Skip to main content
NCBI home page
Springer Nature - PMC COVID-19 Collection logoLink to Springer Nature - PMC COVID-19 Collection
. 2008 Mar 26;8(4):324–335. doi: 10.1007/s11934-007-0080-y

Viral lower urinary tract infections

Darius A Paduch 1,✉
PMCID: PMC7089127  PMID: 18519018

Abstract

Lower urinary tract infections (UTIs) are common among the general population and are most often caused by bacterial pathogens. Viruses are an uncommon cause of UTIs in an immunocompetent host; however, viruses are increasingly recognized as the cause of lower UTI, especially hemorrhagic cystitis, among immunocompromised patients. BK virus, adenovirus, and cytomegalovirus are predominant pathogens involved in hemorrhagic cystitis after stem cell and solid organ transplantation, and their early diagnosis and treatment may prevent significant morbidity of hemorrhagic cystitis. The diagnosis of viral lower UTI is based on molecular techniques, and real-time polymerase chain reaction is often the method of choice because it allows for quantification of viral load. Cidofovir is becoming a drug of choice in viral UTIs because it is active against the most common viral pathogens. This review discusses the epidemiology, pitfalls in diagnosis, and current treatment of viral UTIs.

Keywords: Herpes Simplex Virus, Respiratory Syncytial Virus, West Nile Virus, Cystitis, Prostatitis

References and Recommended Reading

  • 1.Yusuf U., Hale G.A., Carr J., et al. Cidofovir for the treatment of adenoviral infection in pediatric hematopoietic stem cell transplant patients. Transplantation. 2006;81:1398–1404. doi: 10.1097/01.tp.0000209195.95115.8e. [DOI] [PubMed] [Google Scholar]
  • 2.Singh D., Kiberd B., Gupta R., et al. Polyoma virus-induced hemorrhagic cystitis in renal transplantation patient with polyoma virus nephropathy. Urology. 2006;67:423.e11–423.e12. doi: 10.1016/j.urology.2005.08.042. [DOI] [PubMed] [Google Scholar]
  • 3.Giraud G., Bogdanovic G., Priftakis P., et al. The incidence of hemorrhagic cystitis and BK-viruria in allogeneic hematopoietic stem cell recipients according to intensity of the conditioning regimen. Haematologica. 2006;91:401–404. [PubMed] [Google Scholar]
  • 4.Hale G.A., Rochester R.J., Heslop H.E., et al. Hemorrhagic cystitis after allogeneic bone marrow transplantation in children: clinical characteristics and outcome. Biol Blood Marrow Transplant. 2003;9:698–705. doi: 10.1016/S1083-8791(03)00269-6. [DOI] [PubMed] [Google Scholar]
  • 5.Gorczynska E., Turkiewicz D., Rybka K., et al. Incidence, clinical outcome, and management of virus-induced hemorrhagic cystitis in children and adolescents after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2005;11:797–804. doi: 10.1016/j.bbmt.2005.06.007. [DOI] [PubMed] [Google Scholar]
  • 6.Boubenider S., Hiesse C., Marchand S., et al. Post-transplantation polyomavirus infections. J Nephrol. 1999;12:24–29. [PubMed] [Google Scholar]
  • 7.Mylonakis E., Goes N., Rubin R.H., et al. BK virus in solid organ transplant recipients: an emerging syndrome. Transplantation. 2001;72:1587–1592. doi: 10.1097/00007890-200111270-00001. [DOI] [PubMed] [Google Scholar]
  • 8.Hofland C.A., Eron L.J., Washecka R.M. Hemorrhagic adenovirus cystitis after renal transplantation. Transplant Proc. 2004;36:3025–3027. doi: 10.1016/j.transproceed.2004.10.090. [DOI] [PubMed] [Google Scholar]
  • 9.Koga S., Shindo K., Matsuya F., et al. Acute hemorrhagic cystitis caused by adenovirus following renal transplantation: review of the literature. J Urol. 1993;149:838–839. doi: 10.1016/s0022-5347(17)36227-4. [DOI] [PubMed] [Google Scholar]
  • 10.Maraha B., Bonten H., van Hooff H., et al. Infectious complications and antibiotic use in renal transplant recipients during a 1-year follow-up. Clin Microbiol Infect. 2001;7:619–625. doi: 10.1046/j.1198-743x.2001.00329.x. [DOI] [PubMed] [Google Scholar]
  • 11.Boldorini R., Brustia M., Veggiani C., et al. Periodic assessment of urine and serum by cytology and molecular biology as a diagnostic tool for BK virus nephropathy in renal transplant patients. Acta Cytol. 2005;49:235–243. doi: 10.1159/000326143. [DOI] [PubMed] [Google Scholar]
  • 12.Hogan T.F., Padgett B.L., Walker D.L., et al. Rapid detection and identification of JC virus and BK virus in human urine by using immunofluorescence microscopy. J Clin Microbiol. 1980;11:178–183. doi: 10.1128/jcm.11.2.178-183.1980. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Duran N., Yarkin F., Evruke C., Koksal F. Asymptomatic herpes simplex virus type 2 (HSV-2) infection among pregnant women in Turkey. Indian J Med Res. 2004;120:106–110. [PubMed] [Google Scholar]
  • 14.Fung J.C., Shanley J., Tilton R.C. Comparison of the detection of herpes simplex virus in direct clinical specimens with herpes simplex virus-specific DNA probes and monoclonal antibodies. J Clin Microbiol. 1985;22:748–753. doi: 10.1128/jcm.22.5.748-753.1985. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Xu F., Sternberg M.R., Kottiri B.J., et al. Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. JAMA. 2006;296:964–973. doi: 10.1001/jama.296.8.964. [DOI] [PubMed] [Google Scholar]
  • 16.Stolt A., Sasnauskas K., Koskela P., et al. Seroepidemiology of the human polyomaviruses. J Gen Virol. 2003;84:1499–1504. doi: 10.1099/vir.0.18842-0. [DOI] [PubMed] [Google Scholar]
  • 17.Schmutzhard J., Merete Riedel H., Zweygberg Wirgart B., Grillner L. Detection of herpes simplex virus type 1, herpes simplex virus type 2 and varicella-zoster virus in skin lesions: comparison of real-time PCR, nested PCR and virus isolation. J Clin Virol. 2004;29:120–126. doi: 10.1016/S1386-6532(03)00113-6. [DOI] [PubMed] [Google Scholar]
  • 18.Vera-Sempere F.J., Rubio L., Moreno-Baylach M.J., et al. Polymerase chain reaction detection of BK virus and monitoring of BK nephropathy in renal transplant recipients at the University Hospital La Fe. Transplant Proc. 2005;37:3770–3773. doi: 10.1016/j.transproceed.2005.09.194. [DOI] [PubMed] [Google Scholar]
  • 19.Lundstig A., Dillner J. Serological diagnosis of human polyomavirus infection. Adv Exp Med Biol. 2006;577:96–101. doi: 10.1007/0-387-32957-9_7. [DOI] [PubMed] [Google Scholar]
  • 20.Minassian H., Schinella R., Reilly J.C. Polyomavirus in the urine: follow-up study. Diagn Cytopathol. 1994;10:209–211. doi: 10.1002/dc.2840100303. [DOI] [PubMed] [Google Scholar]
  • 21.Boon M.E., van Keep J.P., Kok L.P. Polyomavirus infection versus high-grade bladder carcinoma: the importance of cytologic and comparative morphometric studies of plastic-embedded voided urine sediments. Acta Cytol. 1989;33:887–893. [PubMed] [Google Scholar]
  • 22.Coleman D.V., Wolfendale M.R., Daniel R.A., et al. A prospective study of human polyomavirus infection in pregnancy. J Infect Dis. 1980;142:1–8. doi: 10.1093/infdis/142.1.1. [DOI] [PubMed] [Google Scholar]
  • 23.Hirsch H.H., Suthanthiran M. The natural history, risk factors and outcomes of polyomavirus BK-associated nephropathy after renal transplantation. Nat Clin Pract Nephrol. 2006;2:240–241. doi: 10.1038/ncpneph0179. [DOI] [PubMed] [Google Scholar]
  • 24.Fusaro F., Murer L., Busolo F., et al. CMV and BKV ureteritis: which prognosis for the renal graft? J Nephrol. 2003;16:591–594. [PubMed] [Google Scholar]
  • 25.Elfaitouri A., Hammarin A.L., Blomberg J. Quantitative real-time PCR assay for detection of human polyomavirus infection. J Virol Methods. 2006;135:207–213. doi: 10.1016/j.jviromet.2006.03.006. [DOI] [PubMed] [Google Scholar]
  • 26.Singh H.K., Bubendorf L., Mihatsch M.J., et al. Urine cytology findings of polyomavirus infections. Adv Exp Med Biol. 2006;577:201–212. doi: 10.1007/0-387-32957-9_15. [DOI] [PubMed] [Google Scholar]
  • 27.Hatakeyama N., Suzuki N., Yamamoto M., et al. Detection of BK virus and adenovirus in the urine from children after allogeneic stem cell transplantation. Pediatr Infect Dis J. 2006;25:84–85. doi: 10.1097/01.inf.0000195613.00368.df. [DOI] [PubMed] [Google Scholar]
  • 28.Chang C.Y., Gangji A., Chorneyko K., Kapoor A. Urological manifestations of BK polyomavirus in renal transplant recipients. Can J Urol. 2005;12:2829–2836. [PubMed] [Google Scholar]
  • 29.Andrei G., Snoeck R., Vandeputte M., De Clercq E. Activities of various compounds against murine and primate polyomaviruses. Antimicrob Agents Chemother. 1997;41:587–593. doi: 10.1128/aac.41.3.587. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Bridges B., Donegan S., Badros A. Cidofovir bladder instillation for the treatment of BK hemorrhagic cystitis after allogeneic stem cell transplantation. Am J Hematol. 2006;81:535–537. doi: 10.1002/ajh.20567. [DOI] [PubMed] [Google Scholar]
  • 31.Gonzalez-Fraile M.I., Canizo C., Caballero D., et al. Cidofovir treatment of human polyomavirus-associated acute haemorrhagic cystitis. Transpl Infect Dis. 2001;3:44–46. doi: 10.1034/j.1399-3062.2001.003001044.x. [DOI] [PubMed] [Google Scholar]
  • 32.Ison M.G. Adenovirus infections in transplant recipients. Clin Infect Dis. 2006;43:331–339. doi: 10.1086/505498. [DOI] [PubMed] [Google Scholar]
  • 33.Fanourgiakis P., Georgala A., Vekemans M., et al. Intravesical instillation of cidofovir in the treatment of hemorrhagic cystitis caused by adenovirus type 11 in a bone marrow transplant recipient. Clin Infect Dis. 2005;40:199–201. doi: 10.1086/426594. [DOI] [PubMed] [Google Scholar]
  • 34.Hatakeyama N., Suzuki N., Kudoh T., et al. Successful cidofovir treatment of adenovirus-associated hemorrhagic cystitis and renal dysfunction after allogenic bone marrow transplant. Pediatr Infect Dis J. 2003;22:928–929. doi: 10.1097/01.inf.0000091399.29505.21. [DOI] [PubMed] [Google Scholar]
  • 35.Leung A.Y., Chan M.T., Yuen K.Y., et al. Ciprofloxacin decreased polyoma BK virus load in patients who underwent allogeneic hematopoietic stem cell transplantation. Clin Infect Dis. 2005;40:528–537. doi: 10.1086/427291. [DOI] [PubMed] [Google Scholar]
  • 36.Geetha D., Tong B.C., Racusen L., et al. Bladder carcinoma in a transplant recipient: evidence to implicate the BK human polyomavirus as a causal transforming agent. Transplantation. 2002;73:1933–1936. doi: 10.1097/00007890-200206270-00015. [DOI] [PubMed] [Google Scholar]
  • 37.Runde V., Ross S., Trenschel R., et al. Adenoviral infection after allogeneic stem cell transplantation (SCT): report on 130 patients from a single SCT unit involved in a prospective multi center surveillance study. Bone Marrow Transplant. 2001;28:51–57. doi: 10.1038/sj.bmt.1703083. [DOI] [PubMed] [Google Scholar]
  • 38.Allen C.W., Alexander S.I. Adenovirus associated haematuria. Arch Dis Child. 2005;90:305–306. doi: 10.1136/adc.2003.037952. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Miyamura K., Takeyama K., Kojima S., et al. Hemorrhagic cystitis associated with urinary excretion of adenovirus type 11 following allogeneic bone marrow transplantation. Bone Marrow Transplant. 1989;4:533–535. [PubMed] [Google Scholar]
  • 40.Chakrabarti S., Mautner V., Osman H., et al. Adenovirus infections following allogeneic stem cell transplantation: incidence and outcome in relation to graft manipulation, immunosuppression, and immune recovery. Blood. 2002;100:1619–1627. doi: 10.1182/blood-2002-02-0377. [DOI] [PubMed] [Google Scholar]
  • 41.Moriyama Y., Koike T., Shibata A. Hemorrhagic cystitis after conditioning for bone marrow transplantation and its prophylaxis. Jpn J Clin Oncol. 1984;14(Suppl1):531–536. [PubMed] [Google Scholar]
  • 42.Nagafuji K., Aoki K., Henzan H., et al. Cidofovir for treating adenoviral hemorrhagic cystitis in hematopoietic stem cell transplant recipients. Bone Marrow Transplant. 2004;34:909–914. doi: 10.1038/sj.bmt.1704682. [DOI] [PubMed] [Google Scholar]
  • 43.Legrand F., Berrebi D., Houhou N., et al. Early diagnosis of adenovirus infection and treatment with cidofovir after bone marrow transplantation in children. Bone Marrow Transplant. 2001;27:621–626. doi: 10.1038/sj.bmt.1702820. [DOI] [PubMed] [Google Scholar]
  • 44.Gavin P.J., Katz B.Z. Intravenous ribavirin treatment for severe adenovirus disease in immunocompromised children. Pediatrics. 2002;110:e9. doi: 10.1542/peds.110.1.e9. [DOI] [PubMed] [Google Scholar]
  • 45.Miyamura K., Hamaguchi M., Taji H., et al. Successful ribavirin therapy for severe adenovirus hemorrhagic cystitis after allogeneic marrow transplant from close HLA donors rather than distant donors. Bone Marrow Transplant. 2000;25:545–548. doi: 10.1038/sj.bmt.1702195. [DOI] [PubMed] [Google Scholar]
  • 46.Jurado M., Navarro J.M., Hernandez J., et al. Adenovirus-associated haemorrhagic cystitis after bone marrow transplantation successfully treated with intravenous ribavirin. Bone Marrow Transplant. 1995;15:651–652. [PubMed] [Google Scholar]
  • 47.Chen F.E., Liang R.H., Lo J.Y., et al. Treatment of adenovirus-associated haemorrhagic cystitis with ganciclovir. Bone Marrow Transplant. 1997;20:997–999. doi: 10.1038/sj.bmt.1700997. [DOI] [PubMed] [Google Scholar]
  • 48.Kurosaki K., Miwa N., Yoshida Y., et al. Therapeutic basis of vidarabine on adenovirus-induced haemorrhagic cystitis. Antivir Chem Chemother. 2004;15:281–285. doi: 10.1177/095632020401500507. [DOI] [PubMed] [Google Scholar]
  • 49.Kawakami M., Ueda S., Maeda T., et al. Vidarabine therapy for virus-associated cystitis after allogeneic bone marrow transplantation. Bone Marrow Transplant. 1997;20:485–490. doi: 10.1038/sj.bmt.1700923. [DOI] [PubMed] [Google Scholar]
  • 50.Kitabayashi A., Hirokawa M., Kuroki J., et al. Successful vidarabine therapy for adenovirus type 11-associated acute hemorrhagic cystitis after allogeneic bone marrow transplantation. Bone Marrow Transplant. 1994;14:853–854. [PubMed] [Google Scholar]
  • 51.Spach D.H., Bauwens J.E., Myerson D., et al. Cytomegalovirus-induced hemorrhagic cystitis following bone marrow transplantation. Clin Infect Dis. 1993;16:142–144. doi: 10.1093/clinids/16.1.142. [DOI] [PubMed] [Google Scholar]
  • 52.Basquiera A.L., Calafat P., Parodi J.M., et al. Cytomegalovirus-induced haemorrhagic cystitis in a patient with neurogenic bladder. Scand J Infect Dis. 2003;35:902–904. doi: 10.1080/00365540310016655. [DOI] [PubMed] [Google Scholar]
  • 53.Childs R., Sanchez C., Engler H., et al. High incidence of adeno-and polyomavirus-induced hemorrhagic cystitis in bone marrow allotransplantation for hematological malignancy following T cell depletion and cyclosporine. Bone Marrow Transplant. 1998;22:889–893. doi: 10.1038/sj.bmt.1701440. [DOI] [PubMed] [Google Scholar]
  • 54.Tutuncuoglu S.O., Yanovich S., Ozdemirli M. CMV-induced hemorrhagic cystitis as a complication of peripheral blood stem cell transplantation: case report. Bone Marrow Transplant. 2005;36:265–266. doi: 10.1038/sj.bmt.1705030. [DOI] [PubMed] [Google Scholar]
  • 55.Mueller B.U., MacKay K., Cheshire L.B., et al. Cytomegalovirus ureteritis as a cause of renal failure in a child infected with the human immunodeficiency virus. Clin Infect Dis. 1995;20:1040–1043. doi: 10.1093/clinids/20.4.1040. [DOI] [PubMed] [Google Scholar]
  • 56.Kalil A.C., Levitsky J., Lyden E., et al. Meta-analysis: the efficacy of strategies to prevent organ disease by cytomegalovirus in solid organ transplant recipients. Ann Intern Med. 2005;143:870–880. doi: 10.7326/0003-4819-143-12-200512200-00005. [DOI] [PubMed] [Google Scholar]
  • 57.Mengoli C., Cusinato R., Biasolo M.A., et al. Assessment of CMV load in solid organ transplant recipients by pp65 antigenemia and real-time quantitative DNA PCR assay: correlation with pp67 RNA detection. J Med Virol. 2004;74:78–84. doi: 10.1002/jmv.20149. [DOI] [PubMed] [Google Scholar]
  • 58.Bielorai B., Shulman L.M., Rechavi G., Toren A. CMV reactivation induced BK virus-associated late onset hemorrhagic cystitis after peripheral blood stem cell transplantation. Bone Marrow Transplant. 2001;28:613–614. doi: 10.1038/sj.bmt.1703187. [DOI] [PubMed] [Google Scholar]
  • 59.Held T.K., Biel S.S., Nitsche A., et al. Treatment of BK virus-associated hemorrhagic cystitis and simultaneous CMV reactivation with cidofovir. Bone Marrow Transplant. 2000;26:347–350. doi: 10.1038/sj.bmt.1702487. [DOI] [PubMed] [Google Scholar]
  • 60.McClanahan C., Grimes M.M., Callaghan E., Stewart J. Hemorrhagic cystitis associated with herpes simplex virus. J Urol. 1994;151:152–153. doi: 10.1016/s0022-5347(17)34899-1. [DOI] [PubMed] [Google Scholar]
  • 61.Nguyen M.L., Borochovitz D., Thomas G., et al. Hemorrhagic cystitis with herpes simplex virus type 2 in the bladder mucosa. Clin Infect Dis. 1992;14:767–768. doi: 10.1093/clinids/14.3.767. [DOI] [PubMed] [Google Scholar]
  • 62.DeHertogh D.A., Brettman L.R. Hemorrhagic cystitis due to herpes simplex virus as a marker of disseminated herpes infection. Am J Med. 1988;84:632–635. doi: 10.1016/0002-9343(88)90148-9. [DOI] [PubMed] [Google Scholar]
  • 63.Sacks S.L., Griffiths P.D., Corey L., et al. HSV shedding. Antiviral Res. 2004;63Suppl1:S19–S26. doi: 10.1016/j.antiviral.2004.06.004. [DOI] [PubMed] [Google Scholar]

Articles from Current Urology Reports are provided here courtesy of Nature Publishing Group

RESOURCES