Streptococcus Pneumoniae Urinary Tract Infection in 3-Year-Old Girl

Authors

  • Daniel Lubarsky UTCOM

DOI:

https://doi.org/10.46570/utjms.vol6-2019-317

Keywords:

Streptococcus pneumonia, Urinary Tract Infection

Abstract

Streptococcus pneumonia is a gram-positive bacteria most commonly associated with respiratory tract infections such as acute otitis media, sinusitis, and pneumonia. While a common cause of upper respiratory infections, the current Infectious Diseases Society of America (IDSA) guidelines on Urinary Tract Infections (UTIs) do not cite S. pneumoniae as a cause for UTIs in children. In addition, previous research associating S. pneumonia with UTIs has been scarce. We report the case of a three-year-old girl presenting to the emergency room with abdominal pain, vomiting, and fever. Her clinical picture was consistent with right sided pyelonephritis. A urine analysis (UA) was conducted which showed trace leukocyte esterase, 150mg/dL ketones, 21-50 WBCs, and negative nitrites. A blood culture returned positive for Streptococcus pneumoniae along with right kidney hydronephrosis on ultrasound. This patient presented with a full clinical picture of pyelonephritis, fever, leukocytosis, elevated CRP and Procalcitonin levels, and later found to be S. pneumoniae positive. Although the urine culture did not grow any definitive single bacteria as a causative agent, due to the presentation of pyelonephritis along with CVA tenderness, dysuria, and a positive blood culture, we conclude the patient was exhibiting urosepsis due to S. pneumoniae. Upon discovering previous case reports noting S. pneumoniae as a possible agent for UTIs, we believed this bacterium to be contributing to the patient’s symptoms. While S. pneumoniae has only been a rarely reported cause of UTIs, we believe there is sufficient evidence that demonstrates S. pneumoniae to at least be considered a possible contributing cause of UTIs, especially if the patient has a coinciding septic picture.

Contributors: Daniel Lubarsky (a) (1) Daniel Garcia (b) and Deepa Mukundan (c)

(a) M.D. Candidate, Class of 2021, The University of Toledo Heath Science Campus, Toledo, OH, USA, (b) Department of Pediatrics, University of Toledo Health Science Campus, Toledo, OH, USA , and (c) Department of Pediatric Infectious Disease, The University of Toledo Heath Science Campus, Toledo, OH, USA

References

Maraqa, N. F. (2014). Pneumococcal infections. Pediatr Rev, 35(7), 299-310. doi:10.1542/pir.35-7-299 DOI: https://doi.org/10.1542/pir.35.7.299

Gupta, K., Hooton, T. M., Naber, K. G., Wullt, B., Colgan, R., Miller, L. G., Soper, D. E. (2011). International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical Infectious Diseases, 52(5), e103-e120. doi:10.1093/cid/ciq257 DOI: https://doi.org/10.1093/cid/ciq257

Robinson, J. L., Finlay, J. C., Lang, M. E., Bortolussi, R., Canadian Paediatric Society, I. D., & Immunization Committee, C. P. C. (2014). Urinary tract infections in infants and children: Diagnosis and management. Paediatr Child Health, 19(6), 315-325. DOI: https://doi.org/10.1093/pch/19.6.315

Roberts, K. B. (2012). Revised AAP Guideline on UTI in Febrile Infants and Young Children. Am Fam Physician, 86(10), 940-946.

Chishti, A. S., Maul, E. C., Nazario, R. J., Bennett, J. S., & Kiessling, S. G. (2010). A guideline for the inpatient care of children with pyelonephritis. Ann Saudi Med, 30(5), 341-349. doi:10.4103/0256-4947.68549 DOI: https://doi.org/10.4103/0256-4947.68549

Miller, M. A., Kaplan, B. S., Sorger, S., & Knowles, K. F. (1989). Pneumococcosuria in children. J Clin Microbiol, 27(1), 99-101. DOI: https://doi.org/10.1128/jcm.27.1.99-101.1989

Nguyen, V. Q., & Penn, R. L. (1988). Pneumococcosuria in adults. J Clin Microbiol, 26(6), 1085-1087. DOI: https://doi.org/10.1128/jcm.26.6.1085-1087.1988

Dufke, S., Kunze-Kronawitter, H., & Schubert, S. (2004). Pyelonephritis and urosepsis caused by Streptococcus pneumoniae. J Clin Microbiol, 42(9), 4383-4385. doi:10.1128/JCM.42.9.4383-4385.2004 DOI: https://doi.org/10.1128/JCM.42.9.4383-4385.2004

Burckhardt, I., & Zimmermann, S. (2011). Streptococcus pneumoniae in urinary tracts of children with chronic kidney disease. Emerg Infect Dis, 17(1), 120-122. doi:10.3201/eid1701.100895 DOI: https://doi.org/10.3201/eid1701.100895

Krishna, S., Sanjeevan, K. V., Sudheer, A., Dinesh, K. R., Kumar, A., & Karim, S. (2012). Pneumococcusuria: From bench to bedside. Indian J Med Microbiol, 30(1), 96-98. doi:10.4103/0255-0857.93056 DOI: https://doi.org/10.4103/0255-0857.93056

Burckhardt, I., Panitz, J., van der Linden, M., & Zimmermann, S. (2016). Streptococcus pneumoniae as an agent of urinary tract infections - a laboratory experience from 2010 to 2014 and further characterization of strains. Diagn Microbiol Infect Dis, 86(1), 97-101. doi:10.1016/j.diagmicrobio.2016.06.009 DOI: https://doi.org/10.1016/j.diagmicrobio.2016.06.009

Downloads

Published

2019-12-03

How to Cite

Lubarsky, D. (2019). Streptococcus Pneumoniae Urinary Tract Infection in 3-Year-Old Girl. Translation: The University of Toledo Journal of Medical Sciences, 6, 32–34. https://doi.org/10.46570/utjms.vol6-2019-317

Issue

Section

Case Reports

Most read articles by the same author(s)