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New Clues Found in the Cystitis Puzzle

November 23, 1998|THOMAS H. MAUGH II

The intense pain, burning and frequent urination due to cystitis represents one of the most common problems encountered by women. An estimated 7 million American women are sent to their doctors each year by these annoying bladder infections.

Cystitis is readily cured with antibiotics, but some women seem to be more susceptible to infections, suffering repeated, painful bouts of the problem.

New research reported Friday in Science, however, indicates that such women are simply suffering repeated outbreaks triggered by a bacterium that has hidden itself deep in the bladder lining where it can't be reached by drugs.

Cystitis is caused by a pathogenic form of the bacterium Escherichia coli. These bacteria have hair-like projections on their surface, called pili, that allow them to cling tightly to the cells on the inner lining of the bladder.

Microbiologist Scott J. Hultgren and his colleagues at the Washington University School of Medicine in St. Louis studied this process in mice. They observed that the bacteria's attachment to those cells caused the affected cells to commit suicide, shedding from the lining of the bladder and taking the bacteria with them. Combined with the action of an antibiotic, this shedding can end an infection.

In many cases, however, the bacteria also invade cells deep in the bladder wall, the researchers found. Attached to these cells, the bacteria were sheltered from antibiotics and could cause new infections later.

Hultgren's team has devised a vaccine that prevents this process in mice, killing many of the hidden bacteria and preventing future outbreaks. They hope to begin testing it in women within two years.

Chemical May Drive HIV From Hiding Spots

A new treatment for HIV infection may be able to flush the virus from hidden reservoirs in the body, such as resting immune cells and lymph nodes, federal researchers reported last week at a meeting of the Infectious Diseases Society of America.

Dr. Anthony Fauci and his colleagues at the National Institute of Allergy and Infectious Diseases added a naturally occurring chemical called interleukin-2 (IL-2) to the standard combination of drugs received by 14 patients and compared results to 12 patients who received only the standard combination.

The virus could be found in so-called "safe havens" in all 12 receiving standard treatment and in most of those receiving IL-2. In three of those receiving IL-2, however, the virus could not be found anywhere. Fauci plans eventually to take these three off treatment to determine if the virus is really gone.

FDA Warns Tasmar May Damage Liver

The Food and Drug Administration on Nov. 16 sent letters to physicians warning that three patients taking the Parkinson's disease drug Tasmar died from acute liver failure. About 60,000 patients have taken the drug.

The FDA cautioned physicians and patients to be alert to possible signs of liver damage, such as jaundice, fatigue and loss of appetite. The agency also said that if the drug does not produce favorable effects within three weeks, its use should be halted.

Fetus Treated for Spina Bifida

At least some cases of spina bifida can be cured by surgery when the fetus is only 23 weeks old, Philadelphia researchers reported in Saturday's Lancet. In so-called open spina bifida, the nerves of the spinal cord are exposed to damage because there is no protective bone and skin over them. The condition can produce severe physical disabilities, including paraplegia.

Dr. N. Scott Adzick and his colleagues at the Children's Hospital of Philadelphia operated on a 23-week-old fetus that had been shown to have a spina bifida lesion by ultrasound. Seven weeks after the surgery, a boy weighing nearly 3 pounds was delivered by caesarean section. The baby's leg movements were good at birth, and he has developed normally to his current age of 6 months, Adzick said.

Mother's Cigarettes Can Taint Breast Milk

A mother's smoking can affect the taste and smell of her breast milk, thereby possibly setting the stage for her child to begin smoking later in life, according to researchers for the Monell Chemical Sense Center in Philadelphia. They reported in Thursday's New England Journal of Medicine that expert "sniffers," people with a highly trained sense of smell, can readily identify milk from a mother who smoked a cigarette 30 to 60 minutes earlier.

They also confirmed earlier findings that nicotine from the cigarettes is present in the milk. The findings may help to explain why children of smokers are more likely to smoke.

Psychotherapy, Drugs Equally Effective

Psychotherapy and antidepressant medications are equally effective in treating major depression, according to a study in the December issue of the Journal of Consulting and Clinical Psychology. Psychologists Herbert C. Schulberg and Paul A. Pilkonis of the University of Pittsburgh School of Medicine studied 91 depressed patients who were prescribed nortriptyline and 93 who received interpersonal psychotherapy.

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