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dc.contributor.authorGanguli, Leelaen
dc.date.accessioned2018-09-13T15:56:14Z
dc.date.available2018-09-13T15:56:14Z
dc.date.issued1966
dc.identifier.urihttp://hdl.handle.net/1842/32250
dc.description.abstracten
dc.description.abstract1. The literature regarding the etiology and pathology of human urinary tract infections has been reviewed. Particular reference was paid to factors involved in the initiation and perpetuation of urinary infection in man by an ascending route. || 2. Animal experimental models used to study the human disease were considered in detail. Some of the limitations in the application of these results were considered. || 3. The literature regarding methods used to diagnose the presence and the severity of human urinary infection was considered, namely: quantitative and semi- quantitative culture of urine, Gram stain of uncentrifuged urine, pyuria, white cell excretion rate, estimation of white cell concentration, "pyrexal" and prednisolone tests, radiology of the urinary tract including the demonstration of vesico- ureteral reflux, serological typing of urinary strains of Escherichia coli and the serum antibody response to a urinary infection. || 4. The concept of "significant bacteriuria ", developed by counting the numbers of viable organisms present in 1 ml. of voided urine, was considered in detail with reference to the findings of Kass (1956). The importance of asymptomatic bacteriuria in pregnancy and the possible complications associated with the presence of this condition were considered. || 5. Chemical and bacteriological screening tests used to detect women with significant bacteriuria were considered. || 6. The modified nitrite test and the triphenyl tetra - zolium chloride (T.T.C.) test to detect significant bacteriuria were evaluated in 1,000 specimens of urine from antenatal and infertile women. The former test detected 69 out of 71 or 97% of urine specimens with significant bacteriuria as determined by a quantitative culture technique. The T.T.C. test detected only 54 or 765 of these infected urines. || 7. A total of 9,741 consecutive pregnant women attending the Simpson Memorial Maternity Pavilion had urine specimens examined by the extended nitrite test. All positive by this test had a confirmatory quantitative culture of this urine specimen done. Of these, 595 or 6.1% were found to have significant bacteriuria. || 8. 1,443 married but infertile women attending the Infertility Clinic also had urine specimens examined. Of these, 118 or 8.2% were found to have significant bacteriuria. This finding was compared to the reported incidence in mature unmarried women and school -children. It was postulated that marriage and sexual intercourse was a factor in initiating the occurrence of significant bacteriuria in pregnant women. Kass's claim (1960) that all women with bacteriuria of pregnancy acquire it in 250. the first two months of pregnancy was considered unlikely. || 9. A group of 127 women with asymptomatic bacteriuria were included in a treatment trial. Suiphadimidine or cycloserine was given for two weeks to alternate women in the trial and the results evaluated during the remainder of pregnancy by examination of specimens of urine by quantitative culture technique. || 10. The immediate result of treatment in each case was evaluated by examination of a specimen of urine one week after cessation of therapy. In 96 out of 127 or 75.6% the treatment was successful. || 11. The long -term results were more disappointing since only 65 or 51.2% of these 127 women remained uninfected during the rest of pregnancy. In 31 women there was a recurrence of bacteriuria during the follow -up period. || 12. There was no significant difference in the results obtained by these two drugs. || 13. The occurrence of the following complications during pregnancy, viz., bacteriologically proven acute urinary infection with symptoms, anaemia, toxaemia or hypertension, prematurity by weight, prematurity by gestation, abortion, and total foetal loss was determined in treated and untreated women with bacteriuria and a non-bacteriuric control group of pregnant women. || 14. There was a highly significant difference in the incidence of symptomatic infections in the treated and untreated women with bacteriuria and the non -bacteriuric control group. Successful treatment of asymptomatic bacteriuria was highly effective in preventing symptomatic infection during pregnancy. || 15. The incidence of anaemia was significantly higher in pregnant women with bacteriuria which was untreated or unsuccessfully treated when compared with non - bacteriuric or successfully treated women. || 16. The incidence of toxaemia or hypertension was not significantly reduced by successful treatment or asymptomatic bacteriuria of pregnancy. The incidence of this complication was significantly higher in bacteriuric women when compared to non -bacteriuric controls. || 17. No correlation between the incidence of prematurity and bacteriuria of pregnancy was found. || 18. The incidence of abortion and total foetal loss was significantly higher in the untreated bacteriuric pregnant women in comparison with the other groups. || 19. A standardised method for estimating the in vitro sensitivity of urinary pathogens to sulphadimidine has been developed. || 20. There was good correlation between the results of in vitro sensitivity tests and the clinical response to treatment in 52 out of 62 patients in the trial. || 21. There was no significant relationship between the results of in vitro sensitivity tests and the clinical response to treatment in 65 women treated with cycloserine. These findings are discussed. || 22. Rabbit antisera to the following standard Escherichia coli '0' types were prepared, i.e. 01, 02, 04, 06, 07, 087 018, 025, 075, 077. || 23. It was possible to serologically type 139 or 55.4% of 251 urinary strains of Escherichia coli with the above antisera. These typed strains were obtained during the study of 51 patients with asymptomatic bacteriuria of pregnancy. || 24. The relative frequency of occurrence of each of these '0' types in 47 women with asymptomatic bacteriuria were determined. '0' type 6 occurred most frequently, in 11 of these women, '0' type 75 in nine women and '0' type 2 in eight women. These results are discussed with reference to results obtained by other workers in this field. || 25. The haemagglutination technique of Neter et al. (1952) for the detection of antibodies to Escherichia coli has been modified in this study. || 26. The bacterial agglutination technique and haemagglutination technique for the estimation of antibodies to urinary strains of Escherichia coli have been evaluated. || 27. The haemagglutination technique was found to be more sensitive in estimating the antibody response in 81 non -bacteriuric pregnant women. Ten standard '0' type strains of Escherichia coli were used as antigens in each of these patients. || 28. The antibody response also estimated in 54 women who were successfully treated for asymptomatic bacteriuria of pregnancy, 21 women who had a recurrence of bacteriuria following treatment and in nine bacteriuric women who failed to respond to treatment. || 29. In five women who failed to respond to treatment there was a significant antibody response in three of whom the rise in antibody titre coincided with the clinical onset of symptoms of acute pyelonephritis.en
dc.publisherThe University of Edinburghen
dc.relation.ispartofAnnexe Thesis Digitisation Project 2018 Block 20en
dc.relation.isreferencedbyen
dc.titleLaboratory studies on bacteriuriaen
dc.typeThesis or Dissertationen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnamePhD Doctor of Philosophyen


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