Gas-Forming Infection of the Urinary Tract: An Investigation of Fermentation As a Mechanism

Abstract

Most gas-forming infections occur in patients with diabetes. Carbon dioxide formation, resulting from fermentation of the high concentration of sugar in the urine and tissue by infecting organisms, was regarded as the key factor of gas formation in previous reports. Gas from an emphysematous infection of a polycystic kidney was analyzed to understand better the mechanisms involved in gas-forming infections of the urinary tract. The term emphysematous renal polycystic infection is proposed for this particular condition. Gas from the cysts contained 4.1% carbon dioxide, 10.5% oxygen, 67.3% nitrogen and 18.1% unknown gas. This finding is astonishingly similar to that of Wheeler in 1954 and cannot be fully explained by the sugar fermentation theory. Therefore, we propose a new hypothesis. Impaired transportation of gas produced by rapid catabolism leads to gas accumulation in the tissue, which will gradually expand and create chambers to form gas bubbles. Gas of adjacent tissues will attempt to come into equilibrium with the gas bubbles. Positive equilibrium will lead to continuous expansion of the lesion bubble. However, if the chamber is unable to withstand the increasing pressure then rupture or spontaneous drainage of the gas bubble may occur. During negative equilibrium gas in the bubble gradually simulates tissue gas with eventual shrinkage of the bubble. If the chamber is unable to sustain the pressure it collapses and the bubble disappears. However, if the chamber is capable of sustaining the pressure the bubble still may persist even when the gas content is equivalent to tissue gas. This hypothesis may lead to better understanding of emphysematous infections of the urinary tract and also may cast light on emphysematous infections of other organ systems.

Clinical Significance and Mechanism of Gas Formation of Pyogenic Liver Abscess Due to Klebsiella pneumoniae

“…Local tissue damage caused by gas-forming bacteria and compounded by the diabetic microangiopathy would perhaps markedly retard the transport of catabolic end products away from the lesion and thereby result in gas accumulation. Considering results of our study and other studies (1,4,7,13,23), we hypothesized that the gas formation involves increased production of gas, impaired transportation of gas, and equilibrium between the gas in local tissues and that in abscesses. Because N 2 exists in all body fluids and tissues in high concentrations, it is not surprising that N 2 levels were high in gas samples taken from abscesses.…”

“…Gas-forming infection depends on rapid catabolism and impaired transport of the end products at inflammatory sites (23). The high level of glucose in tissue and compromised immunity in diabetic patients provide microbes with a microenvironment in favor of vigorous metabolism and growth (13,20).…”

Emphysematous Pyelonephritis

“…Five of the 6 gas samples contained hydrogen (H 2, 3.4∼28%; average, 12.8%) and all had carbon dioxide (CO 2, 4.0∼39.5%; average, 14.4%). The only 1 without H 2 was obtained because H 2 itself was used as a carrier gas for gas analysis, 16 and could not detect the H 2 . Large amounts of …”

Emphysematous Cystitis: A Case Report

“…A generally accepted one is the accumulation of carbon dioxide and hydrogen in tissues as a result of fermentation formed by infective organisms. The primary factor for gas production is thought to be increased glucose in urine and tissues for diabetic patients, and albumin or lactose for non-diabetics [4]. Gas formation resulting from fermentation process increases local pressure and leads to the deterioration of tissue perfusion and infarct.…”