–Binayak Das, Amity University Kolkata
Purple Urine Bag Syndrome or PUBS, is a rare condition observed mostly in female patients with weakened kidneys, constipation and a highly alkaline urinary-tract infection (UTI). The urine collecting inside the patient’s catheter and its tube starts to develop a deep purple hue, which is also the initial characteristic visual feature denoting the onset of the condition. The cause for this complication points towards a high amount of sulphatase and phosphatase producing bacteria in the urinary tract, summed up with constipation and renal failure as the two main contributing risk factors.
The bacterial species that are associated with this syndrome are- P. stuartii and P. rettgeri, K. pneumoniae, P. mirabilis, E. coli, Enterococcus species, M. morganii, P. aeruginosa, Citrobacter species, and group B Streptococci, although it is not necessary for all of these gram-negative bacteria to be present in each individual’s case of PUBS.
In our body, under normal circumstance, the amino acid tryptophan is broken down in our digestive system by the gut bacteria, leading to the production of a compound known as- indole, which then gets sent to the liver. There, it is converted into indoxyl sulphate and most of it is then excreted into the urine, where it is again broken down into indoxyl by other bacteria, and is finally removed from the body.
In cases where the dietary tryptophan intake is higher than normal, with an alkaline urinary tract and catheterized conditions, one extra step takes place at this point in the process, which is the root cause for the discoloured urine and this condition altogether. A mix of the aforementioned bacteria comes into play here, and further degrades the indoxyl into indigo and indirubin, and these finally add up and react with the catheter tubing to form the purple urine.
This condition is sometimes misdiagnosed by health professionals, due to the rarity of it, and from confusion caused due to lack of knowledge regarding the causes that might lead to an unusual urine colour. To help prevent this, it is recommended to refer an internationally standardized urine chart, like the Oxford Urine Chart, as an aid for the medical staff to decipher the right cause for any of the possible urine hues.
There is no go-to protocol for treating PUBS. Every treatment should be tailored according to the patient’s individual needs or state. Careful treatment for this condition is very crucial as it is more severe and complicated in comparison to only UTIs on its own, due to the accompanying risk factors. Proper sanitation measures are an absolute fundamental necessity, including timely replacement of the patient’s catheter apparatus. Intravenous application of relevant antibiotics maybe considered as an option (by any medical staff only, do not self-assess) for cases where it persists for longer time frames, or if the patient is immunocompromised. Usage of non-plastic catheter bags has also yielded improved outcomes.
Sources-
- “Purple Urine Bag Syndrome: A Rare Spot Diagnosis”, Dilraj S. Kalsi, Joel Ward, Regent Lee, Ashok Handa, Disease Markers, vol. 2017, Article ID 9131872, 6 pages, 2017. https://doi.org/10.1155/2017/9131872
- Purple urine bag syndrome.Al Montasir A, Al Mustaque A. J Family Med Prim Care [serial online] 2013 [cited 2020 Sep 5];2:104-5. Available from: http://www.jfmpc.com/text.asp?2013/2/1/104/109970
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