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Infection and Immunity, July 2001, p. 4572-4579, Vol. 69, No. 7
0019-9567/01/$04.00+0   DOI: 10.1128/IAI.69.7.4572-4579.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Establishment of a Persistent Escherichia coli Reservoir during the Acute Phase of a Bladder Infection

Matthew A. Mulvey,dagger Joel D. Schilling, and Scott J. Hultgren*

Department of Molecular Microbiology and Microbial Pathogenesis, Washington University School of Medicine, St. Louis, Missouri 63110

Received 23 February 2001/Returned for modification 30 March 2001/Accepted 5 April 2001

The vast majority of urinary tract infections are caused by strains of uropathogenic Escherichia coli that encode filamentous adhesive organelles called type 1 pili. These structures mediate both bacterial attachment to and invasion of bladder epithelial cells. However, the mechanism by which type 1 pilus-mediated bacterial invasion contributes to the pathogenesis of a urinary tract infection is unknown. Here we show that type 1-piliated uropathogens can invade the superficial epithelial cells that line the lumenal surface of the bladder and subsequently replicate, forming massive foci of intracellular E. coli termed bacterial factories. In response to infection, superficial bladder cells exfoliate and are removed with the flow of urine. To avoid clearance by exfoliation, intracellular uropathogens can reemerge and eventually establish a persistent, quiescent bacterial reservoir within the bladder mucosa that may serve as a source for recurrent acute infections. These observations suggest that urinary tract infections are more chronic and invasive than generally assumed.

* Corresponding author. Mailing address: Department of Molecular Microbiology and Microbial Pathogenesis, Box 8230, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110. Phone: (314) 362-3667. Fax: (314) 362-1998. E-mail: hultgren{at}borcim.wustl.edu.

dagger Present address: Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT 84132.

Infection and Immunity, July 2001, p. 4572-4579, Vol. 69, No. 7
0019-9567/01/$04.00+0   DOI: 10.1128/IAI.69.7.4572-4579.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


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