Altered intrinsic defence mechanisms and immune suppression after spinal injuries augment the risk of UTIs possibly due to changes in the microbial flora, immunological deficiencies,1 and alterations in the bladder wall and its urothelium.2,3
Such conditions are presently not readily modifiable in daily clinical practice.4
How can nerve damage lead to an impaired immune system?
Apart from the local injury in the spinal cord, patients may develop a variety of complications characterized by multiple-organ dysfunction such as lung injury, cardiovascular disease, liver and kidney damage, and increased susceptibility to infection.4
The damage to the autonomic nerve system (ANS) leads to a general immune dysfunction through the loss of neural innervation of lymphoid organs.4
- Prüss H, Tedeschi A, Thiriot A et al., Spinal cord injuryinduced immunodeficiency is mediated by a sympatheticneuroendocrine adrenal reflex. Nature Neuroscience. 2017;20(11):1549–1559
- Vasudeva P and Madersbacher H, Factors implicated in pathogenesis of urinary tract infections in neurogenic bladders: some revered, few forgotten, others ignored. Neurourology and Urodynamics. 2014;33(1):95–100
- Allison D J and Ditor D S, Immune dysfunction and chronic inflammation following spinal cord injury. Spinal Cord. 2015;53(1):14–18
- Kennelly M, Thiruchelvam N, Averbeck M A et al., Adult neurogenic lower urinary tract dysfunction and intermittent catheterisation in a community setting: Risk factors model for urinary tract infections. Advances in Urology. 2019;Apr 2:1–13