CLINICAL STUDY OF RECURRENT BACTERIAL CYSTITIS A SUPPLEMENTARY STUDY

Abstract

In the previous study, the re-construction of normal vaginal flora which was made up with artificial colonization of cultured viable Lactobacilli, was proved to be effective in preventing the recurrent urinary tract infection, and then it was clarified that the acquired ill disposition, easily falling in recurrent urinary infection, in preclimacteric females resulted from the establishment of pathogenic bacterial flora on their vaginal mucosa.
The procedure, the colonization of viable Lactobacilli on vaginal mucosa, had resulted in some 80 to 90% effectiveness in preventing the recurrent urinary infection for from 14 to 34 months' period in each of 17 cases successfully tried out. There were 9 cases out of them, who were without the persistence of Lactobacilli from their vagina in the above-mentioned follow up/or and further 12 months' periods, and their fates for urinary tract infection were as followings,
a) 2 cases had re-acquired the ill disposition,
b) 2 cases had entirely been free from the urinary tract infection for 46 and 38 months respectively since the completion of the procedure,
c) 4 cases had suffered from one or 2 single episode infections through the follow-up period from 24 to 38 months,
d) the last one case had been free from infection in the first 20 months, and then suffered 2 infections in the last 6 months through her 37 months' follow up period, and the effectiveness of the procedure was suspended.
The well being 4 cases out of 6 (b+c), had carried uniformly some coryneform Gram negative small rods in their vaginal flora as predominant organism, and one case out of the remaining 2 cases carried a few numbers of Esch. coli, and the last case (d) had also carried a Gram negative small rod, which was identified as Haemophilus parainfluenzae, in recent 9 months as a predominant organism.
For the hope of discovering some predominant organisms which did not cause any urinary infections instead of Lactobacilli which were supposed to be missing in the postmenopausal stage, we surveyed about the normal vaginal bacteria above all the predominant ones in 40 normal females who visited our gynecological clinic for the cytological examination of cancer. They were 32 to 62 years of age and more than 60% of them were in the 5th decade. The vaginal pool secretions were subjected to cytological and bacteriological examinations and also pH of the secretions were determined by a paper method using Brom cresol green as an indicator.
The results of the survey suggested that, in “normal” females the predominant organisms in vaginal bacterial flora were only consisted from Lactobacilli and some Gram negative small rods, presumably so-called Haemophilus vaginalis (Gardner & Dukes, 1955), and their predominacies in vaginal flora changed from the former to the latter alternately correlating with the ovarian activities representative of premenopausal and postmenopausal situations, and then the latter gradually disappeared with aging of the hosts.
For the last condition of vaginal mucosa, we called temporarily “scanty material stage” of vaginal mucosa, and took the condition which was also represented as carrying scanty vaginal secretion or/and only a few cell and bacterial components, for showing a consumed circumstance for bacterial growth, even if there were any urinary pathogens, did not permit them sufficient growth enough to initiate some infective diseases.
Out of our patients, subjected to the procedure, and missing the Lactobacilli thereafter, and not yet having any re-acquistions of the ill disposition, there were some who had the coryneform Gram negative small rod as predominant organism in their vaginal flora, and there was one who had only a few numbers of Esch. coli as an inhabitant persisted.