Purple urine bag syndrome

Purple urine bag syndrome is a medical syndrome where purple discoloration of urine occurs in people with urinary catheters and co-existent urinary tract infection. Bacteria in the urine produce the enzyme indoxyl phosphatase. This converts indoxyl sulfate in the urine into the red and blue colored compounds indirubin and indigo.[1] The most commonly implicated bacteria are Providencia stuartii, Providencia rettgeri, Klebsiella pneumoniae, Proteus mirabilis, Escherichia coli, Morganella morganii, and Pseudomonas aeruginosa.[2]

Signs and symptoms

People with purple urine bag syndrome usually do not complain of any symptoms. Purple discoloration of urine is often the only finding, frequently noted by caregivers. It is usually considered a benign condition, although in the setting of recurrent or chronic urinary tract infection, it may be associated with drug-resistant bacteria.[3]

Pathophysiology

Tryptophan in the diet is metabolized by bacteria in the gastrointestinal tract to produce indole. Indole is absorbed into the blood by the intestine and passes to the liver. There, indole is converted to indoxyl sulfate. Indoxyl sulfate is excreted in the urine. In purple urine bag syndrome, bacteria that colonize the urinary catheter convert the indoxyl sulfate to indirubin and indigo.[1]

Epidemiology

Purple urine bag syndrome is more common in female nursing home residents. Other risk factors include alkaline urine, constipation, and polyvinyl chloride catheter use.[4]

History

The syndrome was first described in 1978.[5]

References

  1. 1 2 Tan, CK; Wu YP; Wu HY; Lai CC (August 2008). "Purple urine bag syndrome". Canadian Medical Association Journal 179 (5): 491. doi:10.1503/cmaj.071604. PMC 2518199. PMID 18725621.
  2. ↑ Lin, CH; Huang HT; Chien CC; et al. (December 2008). "Purple urine bag syndrome in nursing homes: ten elderly case reports and a literature review". Clinical Interventions in Aging 3 (4): 729–734. PMC 2682405. PMID 19281065.
  3. ↑ Bhattarai, M; Mukhtar HB; Davis TW; et al. (2013). "Purple urine bag syndrome may not be benign: a case report and brief review of the literature". Case Reports in Infectious Diseases 2013: 863853. doi:10.1155/2013/863853. PMC 3705812. PMID 23864970.
  4. ↑ Su, FH; Chung SY; Chen MH; et al. (September 2005). "Case analysis of purple urine-bag syndrome at a long-term care service in a community hospital". Chang Gung Medical Journal 28 (9): 636–642. PMID 16323555.
  5. ↑ Barlow, GB; Dickson JAS (March 1978). "Purple urine bags". Lancet 1 (8062): 502. doi:10.1016/s0140-6736(78)90163-0. PMID 76045.
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