World Rural Health Conference
Home Print this page Email this page Small font size Default font size Increase font size
Users Online: 723
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents 
CASE REPORT
Year : 2015  |  Volume : 4  |  Issue : 1  |  Page : 130-131  

Purple urine bag syndrome: Time for awareness


1 Department of Community Health, GI Sciences, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India

Date of Web Publication27-Feb-2015

Correspondence Address:
Krishna Manjunath
Department of Community Health, Christian Medical College, Bagayam, Vellore - 632 004, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4863.152270

Rights and Permissions
  Abstract 

Purple urine bag syndrome occurs commonly in long-term catheterized patients causing significant stress for patients, care takers, and health care providers. This may lead to unwarranted investigation as well as treatment when not identified early. Demographic changes in Indian population with increasing geriatric care make it a case to increase awareness of this condition among health care providers in primary and secondary care settings.

Keywords: Catheter, geriatric care, purple urine bag syndrome


How to cite this article:
Alex R, Manjunath K, Srinivasan R, Basu G. Purple urine bag syndrome: Time for awareness. J Family Med Prim Care 2015;4:130-1

How to cite this URL:
Alex R, Manjunath K, Srinivasan R, Basu G. Purple urine bag syndrome: Time for awareness. J Family Med Prim Care [serial online] 2015 [cited 2019 Jul 19];4:130-1. Available from: http://www.jfmpc.com/text.asp?2015/4/1/130/152270


  Introduction Top


Purple urine bag syndrome (PUBS) is an uncommon condition where the urine bag and tubing of long-term catheterized patients turn purple. First reported by Barlow and Dickson in 1978 it is more commonly seen in chronically catheterized women and associated with chronic constipation. The process of purple discoloration has been described extensively beginning with deamination of tryptophan to tryptophase by the intestinal anaerobic bacteria which form indole, pyruvic acid, and ammonia. Indole is transported via portal circulation and converted to indoxyl sulfate (indicant) in the liver. Indican excreted through urine is converted to indoxyl by indoxylsulfatase and indoxyl phosphatise produced by urinary bacteria. Indoxyl on oxidation in alkaline urine produces pigments indigo (blue) and indirubin (red). Indirubin reacts with the urine bag and along with indigo to produce a purple color. [1] There have also been case reports of purple diaper syndrome. [2] Dehydration is also an important factor as the serum concentration of indoxyl sulfate was found to have a linear correlation with the severity of the azotemia. [3]


  Case Report Top


We encountered an 83-year old male with the history of benign enlargement of prostate and chronic renal failure on long-term catheterization who presented with purple discoloration of his urine bag and catheter [Figure 1]. There was no associated fever, altered sensorium, abdominal pain, or constipation with no findings suggestive of systemic infection. Urine analysis yielded alkaline urine [pH-7] with few white blood cells and microscopic hematuria, serum creatinine was 3.06 mg% while blood sugars and electrolytes were within normal range. The urine culture yielded insignificant growth of Klebsiella pneumonia, Morganellamorganii, Enterococcus, Citrobaterdiversus, and Pseudomonas aeruginosa. Antibiotic treatment was deferred and the catheter changed to silicone tubing. Following this the urine color changed normal but purple discoloration reappeared after 2 weeks and persisted. The purple discoloration caused considerable distress to the patient and care-takers. They were informed of the harmless nature of the discoloration and reassured.
Figure 1: Purple discolouration of urine bag and catheter

Click here to view



  Discussion Top


The prevalence of PUBS has been reported globally ranging from 9.8% to 8.3% [4] among hospitalized patients and 16.7% [5] to as high as 42.1% [6] among patients with prolonged catheter use. It was found to be associated with alkaline urine, urinary tract infections, renal failure, polyvinyl chloride urine bag, and dementia. [3] Though most cases of PUBS turn out to be clinically harmless underlying UTI can lead to serious complications as typical symptoms of dysuria are absent. [7] The awareness of this syndrome and need to initiate treatment for urinary tract infection are necessary as the outcome may be fatal if progresses to generalized septicemia. [8]

Considering the changing demography of the Indian population with increasing life expectancy, improved geriatric care and geriatric specialty centers, it would serve better if practicing clinicians in primary and secondary health care setting be aware of this condition. It would serve to avoid expensive investigations, unjustified antibiotic use, and unwarranted anxiety among patients, care takers and treating physicians while promoting early diagnosis and management of PUBS. Creating awareness among patients and care-providers would benefit them in reducing anxiety and unwarranted cost of repeated health visits.


  Acknowledgement Top


We would like to acknowledge the support of Department of Community Health, Christian Medical College, Bagayam, Vellore-632004.

 
  References Top

1.
Khan F, Chaudhry MA, Qureshi N, Cowley B. Purple urine bag syndrome: An alarming hue? A brief review of the literature. Int J Nephrol 2011;2011:419213.  Back to cited text no. 1
    
2.
Komiyama A. Purple diaper syndrome in geriatrics. J Am Geriatr Soc 2006;54:1954-5.  Back to cited text no. 2
    
3.
Stanfel LA, Gulyassy PF, Jarrard EA. Determination of indoxylsulfate in plasma of patients with renal failure by use of ion-pairing liquid chromatography. Clin Chem 1986;32:938-42.  Back to cited text no. 3
    
4.
Su FH, Chung SY, Chen MH, Sheng ML, Chen CH, Chen YJ, et al. Case analysis of purple urine-bag syndrome at a long-term care service in a community hospital. Chang Gung Med J 2005;28:636-42.  Back to cited text no. 4
    
5.
ShiaoCC, WengCY, ChuangJC, HuangMS, ChenZY. Purple urine bag syndrome: A community-based study and literature review. Nephrology (Carlton) 2008;13:554-9.  Back to cited text no. 5
    
6.
Lin CH, Huang HT, Chien CC, Tzeng DS, Lung FW. Purple urine bag syndrome in nursing homes: Ten elderly case reports and a literature review. Clin Interv Aging 2008;3:729-34.  Back to cited text no. 6
    
7.
Peters P, Merlo J, Beech N, Giles C, Boon B, Parker B, et al. The purple urine bag syndrome: A visually striking side effect of a highly alkaline urinary tract infection. Can Urol Assoc J 2011;5:233-4.  Back to cited text no. 7
    
8.
Tasi YM, Huang MS, Yang CJ, Yeh SM, Liu CC. Purple urine bag syndrome, not always a benign process. Am J Emerg Med 2009;27:895-7.  Back to cited text no. 8
    


    Figures

  [Figure 1]



 

Top
   
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
Acknowledgement
References
Article Figures

 Article Access Statistics
    Viewed1834    
    Printed31    
    Emailed0    
    PDF Downloaded194    
    Comments [Add]    

Recommend this journal