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Immunologic Responses in Urinary-Tract Infections: Title and subTitle BreakPrognostic and Diagnostic Evaluation FREE

Jay P. Sanford, MD; Jack A. Barnett, MD
[+] Author Affiliations

Read before the 18th clinical convention of the American Medical Association, Miami Beach, Fla, Dec 1,1964.

Reprint requests to 5323 Harry Hines Blvd, Dallas 75235 (Dr. Sanford).


From the Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas.


JAMA. 1965;192(7):587-592. doi:10.1001/jama.1965.03080200005001
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Circulating antibodies develop in both experimental and clinical pyelonephritis. However, the relationship of such antibodies to antibacterial resistance is complex, and conclusions drawn from various observations have been controversial. In experimental pyelonephritis caused by gram-negative bacilli, preimmunization was protective; however, it was nullified by obstructive uropathy. Clinical assessment of antibody response has had two goals: determination of diagnostic value and assessment of protective effects. While a single hemagglutinin titer is of limited value, a significant rise in anti-0 hemagglutinin titer suggests pyelonephritis. In patients with cystitis, titers tend to remain stable. Immunity appears to play little role in recovery, but may be a determinant in selection of organisms involved in reinfection.

REFERENCES

Landy, M., and Pillemer, L.:  Increased Resistance to Infection and Accompanying Alteration in Properdin Levels Following Administration of Bacterial Lipopolysaccharides , J Exp Med 104: 383-409 ( (Sept) ) 1956;.
McCabe, W.R.:  Endotoxin Tolerance: Its Induction by Experimental Pyelonephritis , J Clin Invest 42:610-617 ( (May) ) 1963;.
McCabe, W.R.:  Endotoxin Tolerance: Its Occurrence in Patients With Pyelonephritis , J Clin Invest 42:618-625 ( (May) ) 1963;.
Freter, R.:  Fatal Enteric Cholera Infection in Guinea Pig, Achieved by Inhibition of Normal Enteric Flora , J Infect Dis 97: 57-65 ( (July) -Aug) 1955;.
Landy, M., et al:  Studies on O Antigen of Salmonella typhosa: Immunologic Properties of Purified Antigen , J Immunol 74:466-478 ( (June) ) 1955;.
Ribi, E., et al:  Physical and Chemical Analysis of Endotoxin From Salmonella enteritidis , J Immunol 84:32-47 ( (Jan) ) 1960;.
Abernathy, R.S.:  Homologous and Heterologous Resistance in Mice Given Bacterial Endotoxins , J Immunol 78:387-394 ( (May) ) 1957;.
Braude, A.I., and Siemienski, J.:  Influence of Endotoxin on Resistance to Infection , Bull NY Acad Med 37:448-467 ( (July) ) 1961;.
Pfaundler, M.:  Eine neue Form der Serumreaktion auf Coliund Proteusbacillosen , Zbl Bakt 23:9-15 ( (Jan 8) ), 71-79 (Jan 19), 131-138 (Jan 31) 1898;.
Hees, H.:  Beitrag zur Verwertung der Coli-Agglutination , Zbl Bakt 99:19-25 ( (July) ) 1926;.
Siede, W., and Luz, K.:  Agglutinabilität und Pathogenität des Bacterium coli bei Erkrankungen der Harnwege , Klin Wschr 10:241-245 ( (March) ) 1941;.
Hughes, W.H.:  Failure of Immunity Responses in Localized Disease , Brit Med J 1:366-368 ( (March 17) ) 1945;.
Needell, M.H., et al:  Antibody (Hemagglutinin) Response of Patients With Infections of Urinary Tract , J Urol 74:674-682 ( (Nov) ) 1955;.
Weyrauch, H.M., et al:  Effects of Antibiotics and Vaccination on Experimental Pyelonephritis , J Urol 78:532-539 ( (Nov) ) 1957;.
Sanford, J.P.; Hunter, B.W.; and Souda, L.L.:  Role of Immunity in Pathogenesis of Experimental Hematogenous Pyelonephritis , J Exp Med 115:383-410 ( (Feb) ) 1962;.
Hunter, B.W.: Akins, L.L.; and Sanford, J.P.:  Role of Immunity in Pathogenesis of Experimental Retrograde Pyelonephritis , J Exp Med 119:869-879 ( (June) ) 1964;.
Sanford, J.P.. et al: " Immunity and Obstructive Uropathy as Determinants in the Pathogenesis of Experimental Pyelonephritis, With Observations on the Distribution of Antibody in Hydronephrotic Kidneys ," in Kass, E.H. (ed.): Second International Pyelonephritis Symposium , to be published.
Cotran, R.S., et al:  Retrograde Escherichia coli Pyelonephritis in the Rat: Bacteriologic, Pathologic, and Fluorescent Antibody Study , J Lab Clin Med 61:987-1004 ( (June) ) 1963;.
Andersen, B.R., and Jackson, G.G.:  Persistent Pyelitis and Pyelonephritis From Retrograde Urinary Tract Infection With Strain of Klebsiella in Rats , J Lab Clin Med 60:457-467 ( (Sept) ) 1962;.
Aran-Sialer, J.A.; Kozij, V.; and Jackson, G.G.:  Effect of Alterations in Humoral and Cellular Host Defense Mechanisms on Pathogenesis of Retrograde Pyelonephritis , abstracted, J Lab Clin Med 60:856 ( (Nov) ) 1962;.
McCabe, W.R., and Jackson, G.G.: " Natural Course of Retrograde Infections of Urinary Tract of Rats With Different Serotypes of Escherichia coli or Enterococcus ," in Quinn, E.L., and Kass, E.H. (eds.): Biology of Pyelonephritis , Boston: Little, Brown & Co., 1960;, pp 39-52.
Austen, K.F., and Cohn, Z.A.:  Contribution of Serum and Cellular Factors in Host Defense Reactions , New Eng J Med 268: 933-938 ( (April 25) ), 994-1000 (May 2), 1056-1064 (May 9) 1963;.
Carey, W.F.; Muschel, L.H.; and Baron, L.S.:  Formation of Bacterial Protoplasts in vivo , J Immunol 84:183-188 ( (Feb) ) 1960;.
Braude, A.I.; Siemienski, J.; and Jacobs, I.:  Protoplast Formation in Human Urine , Trans Assoc Amer Physicians 74:234-245 ( (May) ) 1961;.
Guze, L.B., and Kalmanson, G.M.:  Persistence of Bacteria in Protoplast Form After Apparent Cure of Pyelonephritis in Rats , Science 143:1340-1341 ( (March) ) 1964;.
Barnett, J.A.; Souda, L.L.; and Sanford, J.P.:  Persistence of Immunologic Competence Against Bacterial Antigen in Thymectomized Rats , abstracted, J Lab Clin Med 62:856-857 ( (Nov) ) 1963;.
Slifkin, M., et al:  Value of Serologic Studies in Diagnosis of Chronic Infections of Urinary Tract , abstracted, Bact Proc , 1959;, p 98.
Ehrenkranz, N.J., and Carter, M.J.:  Immunologic Studies in Urinary Tract Infections: Hemagglutinin Response to Escherichia O Antigens in Infections of Varying Severity , J Immunol 92:798-805 ( (May) ) 1964;.
Winberg, J., et al:  Studies of Urinary Tract Infections in Infancy and Childhood: Antibody Response in Different Types of Urinary Tract Infections Caused by Coliform Bacteria , Brit Med J 2:524-527 ( (Aug 31) ) 1963;.
Williamson, J., et al:  Antibacterial Antibodies in Coliform Urinary Tract Infections , Arch Intern Med 114:222-231 ( (Aug) ) 1964;.
Kunin, C.M.:  Antibody Distribution Against Nonenteropathic E coli , Arch Intern Med 110:676-686 ( (Nov) ) 1962;.
Kunin, C.M.: " Microbial Persistence Versus Reinfection in Recurrent Urinary Tract Infections ," in Sylvester, J.L. (ed.): Antimicrobial Agents and Chemotherapy-1962 , Ann Arbor, Mich: Braun-Brumfield, Inc., 1963;, pp 21-25.
Jackson, G.G., et al:  Profiles of Pyelonephritis , Arch Intern Med 110:663-675 ( (Nov) ) 1962;.
Martin, C.M.; Bronstein, E.; and Dray, S.:  Agammaglobulinemia (Clinical Staff Conference, National Institutes of Health) , Ann Intern Med 47:533-543 ( (Sept) ) 1957;.

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Landy, M., and Pillemer, L.:  Increased Resistance to Infection and Accompanying Alteration in Properdin Levels Following Administration of Bacterial Lipopolysaccharides , J Exp Med 104: 383-409 ( (Sept) ) 1956;.
McCabe, W.R.:  Endotoxin Tolerance: Its Induction by Experimental Pyelonephritis , J Clin Invest 42:610-617 ( (May) ) 1963;.
McCabe, W.R.:  Endotoxin Tolerance: Its Occurrence in Patients With Pyelonephritis , J Clin Invest 42:618-625 ( (May) ) 1963;.
Freter, R.:  Fatal Enteric Cholera Infection in Guinea Pig, Achieved by Inhibition of Normal Enteric Flora , J Infect Dis 97: 57-65 ( (July) -Aug) 1955;.
Landy, M., et al:  Studies on O Antigen of Salmonella typhosa: Immunologic Properties of Purified Antigen , J Immunol 74:466-478 ( (June) ) 1955;.
Ribi, E., et al:  Physical and Chemical Analysis of Endotoxin From Salmonella enteritidis , J Immunol 84:32-47 ( (Jan) ) 1960;.
Abernathy, R.S.:  Homologous and Heterologous Resistance in Mice Given Bacterial Endotoxins , J Immunol 78:387-394 ( (May) ) 1957;.
Braude, A.I., and Siemienski, J.:  Influence of Endotoxin on Resistance to Infection , Bull NY Acad Med 37:448-467 ( (July) ) 1961;.
Pfaundler, M.:  Eine neue Form der Serumreaktion auf Coliund Proteusbacillosen , Zbl Bakt 23:9-15 ( (Jan 8) ), 71-79 (Jan 19), 131-138 (Jan 31) 1898;.
Hees, H.:  Beitrag zur Verwertung der Coli-Agglutination , Zbl Bakt 99:19-25 ( (July) ) 1926;.
Siede, W., and Luz, K.:  Agglutinabilität und Pathogenität des Bacterium coli bei Erkrankungen der Harnwege , Klin Wschr 10:241-245 ( (March) ) 1941;.
Hughes, W.H.:  Failure of Immunity Responses in Localized Disease , Brit Med J 1:366-368 ( (March 17) ) 1945;.
Needell, M.H., et al:  Antibody (Hemagglutinin) Response of Patients With Infections of Urinary Tract , J Urol 74:674-682 ( (Nov) ) 1955;.
Weyrauch, H.M., et al:  Effects of Antibiotics and Vaccination on Experimental Pyelonephritis , J Urol 78:532-539 ( (Nov) ) 1957;.
Sanford, J.P.; Hunter, B.W.; and Souda, L.L.:  Role of Immunity in Pathogenesis of Experimental Hematogenous Pyelonephritis , J Exp Med 115:383-410 ( (Feb) ) 1962;.
Hunter, B.W.: Akins, L.L.; and Sanford, J.P.:  Role of Immunity in Pathogenesis of Experimental Retrograde Pyelonephritis , J Exp Med 119:869-879 ( (June) ) 1964;.
Sanford, J.P.. et al: " Immunity and Obstructive Uropathy as Determinants in the Pathogenesis of Experimental Pyelonephritis, With Observations on the Distribution of Antibody in Hydronephrotic Kidneys ," in Kass, E.H. (ed.): Second International Pyelonephritis Symposium , to be published.
Cotran, R.S., et al:  Retrograde Escherichia coli Pyelonephritis in the Rat: Bacteriologic, Pathologic, and Fluorescent Antibody Study , J Lab Clin Med 61:987-1004 ( (June) ) 1963;.
Andersen, B.R., and Jackson, G.G.:  Persistent Pyelitis and Pyelonephritis From Retrograde Urinary Tract Infection With Strain of Klebsiella in Rats , J Lab Clin Med 60:457-467 ( (Sept) ) 1962;.
Aran-Sialer, J.A.; Kozij, V.; and Jackson, G.G.:  Effect of Alterations in Humoral and Cellular Host Defense Mechanisms on Pathogenesis of Retrograde Pyelonephritis , abstracted, J Lab Clin Med 60:856 ( (Nov) ) 1962;.
McCabe, W.R., and Jackson, G.G.: " Natural Course of Retrograde Infections of Urinary Tract of Rats With Different Serotypes of Escherichia coli or Enterococcus ," in Quinn, E.L., and Kass, E.H. (eds.): Biology of Pyelonephritis , Boston: Little, Brown & Co., 1960;, pp 39-52.
Austen, K.F., and Cohn, Z.A.:  Contribution of Serum and Cellular Factors in Host Defense Reactions , New Eng J Med 268: 933-938 ( (April 25) ), 994-1000 (May 2), 1056-1064 (May 9) 1963;.
Carey, W.F.; Muschel, L.H.; and Baron, L.S.:  Formation of Bacterial Protoplasts in vivo , J Immunol 84:183-188 ( (Feb) ) 1960;.
Braude, A.I.; Siemienski, J.; and Jacobs, I.:  Protoplast Formation in Human Urine , Trans Assoc Amer Physicians 74:234-245 ( (May) ) 1961;.
Guze, L.B., and Kalmanson, G.M.:  Persistence of Bacteria in Protoplast Form After Apparent Cure of Pyelonephritis in Rats , Science 143:1340-1341 ( (March) ) 1964;.
Barnett, J.A.; Souda, L.L.; and Sanford, J.P.:  Persistence of Immunologic Competence Against Bacterial Antigen in Thymectomized Rats , abstracted, J Lab Clin Med 62:856-857 ( (Nov) ) 1963;.
Slifkin, M., et al:  Value of Serologic Studies in Diagnosis of Chronic Infections of Urinary Tract , abstracted, Bact Proc , 1959;, p 98.
Ehrenkranz, N.J., and Carter, M.J.:  Immunologic Studies in Urinary Tract Infections: Hemagglutinin Response to Escherichia O Antigens in Infections of Varying Severity , J Immunol 92:798-805 ( (May) ) 1964;.
Winberg, J., et al:  Studies of Urinary Tract Infections in Infancy and Childhood: Antibody Response in Different Types of Urinary Tract Infections Caused by Coliform Bacteria , Brit Med J 2:524-527 ( (Aug 31) ) 1963;.
Williamson, J., et al:  Antibacterial Antibodies in Coliform Urinary Tract Infections , Arch Intern Med 114:222-231 ( (Aug) ) 1964;.
Kunin, C.M.:  Antibody Distribution Against Nonenteropathic E coli , Arch Intern Med 110:676-686 ( (Nov) ) 1962;.
Kunin, C.M.: " Microbial Persistence Versus Reinfection in Recurrent Urinary Tract Infections ," in Sylvester, J.L. (ed.): Antimicrobial Agents and Chemotherapy-1962 , Ann Arbor, Mich: Braun-Brumfield, Inc., 1963;, pp 21-25.
Jackson, G.G., et al:  Profiles of Pyelonephritis , Arch Intern Med 110:663-675 ( (Nov) ) 1962;.
Martin, C.M.; Bronstein, E.; and Dray, S.:  Agammaglobulinemia (Clinical Staff Conference, National Institutes of Health) , Ann Intern Med 47:533-543 ( (Sept) ) 1957;.
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