Recovery of blood-borne bacteria from human urine

Unusual manifestations of invasive pneumococcal infection

Unusual pneumococcal infections occurred frequently in the preantibiotic age but rapidly declined with the advent of the antibiotic era. Unfortunately, the morbidity and mortality associated with invasive pneumococcal disease remain high despite antibiotic therapy and monumental advances in medical technology. The incidence of invasive pneumococcal disease has increased recently because of the onset of the human immunodeficiency virus (HIV) epidemic and the emergence of antibiotic-resistant pneumococcus. Robert Austrian described the clinical triad of pneumococcal pneumonia, meningitis, and endocarditis, a syndrome that now bears his name. Although seen infrequently today, unusual manifestations of pneumococcal infection such as those Austrian reported still occur. A review of these cases is warranted because, as drug-resistant organisms continue to emerge worldwide, more unusual pneumococcal infections will be seen. Streptococcus pneumoniae is responsible for a remarkable array of disease processes; our literature review uncovered 95 different types of unusual pneumococcal infections representing 2,064 cases. Examples of these infections included pancreatic and liver abscesses, aortitis, gingival lesions, phlegmonous gastritis, inguinal adenitis, testicular and tubo-ovarian abscesses, and necrotizing fasciitis. We also reviewed predisposing underlying illnesses and conditions. Alcoholism, HIV infection, splenectomy, connective tissue disease, steroid use, diabetes mellitus, and intravenous drug use remain common risk factors for invasive pneumococcal infections. Currently, multidrug-resistant S. pneumoniae remains susceptible to vancomycin and several new third-generation fluoroquinolones. As what some fear will be a possible postantibiotic era approaches, clinicians must be able to recognize and manage unusual pneumococcal infections.

Pneumococcosuria in adults

Pneumococcal bacteriuria is usually felt to indicate systemic pneumococcal infection, especially in children. To determine the frequency and significance of pneumococcosuria in adults, we reviewed the Shreveport Veterans Administration Medical Center microbiology laboratory log books for 1982 through 1985. During these 4 years, more patients had pneumococcal bacteriuria than bacteremia (38 versus 33), but only 2 patients had both. The medical records from 31 bacteriuric patients with 35 positive urine specimens were available for review. The collection technique was reliable for 23 (66%) urine specimens; the type of collection technique used was unknown for 12 (34%). The urine pH was less than or equal to 6 in 24 (68%) specimens, and the specific gravity was greater than 1.020 in 12 specimens (34%). A total of 24 specimens grew only Streptococcus pneumoniae, and 11 yielded mixed growth. All 31 patients were men, 25 (81%) were 60 years or older, and 13 (42%) had underlying genitourinary disorders. A total of 7 patients had genitourinary symptoms, 7 had fever, 5 had leukocytosis, and 12 had pyuria; however, these symptoms and signs were frequently accounted for by factors other than pneumococcosuria. Pneumococcosuria was an unexpected finding in all but two (6%) bacteremic patients. These were the only patients with systemic pneumococcal infections, and both died despite appropriate antibiotics. Among the 20 surviving patients with follow-up urine samples, pneumococcosuria resolved whether or not they had received antibiotics. Thus, pneumococcosuria in our patient population was frequently not accompanied by systemic pneumococcal infection and by itself did not require antibiotic therapy.

Detection of bacterial antigens in body fluids by the Phadebact system

150 infected patients from 2 study centers had body fluids examined for presence of bacterial antigens (group B streptococcus, Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b) using the Pharmacia Phadebact system. The rates of detection of the pneumococcal antigens in the urine or serum of the patients with pneumococcal pneumonia, pneumococcal bacteremia and pneumococcal meningitis were 0.38, 0.47 and 0.5, respectively. The overall detection rate for H. influenzae infections was 0.92 and for group B streptococcal infections 0.87. Serum and urine from 100 non-infected patients were also tested for the presence of group B streptococcus, S. pneumoniae, N. meningitidis and H. influenzae type b antigens with only 1 false positive (H. influenzae type b).