Infectious cystitis

Epidemiology

• Bacterial cystitis

  • Most common cause of cystitis

  • Much more common in women due to short urethra, drier periurethral environment and lack of antibacterial substances that are present in prostatic fluid in men

  • Predisposing conditions: Structural abnormalities of genitourinary tract (exstrophy, urethral malformations, fistulae with other organs, diverticuli, etc.), vesicle calculi, urine stasis, alkaline urine, or systemic diseases such as diabetes, chronic renal disease, and immunosuppression

  • Caused by coliform bacteria such as Escherichia coli , Klebsiella pneumonia , Streptococcus faecalis ; less commonly Proteus vulgaris , Pseudomonas pyocyanea , Neisseria gonorrhoeae , Salmonella typhi , and diphtheroids

  • Access to bladder mostly by ascending route through urethra

• Tuberculous cystitis

  • Almost always caused by Mycobacterium tuberculosis; Mycobacterium bovis in only 3% of cases

  • Follows renal tuberculosis, rarely secondary to genital infection in men

  • Accounts for 7% of extrapulmonary tuberculosis cases

• Viral cystitis

  • Usually in immunosuppressed patients after bone marrow or kidney transplantation

  • Most frequently adenoviruses types 11 and 21; also papovavirus and rarely herpes simplex type 2, herpes zoster, and cytomegalovirus

• Fungal cystitis

  • Most often caused by Candida albicans ; rarely Aspergillus or other fungi

  • Mostly women, debilitated or diabetic patients, or patients under antibiotic therapy

• Schistosomal cystitis

  • Most prevalent in the Middle East and in most African countries