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Hoffmann, R. A wiki for the life sciences where authorship matters. Nature Genetics (2008)

Host and bacterial virulence factors predisposing to emphysematous pyelonephritis.

BACKGROUND: Emphysematous pyelonephritis (EPN) is a rare, severe, gas-forming infection of the kidney, and its precise pathogenesis remains obscure. METHODS: To investigate the roles of host and bacterial virulence factors in the pathogenesis of EPN, we compared: (1) host factors in patients with EPN (n = 47) with those in patients with acute renal infections without gas formation (non-EPN; n = 79), (2) the prevalence of virulence gene in causative Escherichia coli strains from 16 of the 47 EPN cases with all 79 non-EPN cases by means of polymerase chain reaction analysis, and (3) gas volumes produced by EPN and non-EPN strains cultured in broths at 3 glucose concentrations (100, 180, and 250 mg/dL [5.6, 10.0, and 13.9 mmol/L]). RESULTS: Diabetes mellitus (DM) with poor glycemic control (ie, hemoglobin A1c level > 11%) and urinary tract obstruction were more prevalent in the EPN group. However, DM with poor glycemic control was the only host factor independently associated with EPN (odds ratio, 4.9; P = 0.018). EPN strains had a greater prevalence of the uropathogenic-specific protein ( usp) genes. Multivariate analyses also showed the association between usp and EPN with borderline significance (odds ratio, 8.4; P = 0.057). There was no significant difference in gas production by E coli isolated from patients with or without EPN. CONCLUSION: DM with poor glycemic control and urinary tract obstruction are host factors predisposing to EPN. There was no difference in gas production between EPN and non-EPN E coli strains. The distribution of E coli virulence genes was remarkably similar between the 2 groups. However, the PapG II adhesin (papG II) gene is significantly decreased and the usp gene is increased with borderline significance in EPN E coli strains.[1]


  1. Host and bacterial virulence factors predisposing to emphysematous pyelonephritis. Tseng, C.C., Wu, J.J., Wang, M.C., Hor, L.I., Ko, Y.H., Huang, J.J. Am. J. Kidney Dis. (2005) [Pubmed]
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