Nontyphoid salmonella urinary tract infections

Non-typhoidal Salmonella causing urinary tract infection in a young male with renal calculi - a case report and comprehensive review

Introduction

Non-typhoidal Salmonella (NTS) causes urinary tract infections infrequently and are usually associated with presence of genitourinary abnormalities.

Case presentation

We report a case of immunocompetent male in his early 20 s with phimosis presented with history of dysuria and burning micturition for 4 months. A renal ultrasonography showed presence of bilateral intrarenal calculi. Urine analysis revealed presence of non-typhoidal Salmonella. Automated identification systems performed poorly in identification of serotype. On serotyping, it was identified as Salmonella enteritidis in the referral centre. The patient was managed with oral antibiotics.

Conclusion

This report highlights the issues of inaccurate identification of NTS even with advanced automated systems and early initiation of therapy based on the knowledge of local susceptibility patterns. UTI in immunocompetent individuals by non-typhoidal Salmonella should always be investigated further to rule out genitourinary abnormalities and appropriate antibiotics must be started to avoid chronicity and complications.

Association between non-typhoidal Salmonella urinary tract infection and Klebsiella pneumoniae lung empyema

Non-typhoidal Salmonella is a known but rare cause of urinary tract infections (UTI). It has been associated with the elderly, urological abnormalities and immunocompromised states. Klebsiella pneumoniae is a common cause of lung empyema, and is typically associated with diabetes and malignancy. Here, we report a patient who was found to have a Salmonella enteritidis bacteriuria as well as a lung empyema secondary to K. pneumoniae.

Salmonella Oranienburg haemorrhagic cystitis in an immunocompetent young male

Introduction. Non-typhoidal salmonella (NTS) bacteriuria is extremely rare. Haemorrhagic cystitis is defined by urinary symptoms including haematuria, frequency, urgency and dysuria. Reports of haemorrhagic cystitis caused by NTS are exceptionally uncommon, especially in immunocompetent, young, male patients.

Case presentation. A 27-year-old male with no past medical history presented to the Emergency Department with a 24 h history of visible haematuria having returned five days earlier from a five month trip across South America. He also reported one week of suprapubic pain with associated dysuria, frequency, difficulty voiding and fevers. A non-contrast abdominal and pelvic CT scan showed a grossly thick-walled bladder with marked peri-vesical stranding, strongly suggestive of cystitis, with an unremarkable appearance of the remainder of the urinary tract. Urine culture at presentation subsequently grew Salmonella Oranienburg. The patient reported total symptomatic relief following just one week of oral antibiotics with no recurrence to date.

Conclusion. NTS urinary tract infection (UTI), especially in healthy young people, is very rare. In such cases, the existence of underlying diseases must be considered, especially diabetes mellitus, urological abnormalities and immunosuppression. However, a diagnosis of NTS UTI should also be among the differentials in those presenting with acute urinary symptoms preceded by gastrointestinal upset, especially following travel in underdeveloped countries. Antibiotic therapy is invariably indicated and close follow-up is warranted due to the risk of several potentially serious complications.

Urinary Tract Infections Due to Nontyphoidal Salmonella

BACKGROUND

We sought to establish the characteristics of symptomatic nontyphoidal Salmonella (NTS) urinary tract infection (UTI) without concomitant gastroenteritis (GE) as a separate clinical entity.

MATERIALS AND METHODS

We conducted a retrospective cohort single-center study and reviewed all cases of NTS bacteriuria between 1995 and 2016. Patients were assigned to a group according to their clinical presentation, namely, symptomatic NTS UTI without GE, GE with NTS bacteriuria or isolated asymptomatic NTS bacteriuria. We compared the characteristics of patients in the NTS UTI group to those of the latter 2 groups.

RESULTS

NTS bacteriuria was found in 77 patients, of which 61 had records available for review. Twenty-one patients (including 17 adults) presented with NTS UTI, 30 patients presented with features of GE with NTS bacteriuria and 10 patients had asymptomatic NTS bacteriuria. NTS UTI was not significantly associated with older age, male sex, diabetes, immunosuppressive states or urologic abnormalities. There was a significant difference in the proportion of patients with an underlying urologic malignancy in the NTS UTI group (4 of 17 patients [23.5%]) as compared to those in the other groups (0 of 24 patients), P = 0.023.

CONCLUSIONS

A unique group of patients with symptomatic NTS UTI without GE was identified. A significant association with urologic malignancies was demonstrated in patients with NTS UTI compared to those with GE and NTS bacteriuria or asymptomatic NTS bacteriuria.

Group d salmonella urinary tract infection in an immunocompetent male

A 62-year-old male with past medical history of benign prostatic hyperplasia presented to the emergency department with complaints of decreased urinary flow, inability to fully empty his bladder, and gross hematuria. Physical examination was unremarkable. Urinalysis revealed large amount of blood and more than 700 white blood cells suggesting a urinary tract infection. Urine culture grew group D Salmonella greater than 100,000 colony-forming units per mL. He was prescribed 6 weeks of trimethoprim/sulfamethoxazole and had resolution of symptoms. Retrospectively, he reported a 3-day history of watery diarrhea about a week prior to onset of urinary symptoms that was presumed to be the hematogenous source in this case. Urinary tract infection from nontyphoidal Salmonella (NTS) is rare and is usually associated with immunosuppression, chronic diseases, such as diabetes or structural abnormalities of the genitourinary tract. Genitourinary tract abnormalities previously reported in the literature that predispose to nontyphoidal Salmonella urinary tract infection include nephrolithiasis, chronic pyelonephritis, retrovesicular fistula, urethrorectal fistula, hydrocele, and post-TURP. We present an exceedingly uncommon case of 62-year-old male with group D Salmonella urinary tract infection predisposed by his history of benign prostatic hyperplasia.

Urinary tract infection due to non-typhoidal Salmonella: report of 19 cases

OBJECTIVES

Urinary tract infection (UTI) caused by non-typhoidal Salmonella (NTS) is rare. The aims were to know the frequency and clinical characteristics of this infection in our area.

PATIENTS AND METHODS

We performed a retrospective analysis of patients with bacteriuria due to NTS diagnosed in our hospital from January 1990 to December 2005.

RESULTS

Nineteen patients with bacteriuria caused by NTS were diagnosed, representing 0.07% of the UTIs diagnosed in our area over the same period. The mean age was 62.5 years old. Eighteen patients (94.7%) had symptoms of UTI (12, cystitis; 6, pyelonephritis), and 1 remained asymptomatic. Fourteen patients (73.6%) had chronic diseases; diabetes mellitus was present in 8 of them (42.1%) and 7 patients (36.8%) were undergoing immunosuppressor treatment. Eight patients (42.1%) had urologic abnormalities. S. enteritidis was the most common serotype isolated (16 cases). Eleven patients required antibiotic treatment over 2 or more weeks. Four patients had recurrent Salmonella UTIs (22.2%), and in 2 of them recurrence occurred after prolonged treatment during 3.5 and 5 weeks, respectively.

CONCLUSIONS

UTI due to NTS was predominantly observed in elderly patients with underlying diseases, especially diabetes mellitus, urologic abnormalities and immunosuppression. Prolonged antibiotic treatment should be considered due to the high frequency of complicating conditions, although the infection can be recurrent despite prolonged treatment.

Urinary tract infection due to a mucoid (M) form of Salmonella. A "new" transformation from M form into T1 form

An eighty-year-old patient suffering from prostatic hypertrophy developed cystitis associated with fever, macrohematuria and significant bacteriuria. In urine cultures, growth of a mucoid (M) form of Salmonella was seen which changed into a T1 form after having been stored at room temperature or passed through U tubes. While the M form did not agglutinate in Salmonella O and H antisera, H antigens of the T1 form could be identified as l,v and 1.7. The isolate was therefore designated S.I M----T1:l,v:1.7. To date, no such M-T1 variation has been described. For diagnostic and epidemiologic purposes Salmonella M forms should be transformed into the N form or a T form (as in our case), because it is possible to demonstrate O or T and H antigens in these forms. The method of transformation and the pathogenesis of urinary excretion of salmonellae are briefly described.