cystitis

Chapter: 17
Acute bacterial cystitis is an infection of the urinary bladder caused mainly by coliform bacteria (usually strains of E. coli and other members of the Enterobacteriaciae) and less often by Gram-positive aerobic bacteria (especially Staphylococcus saprophyticus and the enterococci). The infection usually ascends to the bladder from the urethra. The incidence of acute cystitis is much greater in girls and women than in boys and men because the female urethra is shorter and allows easier ascending infection. Adenovirus infection may lead to hemorrhagic cystitis in children; however, viral cystitis rarely is found in adults.

Predisposing factors include pregnancy, diabetes, urinary calculi, prior instrumentation (e.g., cystoscopy), chemotherapy or radiation therapy. Cystitis may be classified as acute or chronic. Histologically such lesions show nonspecific signs of acute or chronic inflammation. Malakoplakia is a unique form of chronic cystitis in which the infiltrate consists of macrophages that contain cytoplasmic inclusions known as Michaelis-Gutmann bodies. Chronic interstitial cystitis is a persistent form of chronic cystitis of unknown etiology, that does not respond to conventional antibacterial therapy and is often associated with mucosal ulceration (Hunner ulcer).