Urinalysis for interleukin-8 in the non-invasive diagnosis of acute and chronic inflammatory diseases

The Prevalence and Association of Different Uropathogens Detected by M-PCR with Infection-Associated Urine Biomarkers in Urinary Tract Infections

Background

Many emerging uropathogens are currently identified by multiplex polymerase chain reaction (M-PCR) in suspected UTI cases. Standard urine culture (SUC) has significantly lower detection rates, raising questions about whether these organisms are associated with UTIs and truly cause inflammation.

Objective

To determine if microbes detected by M-PCR were likely causative of UTI by measuring inflammatory biomarkers in the urine of symptomatic patients.

Design Setting and Participants

Midstream voided urine was collected from subjects ≥60 years presenting to urology clinics with symptoms of UTI (n = 1132) between 01/2023 and 05/2023. Microbe detection was by M-PCR and inflammation-associated biomarker (neutrophil gelatinase-associated lipocalin, interleukin 8, and interleukin 1β) was by enzyme-linked immunosorbent assay. Biomarker positivity was measured against individual and groups of organisms, E. coli and non-E. coli cases, emerging uropathogens, monomicrobial and polymicrobial cases.

Outcome Measurements and Statistical Analysis

Distributions were compared using 2-sample Wilcoxon Rank Sum test with 2-tailed p-values < 0.05 considered statistically significant.

Results and Limitations

M-PCR was positive in 823 (72.7%) specimens with 28 of 30 (93%) microorganisms/groups detected. Twenty-six of twenty-eight detected microorganisms/groups (93%) had ≥2 biomarkers positive in >66% of cases. Both non-E. coli cases and E. coli cases had significant biomarker positivity (p < 0.05). Limitations were that a few organisms had low prevalence making inferences about their individual significance difficult.

Conclusion

The majority of microorganisms identified by M-PCR were associated with active inflammation measured by biomarker positivity, indicating they are likely causative of UTIs in symptomatic patients. This includes emerging uropathogens frequently not detected by standard urine culture.

Elevated UTI Biomarkers in Symptomatic Patients with Urine Microbial Densities of 10,000 CFU/mL Indicate a Lower Threshold for Diagnosing UTIs

The literature lacks consensus on the minimum microbial density required for diagnosing urinary tract infections (UTIs). This study categorized the microbial densities of urine specimens from symptomatic UTI patients aged ≥ 60 years and correlated them with detected levels of the immune response biomarkers neutrophil gelatinase-associated lipocalin (NGAL), interleukin-8 (IL-8), and interleukin-1-beta (IL-1β). The objective was to identify the microbial densities associated with significant elevation of these biomarkers in order to determine an optimal threshold for diagnosing symptomatic UTIs. Biobanked midstream voided urine samples were analyzed for microbial identification and quantification using standard urine culture (SUC) and multiplex-polymerase chain reaction (M-PCR) testing, while NGAL, IL-8, and IL-1β levels were measured via enzyme-linked immunosorbent assay (ELISA). NGAL, IL-8, and IL-1β levels were all significantly elevated at microbial densities ≥ 10,000 cells/mL when measured via M-PCR (p < 0.0069) or equivalent colony-forming units (CFUs)/mL via SUC (p < 0.0104) compared to samples with no detectable microbes. With both PCR and SUC, a consensus of two or more elevated biomarkers correlated well with microbial densities > 10,000 cells/mL or CFU/mL, respectively. The association between ≥10,000 cells and CFU per mL with elevated biomarkers in symptomatic patients suggests that this lower threshold may be more suitable than 100,000 CFU/mL for diagnosing UTIs.

The role of chemokines and adipokines as biomarkers of Crohn's disease activity: a systematic review of the literature

INTRODUCTION

Crohn's disease (CD) is an inflammatory bowel disease (IBD) that affects the gastrointestinal tract and can have a major impact on the patient's quality of life and social/professional activities. Asymptomatic patients, or those with mild symptoms, experience the active disease with subclinical manifestation. Systematic review (SR) was performed to look for evidence for the role of chemokines and adipokines as markers for CD activity.

METHODS

This SR was conducted by searching published studies in international and regional databases up till July, 2020. CD patients were adults with the disease in activity or remission. All adipokines and chemokines were considered for the analysis and the Rayyan QCRI system was used.

RESULTS

In total, 20 studies were included. Six addressed chemokines and eight adipokines as potential biomarkers of CD activity. CXCL8 was the most studied chemokine (8 studies) and the results were controversial, with 62.5% showing a significant association with CD activity. CXCL10 was investigated by 4 studies and 50% identified it as a potential biomarker. CCL2, CCL11, CCL26 and CXCL1 were examined by 2 articles each. CXCL8 (P=0.002/P=0.001) and CXCL1 (P<0.001) presented the lowest? P value, which qualifies them as potential markers of disease activity. All the adipokines were tested in peripheral blood but 44.4% were also tested in intestinal mucosa, while the percentage in the chemokines' studies was 76.9% in peripheral blood, 46.1% in intestinal mucosa and 7.6% in urine sample respectively.

CONCLUSION

The development of disease activity biomarkers for CD is becoming relevant for clinical practice. Chemokines and adipokines have the potential to signalize CD activity, but validation in larger cohorts of patients, preferable multicenter studies are still needed.

SARS-CoV-2: sewage surveillance as an early warning system and challenges in developing countries

Transmission of novel coronavirus (SARS-CoV-2) in humans happens either through airway exposure to respiratory droplets from an infected patient or by touching the virus contaminated surface or objects (fomites). Presence of SARS-CoV-2 in human feces and its passage to sewage system is an emerging concern for public health. Pieces of evidence of the occurrence of viral RNA in feces and municipal wastewater (sewage) systems have not only warned reinforcing the treatment facilities but also suggest that these systems can be monitored to get epidemiological data for checking trend of COVID-19 infection in the community. This review summarizes the occurrence and persistence of novel coronavirus in sewage with an emphasis on the possible water environment contamination. Monitoring of novel coronavirus (SARS-CoV-2) via sewage-based epidemiology could deliver promising information regarding rate of infection providing a valid and complementary tool for tracking and diagnosing COVID-19 across communities. Tracking the sewage systems could act as an early warning tool for alerting the public health authorities for necessary actions. Given the impracticality of testing every citizen with limited diagnostic resources, it is imperative that sewage-based epidemiology can be tested as an early warning system. The need for the development of robust sampling strategies and subsequent detection methodologies and challenges for developing countries are also discussed.

Influence of the Plant-citrate Complex on Indicators of Systemic Inflammation in Patients with Urolithiasis

Treatment of urolithiasis is a complex task of modern medicine. The search for non-invasive methods of treatment, prevention of relapses and complications, slowing down the development of renal failure is an urgent issue of our time. The study demonstrated a comprehensive analysis of indicators of systemic inflammation in patients with urolithiasis and the effectiveness of using the plant-citrate complex. The objective: to conduct a clinical assessment of systemic inflammation in patients with urolithiasis, to determine the effectiveness of the use of the plant-citrate complex of the drug Uriklar on the indicators of systemic inflammation. Materials and methods. There were examined 52 (55.6 %) patients with urolithiasis, which were divided into two groups: Group I (main group) – 32 patients with urolithiasis who received the herbal citrate complex and Group II (comparison group) – 20 patients with urolithiasis. The control group included 20 almost healthy individuals. All patients underwent clinical and laboratory tests: general and biochemical blood tests to determine the parameters of iron metabolism, lipid profile, CRP, determination of the levels of cytokines in the blood, blood pressure, body mass index. Results. The results of this study demonstrate the development of systemic inflammation in patients with urolithiasis, determined by a decrease in GFR. Against the background of the treatment with Uriklar, a decrease in the levels of pro-inflammatory cytokines, CRP and ferritin is observed, which indicates the anti-inflammatory properties of the drug. Conclusion. Such properties of the plant-citrate complex are pathogenetically substantiated and can be recommended for urolithiasis, which, along with the therapeutic properties, allows to obtain the provision of metaphylaxis of urolithiasis and to slow down the rate of development of chronic kidney disease.

Design of Appropriate Technology-Assisted Urine Tester Enabling Remote and Long-Term Monitoring of Health Conditions

A novel design idea supported by affordable design processes can address unresolved social problems such as the imbalance of opportunity in healthcare services, owing to high costs and a lack of access. We designed an appropriate technology-assisted urine tester to provide healthcare services for the elderly and underprivileged in order to monitor their health conditions daily and remotely help them determine whether to visit hospitals/clinics for in-depth diagnoses. To minimize production costs, we used a charge-coupled device camera for colorimetric-type urine analysis in conjunction with commercially available urine test strips; all other electronic components were mass-produced. We calibrated this urine tester and compared it with a commercially available high-end tester; the results showed high accuracy for most urine compounds. We verified its major device functions by recruiting four participants who tested their urine over four weeks and provided self-surveys of their health conditions. The proposed tester demonstrates a low price-to-performance ratio with high reliability, while its production and maintenance costs are as low as 20 USD per set. We focused on a human-centered technological approach from a simple and innovative design point of view in order to serve people and healthcare providers in an affordable way. We believe that the tester can be widely distributed, exemplifying appropriate technological application for those who require, but cannot enjoy, proper medical services, thereby improving social healthcare sustainability.

Future perspectives of wastewater-based epidemiology: Monitoring infectious disease spread and resistance to the community level

Infectious diseases are acknowledged as one of the most critical threats to global public health today. Climate change, unprecedented population growth with accelerated rates of antimicrobial resistance, have resulted in both the emergence of novel pathogenic organisms and the re-emergence of infections that were once controlled. The consequences have led to an increased vulnerability to infectious diseases globally. The ability to rapidly monitor the spread of diseases is key for prevention, intervention and control, however several limitations exist for current surveillance systems and the capacity to cope with the rapid population growth and environmental changes. Wastewater-Based Epidemiology (WBE) is a new epidemiology tool that has potential to act as a complementary approach for current infectious disease surveillance systems and an early warning system for disease outbreaks. WBE postulates that through the analysis of population pooled wastewater, infectious disease and resistance spread, the emergence of new disease outbreak to the community level can be monitored comprehensively and in real-time. This manuscript provides critical overview of current infectious disease surveillance status, as well as it introduces WBE and its recent advancements. It also provides recommendations for further development required for WBE application as an effective tool for infectious disease surveillance.

Acute Appendicitis: The Reliability of Diagnosis by Clinical Assessment Alone

Background and Aims:

This prospective study aimed to review the trustworthiness of the initial clinical assessment in acute appendicitis without employment of imaging modalities, laparoscopy or any other adjunct diagnostic test.

Patients and Methods:

717 patients were operated on for appendicitis by six different surgeons. Initial clinical and laboratory examination were evaluated in relation to the intraoperative and the pathological appreciation of the appendiceal inflammation.

Results:

598 patients were found to have appendicitis, 34 a different condition, 41 had both appendicitis and an additional condition and 44 no pathology. 6% of the laparotomies and 11 % of the appendectomies were unnecessary. The severity of the inflammation correlated significantly with periumbilical pain, pain migrating to right lower quadrant, loss of appetite, fever, rebound tenderness, local rigidity, polymorphonuclear predominance on deferential, polymorhonucleosis and leukocytosis. Leukocytosis was less frequent in aged patients. All the six surgeons were found to be equally reliable, although they all underestimated the setting compared to the pathologists. Patients with a long duration of symptoms had milder forms of inflammation and increased percentage of unanticipated abdominal conditions.

Conclusions:

Appendicitis can be reliably diagnosed clinically without employment of adjunct tests. These can be reserved for equivocal cases.

Hyperbilirubinemia as a predictor of gangrenous/perforated appendicitis: a prospective study

BACKGROUND

THE AIMS OF THE STUDY WERE: 1) to establish the role of hyperbilirubinemia as a new diagnostic tool to predict gangrenous/perforated appendicitis; and 2) to compare other variables such as age, duration of symptoms, clinical profile, white blood cell count, C-reactive protein and ultrasound in a similar role.

METHODS

This is a prospective study conducted on 50 consecutive cases of acute appendicitis admitted to the emergency ward. These were subjected to investigations to support the diagnosis. These cases were also subjected to liver function tests and clinical diagnosis was confirmed perioperatively and post-operatively by histopathological examination. Their clinical and investigative data were compiled and analyzed. Statistical analysis was performed using either chi square test or fisher's exact test. The level of significance was set at P< 0.05.

RESULTS

Total serum bilirubin including both direct and indirect was found to be significantly increased in case of acute suppurative appendicitis. Serum bilirubin was much higher (P <0.000) in cases of gangrenous/perforated appendicitis.

CONCLUSION

Serum bilirubin is an important adjunct in diagnosing the presence of gangrenous/perforated appendicitis.

Urinary cytokine levels in apparently healthy cats and cats with chronic kidney disease

Chronic kidney disease (CKD) is a common cause of illness and death in cats. The hallmark of CKD in cats is chronic tubulointerstitial nephritis, and inflammation contributes to the progression of renal fibrosis. However, at present, it is difficult to assess directly the degree of intra-renal inflammation without renal biopsy. Measurement of inflammatory cytokine levels in urine may provide a non-invasive means of assessing intra-renal inflammation. Urine cytokine levels (urine cytokine/urine creatinine ratio) were measured in 18 healthy cats and 26 cats with CKD. When urine cytokine levels in healthy and CKD cats were compared, we found significantly higher levels of IL-8 and transforming growth factor-β1 (TGF-β1) in urine of CKD cats, along with significantly lower vascular endothelial growth factor (VEGF) levels. A significant positive correlation between serum creatinine and TGF-β1 levels was found in CKD cats. Urinary cytokine measurement may, potentially, be a useful means of assessing intra-renal inflammation, fibrosis and vascular health in cats with CKD.

Urine IL-8 concentrations in infectious and non-infectious urinary tract conditions

Urine IL-8 concentrations are known to be elevated in urinary tract infection (UTI), as well as in vesicoureteral reflux (VUR) even in the absence of infection. In this study we further investigated urine IL-8 in infants with congenital anomalies of the kidneys and urinary tract and with antenatally diagnosed isolated pelvic dilatation. Urine IL-8 was measured in 159 infants aged 1 month to 1 year with acute UTI (group A, n = 26), resolved UTI (group B, n = 16), VUR without recent UTI (group C, n = 44), non-VUR congenital urinary anomalies without recent UTI (group D, n = 30), isolated antenatal pelvic dilatation (group E, n = 14) and in infants without known urinary tract condition (control group F, n = 29). Median values of urine IL-8/creatinine levels were 61.5, 4.64, 15.5, 14.3, 1.06 and 4.19 pg/μmol in groups A, B, C, D, E and F respectively. Compared with the control group, urine IL-8 was elevated in infants with acute UTI, VUR without acute UTI and congenital anomalies without acute UTI (p < 0.0001; p < 0.005; and p = 0.027 respectively), but not in infants with resolved UTI or with antenatal pelvic dilatation. Urine IL-8 levels are elevated in a variety of infectious and non-infectious urinary tract conditions, and hence may serve as a sensitive but not specific screening biomarker of urinary tract diseases.

Discovery and validation of urine markers of acute pediatric appendicitis using high-accuracy mass spectrometry

STUDY OBJECTIVE

Molecular definition of disease has been changing all aspects of medical practice, from diagnosis and screening to understanding and treatment. Acute appendicitis is among many human conditions that are complicated by the heterogeneity of clinical presentation and shortage of diagnostic markers. Here, we sought to profile the urine of patients with appendicitis, with the goal of identifying new diagnostic markers.

METHODS

Candidate markers were identified from the urine of children with histologically proven appendicitis by using high-accuracy mass spectrometry proteome profiling. These systemic and local markers were used to assess the probability of appendicitis in a blinded, prospective study of children being evaluated for acute abdominal pain in our emergency department. Tests of performance of the markers were evaluated against the pathologic diagnosis and histologic grade of appendicitis.

RESULTS

Test performance of 57 identified candidate markers was studied in 67 patients, with median age of 11 years, 37% of whom had appendicitis. Several exhibited favorable diagnostic performance, including calgranulin A (S100-A8), alpha-1-acid glycoprotein 1 (orosomucoid), and leucine-rich alpha-2-glycoprotein (LRG), with the receiver operating characteristic area under the curve and values of 0.84 (95% confidence interval [CI] 0.72 to 0.95), 0.84 (95% CI 0.72 to 0.95), and 0.97 (95% CI 0.93 to 1.0), respectively. LRG was enriched in diseased appendices, and its abundance correlated with severity of appendicitis.

CONCLUSION

High-accuracy mass spectrometry urine proteome profiling allowed identification of diagnostic markers of acute appendicitis. Usage of LRG and other identified biomarkers may improve the diagnostic accuracy of clinical evaluations of appendicitis.

Interleukin 8 is a surrogate marker for rapid diagnosis of bacteriuria

Urinary tract infection (UTI) is one of the most common sources of infection in children under 5. Rapid diagnosis is a need to avoid complications of UTI. The goal of the present study was to evaluate the use of urinary interleukin 8 (IL8) as a rapid laboratory method for diagnosis of UTI. A total of 116 children were included in the study. They were complaining of different diseases with pyuria. In addition twenty healthy children were included as control subjects. Urine samples were subjected to full chemical, cytological and bacteriological examinations. In addition, urinary IL8 was measured. Patients showed significantly elevated urine IL-8 levels (80-820 pg/ml) compared to control subjects (6-10 pg/ml) (p < 0.0001). There was significant correlation between interleukin 8 level and white blood cells counts in urine (p = 0.039). The mean +/- SD of urinary IL-8 was significantly increased 165.8 +/- 115.1 in urine with bacterial growth (Staphylococcus species and Escherichia coli) p < 0.001 than in urine without growth. Urine with Escherichia coli (E. coli) growth had significantly higher IL 8 level than growth with other types of organisms. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value had higher level for IL8 compared to other parameters in urine examination i.e., nitrite, WBCs and RBCs (85.7%, 60%, 64%, 87%, 64% respectively). This study highlights that bacteriuria is associated with higher level of urinary interleukin 8 than pyuria without bacteriuria. Thus from this study we can conclude that IL8 can be used as rapid surrogate marker for rapid laboratory diagnosis of urosepsis.

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis: Randomized, placebo-controlled pilot study

AIM: To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine (NAC) co-administration with mesalamine in ulcerative colitis (UC) patients.

METHODS: Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine (2.4 g/d) plus N-acetyl-L-cysteine (0.8 g/d) (group A) or mesalamine plus placebo (group B). Patients were monitored using the Modified Truelove-Witts Severity Index (MTWSI). The primary endpoint was clinical remission (MTWSI ≤ 2) at 4 wk. Secondary endpoints were clinical response (defined as a reduction from baseline in the MTWSI of ≥ 2 points) and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment.

RESULTS: Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine (group A) and mesalamine plus placebo (group B) respectively (OR = 1.71; 95% CI: 0.46 to 6.36; P = 0.19; NNT = 7.7). Analysis of variance (ANOVA) of data indicated a significant reduction of MTWSI in group A (P = 0.046) with respect to basal condition without significant changes in the group B (P = 0.735) during treatment. Clinical responses were 66% (group A) vs 44% (group B) after 4 wk of treatment (OR = 2.5; 95% CI: 0.64 to 9.65; P = 0.11; NNT = 4.5). Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.

CONCLUSION: In group A (oral NAC combined with mesalamine) contrarily to group B (mesalamine alone), the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.

Pathophysiology and diagnostic value of urinary trypsin inhibitors

Inflammation is an important indicator of tissue injury. In the acute form, there is usually accumulation of fluids and plasma components in the affected tissues. Platelet activation and the appearance in blood of abnormally increased numbers of polymorphonucleocytes, lymphocytes, plasma cells and macrophages usually occur. Infectious disorders such as sepsis, meningitis, respiratory infection, urinary tract infection, viral infection, and bacterial infection usually induce an inflammatory response. Chronic inflammation is often associated with diabetes mellitus, acute myocardial infarction, coronary artery disease, kidney diseases, and certain auto-immune disorders, such as rheumatoid arthritis, organ failures and other disorders with an inflammatory component or etiology. The disorder may occur before inflammation is apparent. Markers of inflammation such as C-reactive protein (CRP) and urinary trypsin inhibitors have changed our appraisal of acute events such as myocardial infarction; the infarct may be a response to acute infection and (or) inflammation. We describe here the pathophysiology of an anti-inflammatory agent termed urinary trypsin inhibitor (uTi). It is an important anti-inflammatory substance that is present in urine, blood and all organs. We also describe the anti-inflammatory agent bikunin, a selective inhibitor of serine proteases. The latter are important in modulating inflammatory events and even shutting them down.