title: Pathogens in Urine from a Female Patient with Overactive Bladder Syndrome Detected by Culture-independent High Throughput Sequencing: A Case Report.
abstract: BACKGROUND
  Overactive bladder syndrome (OAB) is described as urgency, with or without urgency incontinence. A range of medical conditions shares the symptoms of OAB, however the diagnosis is contingent on the exclusion of urinary tract infection (UTI). Knowing that urine dipstick and routine culture of bacteria can miss UTI diagnosis caused by low-count bacteriuria or "difficult-to-culture" pathogens, we examined a case of OAB with a culture-independent approach.
  
  
  METHODS
  A 61-year-old Norwegian female with a long history of urinary symptoms and a diagnosis of OAB was selected as a suitable subject for a culture-independent 16S rDNA analysis on the patient´s urine. The patient's medical records showed no history of recurrent UTI, however, when the urine specimen was sent to routine culture at the time of study it showed a significant bacteriuria caused by a single bacterium, and the patient was prescribed antibiotics. The 16S rDNA analysis revealed not one, but many different bacteria, including a considerable amount of fastidious bacteria, indicating a polymicrobial state. One year later, the subject was still experiencing severe symptoms, and a follow-up analysis was performed. This time the urine-culture was negative, however, the 16S rDNA profile was quite similar to that of the first sample, again displaying a complex bacterial profile.
  
  
  CONCLUSIONS
  The use of 16S rDNA pyrosequencing and sequence analysis to uncover "difficult-to-culture" bacteria should be considered when examining patients with chronic urinary symptoms. These methods may contribute to further elucidation of the etiology of overactive bladder syndrome and other urinary syndromes.
authors: University of Oslo, Department of Biosciences, Centre for Ecological and Evolutionary Synthesis, P.O. Box 1066 Blindern, 0316 Oslo, Norway.
authors: Huma
authors: H
authors: Siddiqui
authors: University of Oslo, Oslo University Hospital, Norwegian Sequencing Centre and Department of Medical Genetics, 0407 Oslo, Norway.
authors: Karin
authors: K
authors: Lagesen
authors: University of Oslo, Department of Biosciences, Centre for Ecological and Evolutionary Synthesis, P.O. Box 1066 Blindern, 0316 Oslo, Norway.
authors: Alexander J
authors: AJ
authors: Nederbragt
authors: University of Oslo, Oslo University Hospital HF Aker-Oslo and Faculty of Medicine, Urological Clinic, P.O. Box 4956 Nydalen 0424 Oslo, Norway.
authors: Lars M
authors: LM
authors: Eri
authors: University of Oslo, Oslo University Hospital HF Aker-Oslo and Faculty of Medicine, Division of Medicine, ME/CFS-Center, P.O. Box 4956 Nydalen 0424 Oslo, Norway.
authors: Stig L
authors: SL
authors: Jeansson
authors: University of Oslo, Department of Biosciences, Centre for Ecological and Evolutionary Synthesis, P.O. Box 1066 Blindern, 0316 Oslo, Norway.
authors: Kjetill S
authors: KS
authors: Jakobsen
keywords: 16S rDNA; amplicon; high throughput sequencing; microbiome; overactive bladder (OAB); urine.