MFF0088: Measles virus and measles

I remember having measles as a child. I recall the distinctive maculopapular rash and feeling generally miserable while missing out on school.


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Australian Society for Infectious Diseases

Last week, I received a little bump from the Australian Society for Infectious Diseases. The Society published its September issue of ASID ASIDES which focuses on member activities. This issue had a couple of pages on The Medical Fun Facts Podcast.

I’ve been an ASID member for as long as I can remember. The Society welcomes members from many professional groups including specialist microbiologists, infectious diseases physicians, public health physicians, infection prevention and control practitioners, medical laboratory scientists and other suitably qualified persons with an interest in infectious diseases. If you’re interested in knowing more about ASID and becoming a member, please visit the ASID website.

Measles virus

Welcome to The Medical Fun Facts Podcast, it’s Monday 16 October 2017. Tonight, I wanted to talk about the Measles virus (MeV).

The Measles virus is a single-stranded RNA virus in the genus Morbillivirus. As far as I know, the Measles virus only infects humans. I can also infect some other primates experimentally.

It would appear that Measles virus and the animal pathogen, Rinderpest virus have a common ancestry. Within the species, there are currently 8 clades and about 23 subtypes.

When the Measles virus infects humans, it causes the disease measles. I remember having measles as a child. I recall the distinctive maculopapular rash and feeling generally miserable while missing out on school.

Measles

Measles is a contagious infectious disease which is generally regarded as a respiratory illness but in some patients, it progresses to a neurological disease with a fatality rate that is sadly too high given measles the disease can be eradicated and the Measles virus can be safely contained.

Clinical features of measles include:

  • An early fever, conjunctivitis, coryza, cough and in some cases spots on the mucous membrane inside your mouth near where you find your molars, these are known as Koplik spots.
  • A red blotchy rash usually starts on the face around the third to seventh day and then spreads around the body. The rash can last between four and seven days. The peripheral blood white cell count often drops.
  • Complications, resulting from viral replication or bacterial superinfection, may occur up to 4 weeks after the rash. Death can result from neurological infection and severe secondary bacterial infections which causes a severe consolidating or necrotising pneumonia depending on the bacterial cause.
  • The complications include middle ear infection, pneumonia, laryngotracheobronchitis (croup), diarrhoea, febrile seizures, and brain infection (encephalitis). In about 1 in 100,000 cases, Subacute Sclerosing Panencephalitis (SSPE) may develop years after the infection. SSPE has a very high fatality rate and patients endure a painful terrible death.

Diagnosis can be made clinically when fever, maculopapular rash and cough, coryza, or conjunctivitis are present. It is recommended that clinical diagnoses are confirmed by medical testing by medical laboratory scientists and pathologists. The detection of IgM antibody or a four-fold rise in IgG titre or the detection of Measles virus RNA by PCR in blood, urine, and nasopharyngeal specimens will confirm a diagnosis. As always, isolated IgM detection in the absence of typical symptoms should be interpreted very cautiously. In this situation, PCR of a nasopharyngeal specimen is recommended.

Measles generally occurs in populations where vaccination does not occur or the vaccination rate is low. Vaccination campaigns in many countries have clearly demonstrated that measles can be avoided in communities. In parts of Asia and Africa, >100,000 children died of measles. It’s remarkable that people who hesitate about the safety and value of vaccination sometimes are heard to say that measles is a harmless childhood disease. Improved vaccine coverage in Asia and Africa brought the number of deaths in 2000 which was >500,000 to just over 150,000 in 2011.

The average incubation period for measles is 14 days with a range of 7 to 21 days. Measles virus is transmitted by droplet and direct contact with nasal and throat secretions. Measles is widely regarded as one of the most communicable of infectious diseases. Patients are infectious from 4 days prior to the onset of rash to 4 days after the appearance of the rash. That said, the communicability diminishes quite a lot two days after the appearance of the rash.

If you’ve never had measles and if you’ve never been immunised, you’re susceptible to infection. Most people require at least two doses of vaccine for successful immunisation.

Questions for listeners

Have you had measles?

Have you been immunised against measles?

Have you had your children immunised against measles?

Please leave your answers in the comments section of the show notes or on the Facebook page or on YouTube.

That’s episode 88 in the can.

Please hit the show notes at the blog

Please visit the Facebook page

Medical Fun Facts is available in Anchor, the Apple Podcasts app, and on Stitcher. You’ll find the links in the show notes.

If you have any questions or comments please let me know. If I’ve said anything incorrect I welcome correction.

I’ll catch you next week for episode 89. Something beginning with the letter N. Send me suggestions.

Sign up for the newsletter.

Thank you, and good night.

MFF0087: Legionnaires’ disease

We’re up to the letter L and tonight I’ve chosen to talk about Legionnaires’ disease.

Legionnaires’ disease is a type of pneumonia caused by various serogroups in the species Legionella pneumophila.


Hello and welcome to The Medical Fun Facts Podcast.

It’s Monday 9 October 2017 and you’re listening to episode 87.

Listen here or on your favourite podcatcher

Thanks for listening to The Medical Fun Facts Podcast.

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We’re up to the letter L and tonight I’ve chosen to talk about Legionnaires’ disease.

Legionnaires’ disease is a type of pneumonia caused by various serogroups in the species Legionella pneumophila. There are other species in the genus Legionella that can also cause a lung infection, these include Legionella longbeachæ and L. micdadei.

Legionella pneumophila exists in freshwater and can contaminate cooling towers of air conditioning plants as well as hot water tanks. While the bacterium is not spread person-to-person, it can travel distances in aerosolised form as water mist and be inhaled which may then progress to infection. Not everyone exposed will become infected and go on to develop the disease. People at most risk are older immunologically compromised sapiens especially those who smoke and have chronic lung disease.

The incubation period can vary between 10 and 20 days. The proportion of people exposed who go on the develop disease varies depending on the study you read. It can be from <1% to up to 5% in the general population and much higher in a hospitalised population.

Some of the more unusual symptoms that may be seen in patients with Legionnaires’ disease include blood in the sputum, a slow heart rate and a low sodium concentration in the blood.

The bacterium has a wide tolerance of warm temperatures and can survive in freshwater between 25 and 45 °C. Fortunately, temperatures above 60 °C inhibit the bacterium’s growth. Legionella pneumophila lives symbiotically within certain amœbæ and biofilms made up of these amœbæ protect the survival of these pathogenic bacteria.

Legionella pneumophila enters human lungs either by aspiration of contaminated water or by inhalation of contaminated aerosols of water or soil. In the lung, the bacteria are consumed by macrophages which are like the symbiotic free-living amœbæ but unlike the symbiotic amœbæ the bacteria thrive in, the bacteria multiply and cause the death of macrophages. Once dead, the macrophage gives up the bacteria which can go on to infect more macrophages. This has an amplification effect resulting in many more bacteria and many dead macrophages which creates a significant inflammatory reaction as cellular debris has to be cleared by the host cellular immune system. Legionella pneumophila also contains other virulence factors including proteolytic enzymes and toxins. The main host response is cellular and while antibodies are produced the antibodies do not appear to be protective. That is, the antibodies do not provide protective immunity.

Legionnaires’ disease was first described when an outbreak of severe pneumonia was described in 1976 in a meeting of the American Legion at a convention in Philadelphia. While, Legionnaires’ disease is usually due to Legionella pneumophila, there are other causes of legionellosis. For example, in Australia from time to time there have been outbreaks of serious pneumonia in older Australians who have been working with potting mix in their gardens. The cause has often been Legionella longbeachæ. We’ve also seen outbreaks of Legionnaires’ disease associated with hospitals and a large metropolitan public aquarium.

Diagnosis isn’t always straightforward. Bacteria in the genus Legionella are fastidious and easily killed so special culture media like buffered charcoal yeast extract (BCYE) agar, is required and growth can be slow even when using a special atmosphere that must be generated for the bacterium to grow well enough for characterisation. In this day and age, respiratory specimens can be tested by PCR for a relatively rapid, sensitive and specific diagnosis. A popular but less robust test involves looking for Legionella pneumophila serogroup 1 antigens in urine. This test can be undertaken quickly and easily, but it’s expensive and not all legionellosis is caused by that specific serogroup. It’s commonly requested from critical care areas, usually late on a Friday afternoon when medical laboratory scientists are wanting to go home or go out for a drink. I remember when I was a boy, the only rapid assay was an immunofluorescence test that took hours to set up and it had to be read using a fluorescent microscope in a dark room. It was a test that rarely gave clear endpoints and on more than a few occasions I’d be required as the registrar to stay back late into a Friday evening with the medical laboratory scientist to confirm the result and report it through to the intensive care team. It wasn’t uncommon to develop motion sickness in the claustrophobic environment of the dark room cooped up with another person. Good times!

Legionellosis is prevented with good water control mechanisms. For example, water should be kept below or above the 20–50 °C range in which Legionella bacteria thrive. Water stagnation in pipes should be avoided, and if necessary, pipes should be flushed and disinfected before allowing the flow of potable water. Aerosols and biofilm formation should also be inhibited through good design and regular disinfection respectively.

Because of the severity of pneumonia in patients in whom Legionnaires’ disease is not suspected early enough, we often find patients in intensive care or high dependency units. Effective antimicrobial agents include many macrolides, tetracyclines and fluoroquinolones.

Questions for listeners

Had you heard of Legionnaires’ disease before this podcast?

As you get older are you more careful with potting mix?

Why do bad things always happen on a Friday afternoon?

Please leave your answers in the comments section of the show notes or on the Facebook page or on YouTube.

That’s episode 87 in the can.

Please visit the Facebook page

Medical Fun Facts is available in AnchorApple Podcasts app, and Stitcher. You’ll find the links in the show notes.

Subscribe on Android

If you have any questions or comments please let me know. If I’ve said anything incorrect I welcome correction.

I’ll catch you next week for episode 88. Something beginning with the letter M. Send me suggestions.

Sign up for the newsletter.

Thank you, and good night.

Important Announcement about the podcast

I want to let you know of an important change. If you like Medical Fun Facts and if you subscribe to the podcast and/or the blog posts I’m moving platforms from Squarespace to WordPress.com
I will continue to ensure new shows drop every Monday evening at 7 pm Canberra time. Canberra has just changed to Daylight Saving time so there may be a one hour difference to when you previously received each new show.

One of the benefits of moving to WordPress.com is the better comment capability and ease of embedding the audio and video. It’s also easier for me to maintain the site via the WordPress Reader app.


Hello listeners and readers,

I want to let you know of an important change. If you like Medical Fun Facts and if you subscribe to the podcast and/or the blog posts I’m moving platforms from Squarespace to WordPress.com

This means if you would like an e-mail alert for the blog post I’d love you to subscribe to the new service. Please go to medfunfacts.com and on the right hand sidebar add your e-mail address to subscribe. My preference would be for you to subscribe to the newsletter which means every time a show drops you’ll receive a customised e-mail.

If you want to listen to the podcast on iOS via the Apple Podcasts app there is a new feed into the Apple Podcasts app. Please go to medfunfacts.com and click on the Apple Podcasts image on the right hand sidebar.

If you want to listen to the podcast on Android via Stitcher there is a new feed into Stitcher. Please go to medfunfacts.com and click on the Stitcher image on the right hand sidebar.

For Android users who don’t use Stitcher, I’ve also added a Subscribe to Android button so you can use one of the more popular Android podcatchers. Click on the Andy the Android button and let the internet do its magic.

If you do one or more of these things you will receive an e-mail with new posts and/or your podcatcher will capture every new show that drops.

I will continue to ensure new shows drop every Monday evening at 7 pm Canberra time. Canberra has just changed to Daylight Saving time so there may be a one hour difference to when you previously received each new show.

One of the benefits of moving to WordPress.com is the better comment capability and ease of embedding the audio and video. It’s also easier for me to maintain the site via the WordPress Reader app.

If you have any comments or feedback please go to the contact page on medfunfacts.com and send me your thoughts.

From the next show I will stop updating the old site and only the new site will be updated. I’d love you to follow me to the new site.

While you’re at it, if you like food sign up to my food blog and please sign up to my weekly thoughts and stuff blog The links are in the show notes

Don’t forget to sign up to the newsletter!

Thank you and good night.

MFF0086: Be kind to your anus

The take-home message from this is to be kind to your anus. You only have one. If you abuse your anus you’ll live a life of regret.


Be kind to your anus

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Hello and welcome to The Medical Fun Facts Podcast.

It’s Monday 2 October 2017.

Did you know that 10 years ago today I started working at what was then the Australian Government Department of Health and Ageing. I started as the Assistant Secretary of the Health Emergency Management and Biosecurity Branch in the Office of Health Protection. The department is now known simply as the Department of Health or Health and the branch is more simply the Health Emergency Management branch. For me, I’m now a Principal Medical Adviser.

The last two shows were recorded a couple of weeks ago so that I could have last weekend off to spend time in Bendigo with my youngest daughter who was competing in the National Clubs Gymnastics Carnival.

I’ve struggled a little with what to talk about tonight but a friend on Twitter suggested K could be for Kleenex and that surely I’d find something to chat about on Kleenex tissues.

Well apart from cleaning up various bodily fluids and cleaning out various orifices, I’m not sure what else there is to say. I tend not to buy the brand name tissue paper, preferring the cheaper versions. That said, the brand names like Kleenex and Sorbent do have softer products. I remember when I was in medical school a general surgeon who was teaching us about anal pathology and surgery, said that in his opinion we should treat our anuses kindly and always use the softest of toilet tissue. He felt, that as doctors, the least we could do was spend the extra money we earned on brand name dunny fax sheets. I said I was more interested in spending my extra income on better quality beef and he pointed out that a diet rich in meat and poor in vegetables would not be kind to my anus or my colon.

The take-home message from this is to be kind to your anus. You only have one. If you abuse your anus you’ll live a life of regret.

Where the hell am I going with this podcast?

Back to Kleenex and my Tweep’s suggestion. I think we all know what Kleenex tissues can be used for in terms of personal hygiene and soaking up bodily fluids that we don’t want staining anything, so I’m going to focus on the word tissue.

In English, tissue can mean a few things. We’ve already alluded to tissue paper which is absorbent paper with a myriad of uses. Tissue can also mean an intricate structure or network of connected things, hence the term, “a tissue of lies”. The most common meaning, at least for me, is material from biological life consisting of specialised cells and their products. Tissue is sort of the in-between level between just having cells and having an organ. But it’s not just the cells, it’s also the stuff between the cells, the extracellular material which along with the cells forms a matrix. The study of tissue is histology and the study of disease of tissue is histopathology.

Animals have different types of tissues, for example, there is connective tissue, muscle tissue, neural tissue and epithelial tissue.

Connective tissue

In connective tissue, the cells are separated by an extracellular matrix which can be soft or hard. For example, bone matrix is hard while in blood, the plasma is soft. Connective tissue helps give shape to organs.

Muscle tissue

There are three types of muscle tissue. Voluntary or striated muscle. Smooth muscle. Cardiac muscle. Each is distinct and I have fond memories of histology practical lessons sitting behind a microscope trying to understand the morphology of each type.

Neural tissue

We have neural tissue in the central and peripheral nervous systems with the central system consisting of the brain and spinal cord.

Epithelial tissue

Epithelial tissue covers organ surfaces like the skin, the reproductive tract, the respiratory tract and the alimentary canal. The epithelial layers are linked and in most situations semi-permeable. The epithelial tissues function is mostly protective but specialised cells can also secrete, excrete and absorb.

The epithelial tissues form our skin and it lines our digestive system as a mucous membrane where water and nutrients are absorbed. Epithelial cells can expel waste as well as secrete enzymes and hormones from glands.

There are various cellular types of epithelial tissue too. Our skin is stratified squamous epithelium. Our bladders have transitional cell epithelium. Our respiratory system is mostly lined with ciliated columnar epithelium. In a woman’s cervix, the epithelium changes from the tough stratified squamous epithelium of the vagina to the more delicate mucinous columnar cells.

Questions for listeners

What do you use tissue paper for?

Do you have a special use for tissue paper?

How do you keep your anus in good health?

Please leave your answers in the comments section of the show notes or on the Facebook page or on YouTube.

That’s episode 86 in the can.

Please hit the show notes at the blog

Please visit the Facebook page

Medical Fun Facts is available in Anchor, iTunes, Stitcher and YouTube. Just search for “Medical Fun Facts” and you’ll find it.

If you have any questions or comments please let me know. If I’ve said anything incorrect I welcome correction. I’ll catch you next week for episode 87. Something beginning with the letter L. Send me suggestions.

Thank you, and good night.

Postscript

You may notice that I’ve replicated the show notes to this WordPress.com site. My aim is to wean myself from Squarespace and better use the flexibility inherent to WordPress.com

I hope that Apple and Stitcher will approve the changes and new submissions I’ve made for “The Medical Fun Facts Podcast”.

MFF0085: Japanese encephalitis

JEV is maintained in a cycle involving mosquitoes and hosts like pigs and water birds. People get infected when an infected mosquito bites them. Most infections are asymptomatic or subclinical. That said, a very small number of infected persons develop encephalitis or inflammation of the brain.


Hello, and welcome to Medical Fun Facts.

It’s Monday 25 September 2017

If things are going according to plan as this show drops I’m in Bendigo at the National Club Championships for Gymnastics Australia. My youngest daughter is competing for Delta Brisbane.

Thanks for listening and thanks for watching Medical Fun Facts, a short sharp show with a few facts and hopefully one or two funny lines.

Don’t expect too much from this and we’ll all be happy.

Last week I spoke about impetigo or school sores.

This week I want to speak about Japanese Encephalitis.

Some browsers do not render embedded YouTube videos. The link is at https://youtu.be/yMPzTL1grv8

The Japanese encephalitis (JE) virus is a big cause of vaccine-preventable encephalitis in the western Pacific and parts of Asia. The risk for the majority of travellers is pretty low, but that risk varies depending on the destination, the duration of travel, the season, and activities undertaken.

JEV is maintained in a cycle involving mosquitoes and hosts like pigs and water birds. People get infected when an infected mosquito bites them. Most infections are asymptomatic or subclinical. That said, a very small number of infected persons develop encephalitis or inflammation of the brain.

The major symptoms include the sudden onset of headache, high fever, disorientation, coma, tremors and seizures.

In this group of patients with symptoms, about a quarter will die. There is no specific treatment for JE.

Patient management involves supportive care and management of complications.

Personal protective measures to prevent mosquito bites and vaccination are the only ways to prevent JEV infection.

Avoiding mosquito bites

  • Insect repellent.
  • Wear long sleeves and trousers and socks when outside. If you can, treat your clothes with insect repellent too.
  • Try to stay indoors from dusk to dawn. If you can, find accommodation that is air conditioned or well screened with mosquito netting around the beds.

Who should be immunised?

  • People who plan to be in an endemic area for more than 1 month.
  • People undertaking high risk activity whose plans for travel are less than a month. Such high-risk activity includes substantial time outdoors in rural settings, extensive outdoor activities, or when there is some uncertainty about the risk exposure profile for the travel.

The Japanese Encephalitis Virus

JEV is a flavivirus and similar to West Nile Virus and St Louis Encephalitis Virus. Other flaviviruses include Zika virus, Dengue virus, and Yellow Fever virus.
JEV is a single stranded RNA virus which has five genotypes.

Questions for listeners

So, I have some questions for listeners.

  • Have you ever heard of Japanese encephalitis and Japanese encephalitis virus?
  • Have you ever been infected with JEV?
  • Have you been immunised against Japanese encephalitis?

Please leave your answers in the comments section of the show notes or on the Facebook page or on YouTube.

That’s episode 85 in the can.
Please hit the show notes at the blog
Please visit the Facebook page
Medical Fun Facts is available in Anchor, iTunes, Stitcher and YouTube. Just search for “Medical Fun Facts” and you’ll find it.
If you have any questions or comments please let me know. If I’ve said anything incorrect I welcome correction. I’ll catch you next week for episode 86. Something beginning with the letter K. Send me suggestions.
Thank you, and good night.

You can find me on Twitter and Facebook. Please follow me on Twitter and like my Facebook page.

MFF0084: Impetigo

I didn’t realise until recently that the term ‘school sore’ isn’t universally understood. In Australia, especially when I was a boy growing up in Brisbane, school sores were common and parents were asked to get their children to see their family GP whenever school sores erupted.


Hello, and welcome to Medical Fun Facts.

It’s Monday 18 September 2017

Thanks for listening and thanks for watching Medical Fun Facts, a short sharp show with a few facts and hopefully one or two funny lines.

Don’t expect too much from this and we’ll all be happy.

Some browsers do not render the embedded YouTube video. The link is https://youtu.be/Xx615Jicoas

Last week I spoke about hæmaturia or blood in urine.

This week I want to speak about Impetigo or school sores.

I didn’t realise until recently that the term ‘school sore’ isn’t universally understood. In Australia, especially when I was a boy growing up in Brisbane, school sores were common and parents were asked to get their children to see their family GP whenever school sores erupted.

The most common way school sores present is when you see a crusty yellow rash on a child’s face, arms or legs. The most common cause of impetigo is Streptococcus pyogenes whereas in the less common form, that is, bullous impetigo, the cause is usually Staphylococcus aureus. This crude classification with causation is not hard and fast, but it pretty well follows that if you see large blisters with fluid in them the bacterium most likely to be isolated is Staphylococcus aureus or golden staph. Please note that when we use the term golden staph it does not automatically mean it is a multi-drug resistant bacterium.

For more information on golden staph you can go back all the way to episode 2 and check the notes. I’ve put the link to episode 2 in the show notes. Risk factors for school sores include crowding, day care, poor nutrition, diabetes mellitus and contact sports whether they be organised or just playing footy during the lunch break at school. When I was at primary school, I recall Mum warning me that if I see a kid with school sores not to touch or tackle them because I could get the infection too. As far as I know I never had impetigo as a kid.

The best prevention measures include hand washing, avoiding contact with people who have impetigo and cleaning wounds and injuries.

The infection can be treated with simple antibiotics. Although, without treatment, most impetigo resolves within about three weeks.

The problem with not treating this infection though is that the infection can spread and develop into cellulitis and then immunological complications like glomerulonephritis. Impetigo and similar skin infections are common in tropical and subequatorial areas like the Top End of Australia. Unfortunately, Indigenous Australian children living in these tropical and subequatorial zones are prone to impetigo and we see significant problems with acute glomerulonephritis and subsequent renal or kidney disease in these Australians. Along with diabetes mellitus, impetigo is a significant cause of the high rates of renal failure in Indigenous Australians. Such Australians are then prone to other more serious infections and sequelæ. A lot of efforts have gone into preventing skin disease in Indigenous Australian children.

Questions for listeners

So, I have some questions for listeners.

  • Have you ever had school sores?
  • Did you have them more than once?
  • If you have kids what do you tell them about school sores?

Please leave your answers in the comments section of the show notes or on the Facebook page or on YouTube.

That’s episode 84 in the can.

Please visit the Facebook page
Medical Fun Facts is available in Anchor, iTunes, Stitcher and YouTube. Just search for “Medical Fun Facts” and you’ll find it.
If you have any questions or comments please let me know. If I’ve said anything incorrect I welcome correction. I’ll catch you next week for episode 85. Something beginning with the letter J. Send me suggestions.
Thank you, and good night.

You can find me on Twitter and Facebook. Please follow me on Twitter and like my Facebook page.

MFF0083: Hæmaturia

I remember when I was an intern an older man with a significant prostatic disease who thought the problem he had was in his penis so he took a lead pencil, removed the lead and inserted the hollow wooden pencil into his penis and went too far. He wasn’t familiar with the anatomy of his urethra and so when there was a change in direction the sharp tip of the wooden pencil breached his urethra and this lead to significant bleeding and pain.


Hello and welcome to Medical Fun Facts episode 83, something beginning with H

It’s Monday 11 September 2017

Thank you for listening and thank you for watching Medical Fun Facts a short show with a few medical facts and hopefully one or two funny lines.

Don’t expect too much from each episode and we’ll all be happy.

Last week I mentioned my thoughts about using a search engine like Google as a diagnostic aid.

This week I want to talk about hæmaturia or blood in your urine.

The most common causes include:

  • A urinary tract infection
  • Kidney stones anywhere from the renal pelvis or in the bladder or in the ureter
  • Trauma
  • Carcinoma or a malignancy of the kidney, bladder or prostate in men
  • Benign prostatic hypertrophy in older men
  • Having an indwelling catheter
  • Vigorous exercise
  • A less common but noteworthy cause is sounding or deliberate instrumentation of the urethra for nonmedical reasons

There are also other less common causes too.

Some browsers do not render the embedded YouTube video. The link is at https://youtu.be/oJ16d-dzXQc

Urinary tract infection

Urinary tract infections are a relatively common event, especially in young women. Infections caused by bacteria cause inflammation of the mucosal lining of the ureter, bladder and urethra which can lead to the leakage of blood from capillaries. Visible blood in the urine is a good reason to have your urine examined microscopically to check for not only infection but for other abnormalities. It’s also important that urine is not examined by microscopy and culture unless there are symptoms present or unless the patient is pregnant or younger than 16 or has recently had instrumentation of the urethra. The reason I say this is because far too many urine specimens are collected and patients referred for microscopy and culture for no real benefit. It’s a waste of valuable tax dollars that could be spent elsewhere in the health system.

Kidney stones

Kidney stones are awful. I’m fortunate that I’m yet to experience what is known as renal colic which is when a stone or calculus is stuck in a ureter and smooth muscle walls of the ureter squeeze down and you get a blockage. The pain can be very intense and comes in waves. You can get a set of intense pain and then it lulls for a while and then it hits. You experience intense pain, you sweat, you buckle up and end up on the floor crying in pain. Kidney stones are really bad news.

Trauma

A punch in the back around where the kidneys are can cause trauma. A decent enough punch will cause the kidney to bleed and there will be blood in the urine. Did you know that people who receive a kidney or renal transplant have the donated kidney placed in the lower abdomen in the pelvis? If you’ve received a kidney transplant you don’t want to get into a fight and get punched in the lower belly.

Malignancy

A neoplastic disease like renal cell carcinoma, transitional cell carcinoma of the urinary bladder and other malignancies affecting the urological system can cause blood in the urine. So if you have persistent blood in the urine and infection and other causes have been excluded, urine examination by a cytopathology scientist or a cytopathologist is warranted.

Benign prostate disease

As a man in my fifties, every time I feel like passing urine I wonder if my prostate is getting bigger. Prostatic disease needs to be considered in men over the age of 50. Does this mean that men over 50 should seek a blood test with prostatic specific antigen? Not necessarily. This is a very contentious area and may be something I can discuss in a later episode.

Indwelling catheter

If you have a catheter in your urethra with a bulb in your bladder, it’s not uncommon for there to be some friction and rubbing of the delicate mucosal lining of the urethra and bladder. This can lead to blood in the urine. The other thing an indwelling catheter can cause is bacteriuria which is bacteria in the urine. Anyone with an indwelling catheter will within a week have bacteria in their urine. Such a situation though does not mean the person needs antibiotics because the bacteria are colonising the catheter and not causing infection. They may go on to cause infection, but in the main, IDC associated bacteriuria does not require antimicrobial treatment unless the patient has symptoms consistent with a urinary tract infection. The best move is to remove the IDC if possible. If an IDC is required, changing IDCs may be required.

Sounding

Now some men find self-stimulation of the urethra with a metal sound to be enjoyable. This is effectively self-instrumentation, and depending on the metal sound [the link takes you to my favourite NSFW podcast] and the technique of insertion some trauma of the mucosal lining of the urethra can occur. If the trauma is significant, you may see blood at the end of your penis. I remember when I was an intern an older man with a significant prostatic disease who thought the problem he had was in his penis so he took a lead pencil, removed the lead and inserted the hollow wooden pencil into his penis and went too far. He wasn’t familiar with the anatomy of his urethra and so when there was a change in direction the sharp tip of the wooden pencil breached his urethra and this lead to significant bleeding and pain.

Questions

So, some questions for listeners.

  • Have you ever had unexplained blood in your urine?
  • Have you ever put anything in your urethra? If you have, why?

Please leave your answers in the comments section of the show notes or on the Facebook page or on YouTube.

You can find me on Twitter and Facebook. Please follow me on Twitter and like my Facebook page.

If you have any questions or comments please let me know. If I’ve said anything incorrect I welcome correction. I’ll catch you next week for episode 84. Something beginning with the letter I. Send me suggestions.
Thank you, and good night.