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      A Urinary Marker for Occult Systemic Coccal Disease

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          Abstract

          Gram-negative particles, found in ‘normal’ urine by an improved microscopic technique, become excessive (often > 10<sup>5</sup>/ml) in many systemic diseases. In these diseases they are accompanied by sparse, usually fastidious, gram-positive cocci. Antibiotics at moderate doses usually have little effect. Larger doses of antibiotics suppress, or temporarily eliminate, the particles. In this report, the particles are characterized by light microscopy for better identification. Then, by detection of muramic acid in a hydrolysate and by transmission electron microscopy, they are identified as decomposed (‘exploded’) gram-positive cocci. Since explodeds cannot be external contaminants, and their precursors cannot proliferate sufficiently in urine, they must have crossed renal membranes to come from within the body. They are demonstrated in tissue fluids and in synovial fluids by optical microscopy, by their muramic acid, and by transmission electron microscopy. Thus, they cross other membranes. Explodeds are excessive in several rheumatic diseases, in renal diseases, in diseases in which a coccal cause has been sought, and in some in which cocci have never been considered. There is no precedent for explodeds. Their appearance and numbers are compatible with the literature on natural and experimental systemic streptococcal diseases and with the experimental illnesses following injection of streptococcal cell walls. Urinary explodeds are likely to be the end result of the ‘almost physiological’ entry of streptococci into the circulation which necessitates predental antibiotic prophylaxis in mitral disease. Increased numbers of urinary explodeds probably represent excessive entry of precursors or proliferation of precursors within the host. Urinary explodeds serve as a marker for diverse systemic diseases, systemic coccal disease.

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          Author and article information

          Journal
          NEF
          Nephron
          10.1159/issn.1660-8151
          Nephron
          S. Karger AG
          1660-8151
          2235-3186
          1994
          1994
          17 December 2008
          : 68
          : 3
          : 314-326
          Affiliations
          New Orleans, La., USA
          Article
          188393 Nephron 1994;68:314–326
          10.1159/000188393
          7530812
          © 1994 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 13
          Categories
          Original Paper

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