Urinary fungi associated with urinary symptom severity among women with interstitial cystitis/bladder pain syndrome (IC/BPS).

To correlate the presence of fungi with symptom flares, pain and urinary severity in a prospective, longitudinal study of women with IC/BPS enrolled in the MAPP Research Network.

Flare status, pelvic pain, urinary severity, and midstream urine were collected at baseline, 6 and 12 months from female IC/BPS participants with at least one flare and age-matched participants with no reported flares. Multilocus PCR coupled with electrospray ionization/mass spectrometry was used for identification of fungal species and genus. Associations between "mycobiome" (species/genus presence, relative abundance, Shannon's/Chao1 diversity indices) and current flare status, pain, urinary severity were evaluated using generalized linear mixed models, permutational multivariate analysis of variance, Wilcoxon's rank-sum test.

The most specific analysis detected 13 fungal species from 8 genera in 504 urine samples from 202 females. A more sensitive analysis detected 43 genera. No overall differences were observed in fungal species/genus composition or diversity by flare status or pain severity. Longitudinal analyses suggested greater fungal diversity (Chao1 Mean Ratio 3.8, 95% CI 1.3-11.2, p = 0.02) and a significantly greater likelihood of detecting any fungal species (OR = 5.26, 95% CI 1.1-25.8, p = 0.04) in high vs low urinary severity participants. Individual taxa analysis showed a trend toward increased presence and relative abundance of Candida (OR = 6.63, 95% CI 0.8-58.5, p = 0.088) and Malassezia (only identified in 'high' urinary severity phenotype) for high vs low urinary symptoms.

This analysis suggests the possibility that greater urinary symptom severity is associated with the urinary mycobiome urine in some females with IC/BPS.

World journal of urology. 2019 Apr 26 [Epub ahead of print]

J Curtis Nickel, Alisa Stephens, J Richard Landis, Chris Mullins, Adrie van Bokhoven, Jennifer T Anger, A Lenore Ackerman, Jayoung Kim, Siobhan Sutcliffe, Jaroslaw E Krol, Bhaswati Sen, Jocelyn Hammond, Garth D Ehrlich, Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network

Department of Urology, Queen's University at Kingston, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada. ., Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA., National Institutes of Health/NIDDK, Bethesda, MD, USA., Department of Pathology, University of Colorado, Aurora, CO, USA., Division of Urology, Cedars-Sinai Medical Center, Beverly Hills, CA, USA., Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA., Department of Microbiology and Immunology, Drexel College of Medicine, Philadelphia, PA, USA.

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