Dr. Bray Links

Wednesday, January 27, 2016

Do fungi play a role in interstitial cystitis (IC)?

PCR technology has been used in the study of the microbiome and really contributed to this revolution in understanding that we are an ecosystem of good healthy organisms - which has a significant impact on human health. Older culture methods of identifying infections are woefully inadequate for identification of many infectious diseases. Consider tuberculosis which requires months of intensive culture to identify this organism in culture. Not only are PCR techniques considerably faster at giving a actionable result, they are cheaper and can identify organisms that we never would have found with traditional culture technology. I really hope PCR diagnosis of infectious disease is adopted by the mainstream medical community quicker - it will truly usher in a revolution in understanding infectious disease and many previously difficult to treat conditions like IC.



Interstitial cystitis/bladder pain syndrome is characterized by waxing and waning symptoms of bladder pain and storage urinary symptoms.1 Symptom exacerbations among patients with IC/BPS, often called flares, well recognized by physicians and patients, have not been well characterized. Many patients and physicians attribute flares to an infection, and antibiotics are often prescribed.1 and 2 Following the culture status of women with IC/BPS for almost 2 years failed to provide evidence to support the bacterial etiology flare hypothesis.3 However, standard culture techniques have many limitations, including the fact that 99% of known bacteria cannot be cultivated using standard culture media techniques.4 Enhanced culture techniques are reportedly better (larger volumes, multiple media, multiple atmospheric conditions, longer incubation times) at capturing more bacterial and fungal species,5 and 6 while new culture independent methods (such as Ibis T-500 Universal Biosensor technology7) allow for the detection of up to 1% to 3% of the total microbiome without needing an a priori hypothesis of which species are present.

In this study we use a novel, state-of-the-art, culture independent method to compare the microbiota of the lower urinary tract in standard culture negative (for bacteria) female patient with UCPPS (ie IC/BPS) enrolled in the MAPP-EP study8 and 9 who reported a current flare at study entry compared to those women who did not.


There was also no significant difference in the number (percent) or specific genus composition of traditional uropathogens detected between groups (table 4). In patients with IC/BPS with negative standard plate cultures uropathogens were detected in 8.1% vs 9.4% of VB1 in flare vs nonflare cases, respectively. The corresponding values for VB2 specimens were 1.2% vs 3.9%. Univariate analysis revealed a significantly greater prevalence of fungi (Candida and Saccharomyces sp.) in the flare group (15.7%) compared to the nonflare group in VB2 (3.9%) (table 3, p=0.01). When adjusted for antibiotic use and menstrual phase, women who reported a flare remained more likely to have fungi present in VB2 specimens than women who did not report a flare (OR 8.3, CI 1.7–39.4). Representative VB2 heat maps by flare status were developed to illustrate the differences in VB2 between groups (see figure).


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