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. 2020 Feb;38(2):433-446.
doi: 10.1007/s00345-019-02764-0. Epub 2019 Apr 26.

Urinary fungi associated with urinary symptom severity among women with interstitial cystitis/bladder pain syndrome (IC/BPS)

J Curtis Nickel  1 , Alisa Stephens  2 , J Richard Landis  2 , Chris Mullins  3 , Adrie van Bokhoven  4 , Jennifer T Anger  5 , A Lenore Ackerman  5 , Jayoung Kim  5 , Siobhan Sutcliffe  6 , Jaroslaw E Krol  7 , Bhaswati Sen  7 , Jocelyn Hammond  7 , Garth D Ehrlich  7 ; Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network
Affiliations

Urinary fungi associated with urinary symptom severity among women with interstitial cystitis/bladder pain syndrome (IC/BPS)

J Curtis Nickel et al. World J Urol. 2020 Feb.

Abstract

Purpose: To correlate the presence of fungi with symptom flares, pain and urinary severity in a prospective, longitudinal study of women with IC/BPS enrolled in the MAPP Research Network.

Methods: Flare status, pelvic pain, urinary severity, and midstream urine were collected at baseline, 6 and 12 months from female IC/BPS participants with at least one flare and age-matched participants with no reported flares. Multilocus PCR coupled with electrospray ionization/mass spectrometry was used for identification of fungal species and genus. Associations between "mycobiome" (species/genus presence, relative abundance, Shannon's/Chao1 diversity indices) and current flare status, pain, urinary severity were evaluated using generalized linear mixed models, permutational multivariate analysis of variance, Wilcoxon's rank-sum test.

Results: The most specific analysis detected 13 fungal species from 8 genera in 504 urine samples from 202 females. A more sensitive analysis detected 43 genera. No overall differences were observed in fungal species/genus composition or diversity by flare status or pain severity. Longitudinal analyses suggested greater fungal diversity (Chao1 Mean Ratio 3.8, 95% CI 1.3-11.2, p = 0.02) and a significantly greater likelihood of detecting any fungal species (OR = 5.26, 95% CI 1.1-25.8, p = 0.04) in high vs low urinary severity participants. Individual taxa analysis showed a trend toward increased presence and relative abundance of Candida (OR = 6.63, 95% CI 0.8-58.5, p = 0.088) and Malassezia (only identified in 'high' urinary severity phenotype) for high vs low urinary symptoms.

Conclusion: This analysis suggests the possibility that greater urinary symptom severity is associated with the urinary mycobiome urine in some females with IC/BPS.

Keywords: Bladder pain syndrome; Flares; Fungal; Interstitial cystitis; Mycobiome.

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Conflict of interest statement

1. Disclosure of potential conflicts of interest:

CM is an employee of the NIH/NIDDK. The authors report no other potential conflict of interest.

Figures

Figures 1a-c:
Figures 1a-c:
Mean (95%CI) Chao 1 by (a) flare, (b) high or low pain tertile or (c) high or low urinary tertile by month.
Figures 1a-c:
Figures 1a-c:
Mean (95%CI) Chao 1 by (a) flare, (b) high or low pain tertile or (c) high or low urinary tertile by month.
Figures 1a-c:
Figures 1a-c:
Mean (95%CI) Chao 1 by (a) flare, (b) high or low pain tertile or (c) high or low urinary tertile by month.
Figures 2 a-c:
Figures 2 a-c:
Venn diagram of overlapping fungal genera by (a) flare, (b) high or low pain tertile or (c) high or low urinary tertile (c).
Figures 2 a-c:
Figures 2 a-c:
Venn diagram of overlapping fungal genera by (a) flare, (b) high or low pain tertile or (c) high or low urinary tertile (c).
Figures 2 a-c:
Figures 2 a-c:
Venn diagram of overlapping fungal genera by (a) flare, (b) high or low pain tertile or (c) high or low urinary tertile (c).
See this image and copyright information in PMC

References

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