
Couple of strokes and purple urine bag; Dr. Subrata Bhattacharya of Silchar explains the treatment
COVID-19 has blown the minds of doctors enough in 2019 and it did give the health infrastructure of many countries, especially India, a huge reality check. If COVID-19 wasn’t enough to boggle the minds of the doctors, a new strange, rather bizarre medical wonder was reported in Silchar last year. This is a very rare case in the medical history and is the first such case in Assam, third in the entire North East India and approximately 50th case in the country. The name of this syndrome? Purple Urine Bag Syndrome or PUBS in short. In this case, a rare incident was witnessed with purple urine in the catheter pipe and bag of the patient.
In January 2021, an octogenarian female patient was brought to the Medinova Hospital, Silchar, a private nursing home. She was dehydrated, had delirium and aphasia. She had PUBS, her family was worried as they never seen or heard of this condition before. The doctors there were equally clueless. Dr. Subrata Bhattacharya, a gynaecologist and doctor-in charge in this case said, “The patient had a stroke a couple of weeks back and she was discharged when her vitals were stable on the request of the family. She was catheterized then given her medical conditions. After she was discharged, her family took her to someone who performs black magic and we don’t know what happened there. Well, that’s another story. But when she was brought to my clinic, she had a fever, constipation, pain in the lower part of the body, all common symptoms of Urinary Tract Infection. But what was surprising was delirium that is moaning and groaning along with aphasia, that is loss of speech. She also had high blood pressure and for those reasons (aphasia & delirium) it was getting difficult to understand her. Then I called a colleague of mine, Dr. Rajeeb Dey, a neuro-psychiatrist. Before bringing her to the hospital, the colour of her urine in the urine bag changed its colour from purple to indigo-ish colour. We admitted her under the care and gave her antibiotics and sent the urine sample for culture”.
The doctors and pathologists reported that, when the urine was taken out of the bag, it lost its colour and was just cloudy. The attendants of the patient said the urine smells like rotten meat but the doctors didn’t find any offensive smell. This rare case had no written literature about treatment in any medical books and hence the doctors had to resort to internet searches. They did find some medical journals about this case reported only is a host of counties like Japan, Taiwan, the Philippines, South Korea and the US. It was difficult to reach any conclusions and start the treatment. There was no concrete source of information about this infection. After hours of research and calling out many senior doctors, the team of doctors engaged in the treatment of the 80-year-old lady could reach some answers.
The urine culture report of that particular patient was equally confusing. Serratia marcescens is a very atypical organism responsible for this condition. It is a facultative anaerobe and opportunistic pathogen. Dr. Bhattacharya regarding this further said, “We have not found any such case of UTI in India with this bacteria. We could only find two to three cases in the entire world and this was the first case of PUBS with Serratia marcescens in India. We can only assume that it happened due to unhygienic conditions. Dementia or lack of self-care might be responsible for this. The patient also had low immunity and she was old. The patient was recommended to change the catheter which might have been done in a compromised environment. We can only speculate, all these might have been responsible”. The doctor also added, “Another unique finding, in this case, was the acidic urine sample, generally in case of UTI and PUBS, it’s alkaline. After primary treatments and antibiotics, she was fine and so far there has been no recurrence and we are in constant touch with the patient even though she is from a very far-flung and remote area. I must also add that the nurses and administration at Medinova Hospital showed compassion and patience with this patient, even though she was moaning and yelling constantly for the entire three days of her treatment there”.
The first such patient to PUBS in Assam is in a better condition now and thankfully there has been no recurrence of changes in the colour of urine. Speaking about the root causes of this syndrome, the doctor added, “There are no concrete findings of this but hypothetical findings say that it is common in elderly females, mostly women with UTIs and who are bed-ridden. Constipation can also be responsible in some cases and so is the excess consumption of tryptophan amino acid, present mainly in cheese, chicken and other meat etc”. Speaking about its precaution the doctors said, “Awareness is the most important thing here, the patients need not panic and don’t avoid consulting a doctor. People are superstitious and even in this case they went for black magic, superstition and constipation has no space here. Proper health care is important and catchers must be changed timely, in a safe environment. That’s the most vulnerable point for any parasite to make a patient its host. Long term catheterization is also harmful and should be avoided whenever possible. So far, one case of fatality reported with PUBS, alongwith some cases of complications like Gangrene, genital Abscess, septicemia, etc.
This case report has been published in the February 2022 edition of the “Journal of Clinical and Diagnostic Research”, under the title, “A Rare Case of Purple Urine Bag Syndrome Presenting with Delirium and Associated with Acidic Urine and UTI due to Serratia Marcescens: But Do We Still Know Enough?” It has been jointly published by Dr. Subrata Bhattacharya, Dr. Rajeeb Dey and Dr. Ratnadeep Nath.
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