia en pielonefritis del paciente diabético, comprometiendo vía urinaria alta y parénquima renal 1 .…”