Purple urine bag syndrome

Purple urine bag syndrome
A urine bag containing purple liquid
Purple urine bag syndrome usually presents as a purplish discoloration of a catheterized person's collection bag.

Purple urine bag syndrome (PUBS) is a medical syndrome where purple discoloration of urine collection bag occurs in people with urinary catheters and co-existent urinary tract infections. PUBS is most prevalent in elderly females with constipation.[1] Constipation alters the gut bacteria, reducing gastrointestinal motility and leading to increased growth of bacteria in the colon.[2] High bacterial counts in urine are the most important factor causing purple urine bag syndrome.[3] Bacteria in urine produce the enzyme indoxyl sulfatase. This converts indoxyl sulfate in the urine into the red and blue colored compounds indirubin and indigo.[4] People with urinary tract infections using catheters will increase the conversion of indoxyl sulfatase to indirubin and indigo.[2] Indirubin dissolves in plastic and therefore causes urine discoloration. The purple discoloration is the result of reaction between indirubin and plastic urine bags, as well as the presence of indigo.[1] Bacteria in the urine can be found through bacteria culture test. People with purple urine bag syndrome may present with elevated bacterial loads on their culture tests when compared to those who are not affected by this syndrome.[5] The most commonly implicated bacteria are Providencia stuartii, Providencia rettgeri, Klebsiella pneumoniae, Proteus mirabilis, Escherichia coli, Morganella morganii, and Pseudomonas aeruginosa.[6] Purple urine bag syndrome treatment should aim for underlying issues rather than the condition itself.[5] The purple discoloration is harmless and can be resolved with treatments targeted to specific bacteria or any underlying medical conditions.[7] Treatment also consists of providing comfort to both patients and their family, administering antibiotics and performing regular catheter changes. The prognosis is good, however, the morbidity and mortality rates associated with PUBS are elevated depending on patient's underlying health status.[8]

  1. ^ a b Sabanis N, Paschou E, Papanikolaou P, Zagkotsis G (November 2019). "Purple Urine Bag Syndrome: More Than Eyes Can See". Current Urology. 13 (3): 125–132. doi:10.1159/000499281. PMC 6944938. PMID 31933590.
  2. ^ a b Yaqub S, Mohkum S, Mukhtar KN (2013). "Purple urine bag syndrome: A case report and review of literature". Indian Journal of Nephrology. 23 (2): 140–142. doi:10.4103/0971-4065.109442. ISSN 0971-4065. PMC 3658294. PMID 23716923.
  3. ^ Mantani N, Ochiai H, Imanishi N, Kogure T, Terasawa K, Tamura J (March 2003). "A case-control study of purple urine bag syndrome in geriatric wards". Journal of Infection and Chemotherapy. 9 (1): 53–57. doi:10.1007/s10156-002-0210-x. PMID 12673408.
  4. ^ Tan CK, Wu YP, Wu HY, Lai CC (August 2008). "Purple urine bag syndrome". CMAJ. 179 (5): 491. doi:10.1503/cmaj.071604. PMC 2518199. PMID 18725621.
  5. ^ a b Neniwal VK, Swain S, Rulaniya SK, Hota D, Agarwal P, Yadav PK (June 2023). "Purple urine bag syndrome: An unusual manifestation of urinary tract infection, our experience at a tertiary care center". Current Urology. 17 (2): 125–129. doi:10.1097/CU9.0000000000000044. ISSN 1661-7649. PMC 10489393. PMID 37691983.
  6. ^ Lin CH, Huang HT, Chien CC, Tzeng DS, Lung FW (December 2008). "Purple urine bag syndrome in nursing homes: ten elderly case reports and a literature review". Clinical Interventions in Aging. 3 (4): 729–734. doi:10.2147/cia.s3534. PMC 2682405. PMID 19281065.
  7. ^ Cite error: The named reference :0 was invoked but never defined (see the help page).
  8. ^ Kalsi DS, Ward J, Lee R, Handa A (2017). "Purple Urine Bag Syndrome: A Rare Spot Diagnosis". Disease Markers. 2017: 9131872. doi:10.1155/2017/9131872. ISSN 1875-8630. PMC 5727662. PMID 29317791.