Urinary tract infection due to Group B Streptococcus: A case series from Eastern India

Changes of microbiota level in urinary tract infections: A meta-analysis

No consensus has been reached on the dysbiosis signs of microbiota in patients with urinary tract infections (UTIs). This meta-analysis aimed to verify the relationship between microbiota levels and UTIs. PubMed, Web of Science, and Embase databases were retrieved for related articles published from inception until October 20, 2021. The standardized mean difference (SMD) and its related 95% confidence intervals (CIs) of the microbiota diversity and abundance were pooled under a random-effects model. Twelve studies were included in this meta-analysis. The pooled analysis revealed that the microbiota diversity was lower in patients with UTIs than in healthy individuals (SMD = -0.655, 95% CI = -1.290, -0.021, I ² = 81.0%, P = 0.043). The abundance of specific bacteria was higher in UTI subjects compared with healthy control individuals (SMD = 0.41, 95% CI = 0.07-0.74, P = 0.017), especially in North America patients with UTIs. Similar results were also found in studies with the total sample size being greater than 30. Importantly, Escherichia coli levels were increased in patients with UTI, whereas Lactobacillus levels decreased. E. coli and Lactobacilli have huge prospects as potential microbiota markers in the treatment of UTIs.

Distribution of virulence genes and biofilm characterization of human isolates of Streptococcus agalactiae: A pilot study

This study included 21 newly isolated clinical samples of Streptococcus agalactiae (Group B Streptococcus) screened in patients (six male, fifteen female) from various states of India with different infections (urinary tract infections, blood, pus and eye infections). All isolates were identified as Group B Streptococcus (GBS) using hemolytic properties, serogrouping and MALDI-TOF-MS analysis. Six virulence genes, cfb (100%), cylE (90.4%), lmp (85.7%), bca (71.4%), rib (38%) and bac (4.7%) were detected via polymerase chain reaction (PCR). Distribution studies of these six genes revealed five isolates containing five virulence genes (23.8%), followed by ten isolates containing four virulence genes (47.6%). The twenty GBS isolates selected on the glass surface included non-biofilm producers (n = 6, 30%), weak (n = 11, 55%) and moderate biofilm producers (n = 3, 15%). On the polystyrene surface, weak (n = 4, 20%), moderate (n = 2, 10%) and strong (n = 14, 70%) biofilm producers were detected. Live-dead cell staining revealed that more viable cells accumulated in the S. ag 7420 isolate than in the AH1 isolate. Scanning electron microscope (SEM) biofilm analysis showed S. ag AH1 cells appeared as chain-like structures, whereas the S. ag 7420 isolate biofilm cells appeared as fork-like structures on the glass surface. Biofilm elements were analyzed using Energy Dispersive X-Ray Analysis (EDAX) for both isolates and 13 elements with different orders of composition were found. Thus, virulence gene detection, distribution and biofilm formation by these new clinical isolates suggested the virulent nature of these pathogens, which might cause different levels of disease severity in humans.

Intracellular bacterial communities in patient with recurrent urinary tract infection caused by Staphylococcus spp and Streptococcus agalactiae: a case report and literature review

Background

 Urinary tract infections (UTI) are among the most frequent pathologies worldwide. Uropathogenic Escherichia coli (UPEC) is the leading etiological agent; however, depending on the patient's characteristics, the etiology may include some atypical pathogens. Some pathogenic bacteria can internalize in the urothelial and phagocytic cells complicating treatment and timely diagnosis.

Case presentation

We present a clinical case of a married female patient with urological alteration, constant catheterization, and urethral dilation with recurrent UTI for ten years, with five episodes per year and reports of negative urine culture. The microscopic analysis revealed intracellular bacterial communities (IBC) and pyocytes with active bacteria. A protocol was designed for the release of intracellular bacteria in urine samples; without the proposed treatment, the urine culture was negative. However, upon releasing the internalized bacteria, we obtained a polymicrobial urine culture. We isolated and identified Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus simulans, and Streptococcus agalactiae. All microorganisms were sensitive to nitrofurans and sulfas. The patient is under treatment with nitrofurantoin and continuous follow-up by our workgroup.

Conclusions

 It is essential to look for IBC and pyocytes with active bacteria in patients with recurrent UTIs to avoid false-negative urine culture results and provide timely treatment. Polymicrobial culture must be considered depending on the patient and clinical history.

Imaging of Group B Streptococcus infection in pyonephrosis: a case report

Introduction: Pyonephrosis is hydronephrosis accompanied by a bacterial infection in the kidney, causing suppurative destruction of the renal parenchyma; this condition is an emergency and usually associated with stones or chronic urinary tract infections. Urinalysis is typically inaccurate for establishing the diagnosis, as bacteriuria may not manifest due to ureteral obstruction. Case report: We reported a 55-year-old male patient with flanks pain and an account of stone expulsion. Based on history taking, physical examination, radiology examinations, and percutaneous nephrotomy, we concluded a diagnosis of pyonephrosis causing by Streptococcus agalactiae as known as Group B Streptococcus. Discussion: While both US and CT scan guided the early diagnosis, CT was more accurate as it is able to capture the renal function and the underlying cause of obstruction. Pyonephrosis was described as having a pus collection in the pelvicalyceal system, cortex thinning, and the appearance of stones. Conclusion: Pyonephrosis is a rare emergency, and many clinicians find it challenging to recognize since the presentations are frequently nonspecific. In order to prevent renal failure and the spread of bacteremia that entails life-threatening urosepsis, acquiring imaging knowledge (sonography and CT) and other findings are indispensable in determining this entity.