Biochemical and bacteriological investigation of six cases of purple urine bag syndrome (PUBS) in a geriatric ward for dementia

Katsumasa Muneoka, Mariko Igawa, Noriko Kurihara, Jiro Kida, Tomoko Mikami, Isamu Ishihara, Junko Uchida, Kiriko Shioya, Sunao Uchida, Hideto Hirasawa

    Research output: Contribution to journalArticle

    8 Citations (Scopus)

    Abstract

    Aim: Purple urine bag syndrome is a condition in which the urinary catheter bag turns purple. A tryptophan-indigo hypothesis has been proposed as the mechanism of PUBS, in which bacterial decomposition of tryptophan in gut associated with chronic constipation, bacterial overgrowth in the urinary tract and alkaline urine causes production of indigo and discoloration. We considered that further investigation of cases was needed. Methods: We investigated 6 cases exhibiting PUBS (3 males and 3 females). Results: All cases had chronic constipation. Oral ingestion was impossible in one case. PUBS disappeared after antibiotic treatment (3 cases) or spontaneously (one case). Alkaline urine and indicanuria were not found in all cases that showed the disappearance of PUBS. In bacterial culture of urine during the exhibition of PUBS, Enterococcus faecalis was isolated together with Morganella morganii (3 cases) and Pseudomonas aeruginosa (one case). Single infections by Klebsiella pneumoniae or Citrobacter species were also found. After disappearance of PUBS, infected bacterial species changed but no cases showed sterile urine. Urine and blood α-amino-n-butyric acid levels reduced after the disappearance of PUBS whereas tryp-tophan levels did not show related changes. In one case, blood protein concentration increased after the spontaneous disap-pearance of PUBS. Indicanuria and alkalization of urine from urinary catheter bag were more intense than of fresh urine. Conclusions: The present results generally support the Tryptophan-indigo hypothesis'. Furthermore, it was suggested that additional factors associated with the occurrence of PUBS are an environment that facilitates specific bacterial growth in a hospital as well as abnormal metabolism relating to α-amino-n-butyric acid and reduced protein synthesis in patients.

    Original languageEnglish
    Pages (from-to)511-519
    Number of pages9
    JournalJapanese Journal of Geriatrics
    Volume45
    Issue number5
    DOIs
    Publication statusPublished - 2008 Sep

    Fingerprint

    Geriatrics
    Dementia
    Urine
    Indigo Carmine
    Tryptophan
    Urinary Catheters
    Butyric Acid
    Constipation
    Morganella morganii
    Citrobacter
    Enterococcus faecalis
    Klebsiella pneumoniae
    Urinary Tract
    Pseudomonas aeruginosa
    Blood Proteins

    Keywords

    • α-Amino-n-butyric acid
    • Alkaline urine
    • Enterococcus faecalis
    • Indican
    • Purple urine bag syndrome (PUBS)

    ASJC Scopus subject areas

    • Geriatrics and Gerontology

    Cite this

    Biochemical and bacteriological investigation of six cases of purple urine bag syndrome (PUBS) in a geriatric ward for dementia. / Muneoka, Katsumasa; Igawa, Mariko; Kurihara, Noriko; Kida, Jiro; Mikami, Tomoko; Ishihara, Isamu; Uchida, Junko; Shioya, Kiriko; Uchida, Sunao; Hirasawa, Hideto.

    In: Japanese Journal of Geriatrics, Vol. 45, No. 5, 09.2008, p. 511-519.

    Research output: Contribution to journalArticle

    Muneoka, K, Igawa, M, Kurihara, N, Kida, J, Mikami, T, Ishihara, I, Uchida, J, Shioya, K, Uchida, S & Hirasawa, H 2008, 'Biochemical and bacteriological investigation of six cases of purple urine bag syndrome (PUBS) in a geriatric ward for dementia', Japanese Journal of Geriatrics, vol. 45, no. 5, pp. 511-519. https://doi.org/10.3143/geriatrics.45.511
    Muneoka, Katsumasa ; Igawa, Mariko ; Kurihara, Noriko ; Kida, Jiro ; Mikami, Tomoko ; Ishihara, Isamu ; Uchida, Junko ; Shioya, Kiriko ; Uchida, Sunao ; Hirasawa, Hideto. / Biochemical and bacteriological investigation of six cases of purple urine bag syndrome (PUBS) in a geriatric ward for dementia. In: Japanese Journal of Geriatrics. 2008 ; Vol. 45, No. 5. pp. 511-519.
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    abstract = "Aim: Purple urine bag syndrome is a condition in which the urinary catheter bag turns purple. A tryptophan-indigo hypothesis has been proposed as the mechanism of PUBS, in which bacterial decomposition of tryptophan in gut associated with chronic constipation, bacterial overgrowth in the urinary tract and alkaline urine causes production of indigo and discoloration. We considered that further investigation of cases was needed. Methods: We investigated 6 cases exhibiting PUBS (3 males and 3 females). Results: All cases had chronic constipation. Oral ingestion was impossible in one case. PUBS disappeared after antibiotic treatment (3 cases) or spontaneously (one case). Alkaline urine and indicanuria were not found in all cases that showed the disappearance of PUBS. In bacterial culture of urine during the exhibition of PUBS, Enterococcus faecalis was isolated together with Morganella morganii (3 cases) and Pseudomonas aeruginosa (one case). Single infections by Klebsiella pneumoniae or Citrobacter species were also found. After disappearance of PUBS, infected bacterial species changed but no cases showed sterile urine. Urine and blood α-amino-n-butyric acid levels reduced after the disappearance of PUBS whereas tryp-tophan levels did not show related changes. In one case, blood protein concentration increased after the spontaneous disap-pearance of PUBS. Indicanuria and alkalization of urine from urinary catheter bag were more intense than of fresh urine. Conclusions: The present results generally support the Tryptophan-indigo hypothesis'. Furthermore, it was suggested that additional factors associated with the occurrence of PUBS are an environment that facilitates specific bacterial growth in a hospital as well as abnormal metabolism relating to α-amino-n-butyric acid and reduced protein synthesis in patients.",
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    AU - Muneoka, Katsumasa

    AU - Igawa, Mariko

    AU - Kurihara, Noriko

    AU - Kida, Jiro

    AU - Mikami, Tomoko

    AU - Ishihara, Isamu

    AU - Uchida, Junko

    AU - Shioya, Kiriko

    AU - Uchida, Sunao

    AU - Hirasawa, Hideto

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    N2 - Aim: Purple urine bag syndrome is a condition in which the urinary catheter bag turns purple. A tryptophan-indigo hypothesis has been proposed as the mechanism of PUBS, in which bacterial decomposition of tryptophan in gut associated with chronic constipation, bacterial overgrowth in the urinary tract and alkaline urine causes production of indigo and discoloration. We considered that further investigation of cases was needed. Methods: We investigated 6 cases exhibiting PUBS (3 males and 3 females). Results: All cases had chronic constipation. Oral ingestion was impossible in one case. PUBS disappeared after antibiotic treatment (3 cases) or spontaneously (one case). Alkaline urine and indicanuria were not found in all cases that showed the disappearance of PUBS. In bacterial culture of urine during the exhibition of PUBS, Enterococcus faecalis was isolated together with Morganella morganii (3 cases) and Pseudomonas aeruginosa (one case). Single infections by Klebsiella pneumoniae or Citrobacter species were also found. After disappearance of PUBS, infected bacterial species changed but no cases showed sterile urine. Urine and blood α-amino-n-butyric acid levels reduced after the disappearance of PUBS whereas tryp-tophan levels did not show related changes. In one case, blood protein concentration increased after the spontaneous disap-pearance of PUBS. Indicanuria and alkalization of urine from urinary catheter bag were more intense than of fresh urine. Conclusions: The present results generally support the Tryptophan-indigo hypothesis'. Furthermore, it was suggested that additional factors associated with the occurrence of PUBS are an environment that facilitates specific bacterial growth in a hospital as well as abnormal metabolism relating to α-amino-n-butyric acid and reduced protein synthesis in patients.

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    KW - Enterococcus faecalis

    KW - Indican

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