2.2.Epidemiology

Infectious cystitis

The frequency of viral and herpetic cystitis is unclear because culture results can be falsely negative. A large number of people have been suggested to have asymptomatic infections initially with both herpes simplex viruses (HSV), HSV-1 and HSV-2, so the incidence of herpetic cystitis may be higher than culture-positive results indicate. Hemorrhagic cystitis due to adenoviral infections is common in immunocompromised hosts, especially bone marrow transplant recipients or those with AIDS. Hemorrhagic cystitis due to infection with adenoviruses or BK polyoma virus has been reported in 20% and 8% of pediatric bone marrow transplant patients, respectively.

Noninfectious cystitis

Radiation cystitis has been reported to occur in 6.5% of 1784 patients treated with a combination of external beam and intracavitary radiotherapy for stage Ib carcinoma of the cervix. Perez et al reported moderate-to-severe cystitis occurring in 12% of 738 patients treated with definitive irradiation therapy for prostate cancer after 10 years

2.3.Etiology

Infectious etiologies

Nonbacterial cystitis may have an acute, subacute, or chronic course. Some types of nonbacterial cystitis, such as viral or mycobacterial cystitis, can involve other systems or may depend on the degree of host immunosuppression. Improved molecular detection techniques have allowed the recognition of viral infections, such as the BK polyoma virus infections, cytomegalovirus (CMV) infections (associated with hemorrhagic cystitis after bone marrow transplant, and adenoviral infections.

Noninfectious etiologies

Cystitis may occur following radiation therapy to the pelvis for cancer treatment. The average time from the beginning of radiation therapy to initial symptoms can be several months to several years. Symptoms can include anything from mild bleeding to severe recurrent bleeding and pain requiring hospitalization for treatment

2.4.Complications

When treated promptly and properly, bladder infections rarely lead to complications. But left untreated, they can become something more serious. Complications may include:

• Kidney infection. An untreated bladder infection can lead to kidney infection, also called pyelonephritis (pie-uh-low-nuh-FRY-tis). Kidney infections may permanently damage your kidneys.

Young children and older adults are at the greatest risk of kidney damage from bladder infections because their symptoms are often overlooked or mistaken for other conditions.

• Blood in the urine. With cystitis, you may have blood cells in your urine that can be seen only with a microscope (microscopic hematuria) and that usually resolves with treatment. If blood cells remain after treatment, your doctor may recommend a specialist to determine the cause.

Blood in the urine that you can see (gross hematuria) is rare with typical, bacterial cystitis, but this sign is more common with chemotherapy- or radiation-induced cystitis.

2.5.Causes of Cystitis

Cystitis is caused by bacterial infections, but there are various factors that could cause the infection to set in or increase your risk of developing one:

• Different types of bacteria largely cause cystitis, the most common being the Escherichia coli strain of bacteria. This type of bacteria causes nearly 90 percent of all cystitis cases. A cystitis infection can occur at any exit point for urine from the body and since bacteria normally breed in moist places that are also warm, the area in, and around the opening of the urethra is the most common point of infection. In some cases, bacterial infections could result due to sexual intercourse when the bacteria are pushed into the urethra and bladder. This is why very often cystitis is also referred to as honeymoon cystitis.

• Bacterial urinary tract infections can be hospital acquired or community acquired. Hospital acquired bladder infections occur in people who are in a medical care setting such as a clinic or hospital. Bladder infections could occur here due to the use of catheters. Community acquired bladder infections happen to people who are not in a medical care facility setting.

• Some people (especially women) are more susceptible to UTIs than others. Experts suggest that genetics may play a role in this as it has been discovered that women who have been born with certain antigens contract infections such as cystitis more easily.

• Contraceptive devices such as the diaphragm can cause infections if they’ve been fitted improperly. If the diaphragm is the wrong size – for example, if it’s too big, it can restrict the normal flow of urine and prevent the bladder from emptying completely. When this happens, bacteria tend to breed and infections occur.

• Prostate problems in men can also increase the chances of contracting cystitis.

• Poor hygiene habits, tight clothes, and underwear made of synthetic fabric can all lead to frequent UTIs.

• Some people believe that diet can increase or decrease your chance of catching a bladder infection. While there is no conclusive proof, consuming too much of caffeine, chocolate, alcohol, acidic foods, and citric juice can encourage cystitis.

Besides bacterial infections, there are other non-infectious factors that may lead to cystitis such as:

• Interstitial cystitis the cause of the bladder infection in such cases is not known. It is a very painful form of cystitis and mostly afflicts women.

• Chemicals chemicals found in products such as contraceptive jellies or personal hygiene sprays could also cause a UTI to develop.

• Drugs cystitis can be caused by certain medications, especially drugs used for chemotherapy.

• Radiation Radiation treatment for cancers can also increase the risk of cystitis and cause inflammation of the bladder tissue.

• Other conditions cystitis can be common in people suffering from conditions such as PID (Pelvic Inflammatory Disease), Crohn’s disease, lupus, cancers of the uterus or ovaries, tuberculosis, and endometriosis.