尿路感染症におけるL型菌の研究

Abstract

Bacterial L-forms, a cell wall deficient mutant form, are known as inflammatory latent factors which are formed by bacterial cell wall blocking agents (cf. some kinds of antibiotics, lysozyme, serum and so on), but when they revert to parent strain, they acquire parental, high virulence again. The author examined bacterial L-forms in the urinary tract diseases, of which diseases of the upper urinary tract were 94 and those of the lower urinary tract were 84 cases. All the cases were medicated by synthetic penicillins or cephalosporins before examinations. Positive data of bacterial L-forms were shown in 22 cases (23.4%) of the upper tract diseases and 2 cases (2.4%) of the lower tract diseases. Symptoms of bacterial L-forms infections in the urinary tract were not obvious, but clinical data showed some signs of inflammation. Therapy of bacterial L-forms in the urinary tract infection is, at first, how to reduce urinary hyperosmolality. The method of reducing hyperosmolality is operation and water diuresis. Operations were done on 24 cases and thus 20 of the 24 cases improved. Water diuresis was attempted on 10 cases with ureteral calculus using intravenous administration of 5% glucose solution, 1, 000 ml daily for 7 days and thus 8 of the 10 cases improved. Administration of antibiotics was done only for 4 non-improved cases with operation and 2 non-improved cases with water diuresis. Macrolide antibiotics, sensitive to bacterial L-forms, were administered to these 6 cases with usual dosis during 5 to 7 days and finally all cases improved. In two of the 6 cases, recurrence of the urinary infection occurred after withdrawal of macrolide antibiotics administration. In these two cases urine osmolality remained high even after the operation. Sometimes bacterial L-forms are thought to be iatrogenic because of many bacterial cell wall blocking drugs such as synthetic penicillins or cephalosporins which were used mainly as antibiotics against urinary infections in the recent years. Therefore, variant types, for example bacterial L-forms, being apt to survive under hyperosmotic conditions in renal parenchyma, are necessary to be examined clinically and fundamentally in chronic or recurrent urinary infections.