[Changes in the kidneys in patients with successive findings of Mycobacterium xenopi and Mycobacterium fortuitum in the urine--report of 16 cases]].
BACKGROUND
Environmental or MOTT (mycobacteria other than tubercle bacilli) mycobacteria are found in both living environment and most of the food we consume. These mycobacteria can induce a disease in humans, although they rarely do. There are a few reports of urogenital infections caused by these bacteria. This is a report of 16 patients with successive findings of Mycobacterium xenopi and Mycobacterium fortuitum in the urine.


METHODS
In patients suspected for a specific disease of the urogenital tract 7-10 morning urine samples were sent for a bacteriological analysis before initiating any therapy. The samples were treated by 2% NaOH, neutralized by 1% HCl and cultivated on four UIT media with penicillin and acid additives. The cultivated media were incubated at 37C and followed for a potential growth for up to three months. Growth-exhibiting cultures were submitted to a further cultural and biochemical investigation, applying antituberculotic sensitivity tests and a biological probe when needed. The study included 6,468 patients. Finding of mycobacteria was registered in 180 (2.78%) patients. Of them, 164 had Mycobacterium tuberculosis while 16 patients had successive urine culture findings of MOTT bacilli: Mycobacterium xenopi--14 patients or Mycobacterium fortuitum--2 patients.


RESULTS
Of 180 patients with positive bacteriologic urine finding, 164 (91.11%) had Mycobacterium tuberculosis and 16 (8.89%) had MOTT bacilli. Of the latter 16 patients, Mycobacterium xenopi was found in 14. They were all females aged 14-64 yrs. MOTT bacilli were secreted in certain time intervals, ranging from a month to nine years. The bacteria were registered successively, at the frequency rate of 6-53 times. Even 5 of 14 patients worked at the Institute for Lung Diseases as either a nurse, laboratory technician, cleaning lady or an officer at the bacteriologic material admission unit. The evidence of patho-anatomic renal changes was obtained from 11 of 14 patients, including a deformed pelvic system of the kidney, a dilated pelvis of the kidney, papillary ulceration, cystic formations, calcification, hydronephrosis and the presence of concrements. Cystic lesions were the most common ones, registered in 7/14 patients. Regarding functional disorders, haematuria, leukocytes in the sediment, proteinuria and renal colics were most frequently registered. Two patients with successive findings of Mycobacterium fortuitum were presented with neither significant patho-anatomic nor functional renal disorders.


CONCLUSIONS
The following conclusions have emerged from the comparative analysis of the findings: the most common source of Mycobacterium tuberculosis is an infected person. The disease is transmitted by a droplet infection. Smear positive patients infect 50-63% of their family members. The renal disease induced by these bacteria is hematogenous in origin and is always associated with a former extrarenal infection. The infection is bilateral, but always manifested in one of the kidneys only. The symptoms of the infection appear in diverse combinations. The most common is a combination of dysuria and albuminuria, while 20% of patients are asymptomatic. The most effective diagnostic procedures are bacteriologic urine test for mycobacteria and intravenous pyelography. A combined antituberculotic 6-9-month treatment is usually effective. Regarding environmental mycobacteria (MOTT), their host is still obscure. The external environment contains them in abundance, but they are not transmitted from one person to another. The MOTT bacteria's habitat can be earth, water, waste waters, garbage, plant material, sphagnum of the swamp vegetation. They colonize the water-pipe systems in towns and are found in the biofilm which coats the water pipes. Water chlorination does not affect their development. They are also found in country yards, animal farms, raw milk and butter, fruit and vegetables. They are also registered in the house dust, in art
Lovodić-Sivcev
B
B
Institut za plućne bolesti, Sremska Kamenica, Medicinski fakultet, Novi Sad.
Vukelić
A
A
D000293:Adolescent; D000328:Adult; D001437:Bacteriuria / Q000382:microbiology*; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D019907:Mycobacterium fortuitum / Q000187:drug effects / Q000302:isolation & purification*; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D019912:Mycobacterium xenopi / Q000187:drug effects / Q000302:isolation & purification*; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis