A history of frequent renal stones may be indicative of an underlying chronic Proteus infection.
Individuals with a Proteus infection may present with urethritis, cystitis, prostatitis, or pyelonephritis. Like other gram-negative bacteria, Proteus species release endotoxin (part of the gram-negative bacterial cell wall) when invading the bloodstream thereby triggering additional host inflammatory responses which can ultimately result in sepsis or systemic inflammatory response syndrome (SIRS), a severe condition with a 20% to 50% associated incidence of mortality. Additionally, alkaline urine will decrease the solubility of both organic and inorganic compounds, encouraging precipitation and struvite (e.g., magnesium ammonium phosphate and calcium carbonate-apatite) stone formation. Through the production of urease and ammonia, Proteus can produce an environment where it can survive. Proteus species also hydrolyze urea to ammonia, thereby alkalinizing the urine. Proteus species also produce urease, which has been shown to be associated with an increased risk of pyelonephritis and upper UTIs. Once Proteus species attach to the target site, a cascade of events is initiated in the host cell, including interleukin (IL) 6 and IL-8 secretion in addition to apoptosis and epithelial cell desquamation. The tips of these fimbriae also contain certain compounds and polysaccharides that allow for attachment to specific sites in the host organism (e.g., endothelium of the urinary tract) or other inanimate surfaces (e.g., medical devices). mirabilis to host tissue depends on the activity of its fimbriae (or pili), which are tiny projections on the bacterium surface. Additionally, the size of the inoculum has a positive correlation with the level of infection.Īttachment of P. Different components of this membrane interact with the host and host defense mechanisms to determine the organism’s virulence. Proteus species have an extracytoplasmic outer membrane, like other gram-negative bacteria, which contains lipoproteins, polysaccharides, lipopolysaccharides, and a lipid bilayer. mirabilis and the host defense (immune) system determines the resultant infection. In the United States, gram-negative bacteremia occurs as a result of genitourinary tract infections in 35% of patients. mirabilis include female sex, longer duration of catheterization, improper catheter cleaning or care, underlying illness, and lack of availability of systemic antibiotics. Other factors that may increase the risk of infection by P. Risk factors for UTIs include sexual activity in both men and women, unprotected anal intercourse in men, an uncircumcised penis, or immunodeficiency (e.g., CD4 count less than 200/uL).
Complicated UTIs (i.e., secondary to catheterization) have an even higher association with Proteus infection at 20% to 45%. coli being the most common), while in hospital-acquired UTIs, Proteus accounts for 5%.
In otherwise healthy women, Proteus accounts for 1% to 2% of all UTIs ( E. In general, UTIs are more common in individuals aged 20 to 50 years and most common in women of this age group. The most common clinical manifestations of Proteus infection are urinary tract infections (UTIs).
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