Pneumococcosuria in adults

A Narrative Review on the Role of Staphylococcus aureus Bacteriuria in S. aureus Bacteremia

Staphylococcus aureus bacteriuria (SABU) can occur in patients with S. aureus bacteremia (SAB). However, little is known on the (molecular) pathomechanisms of the renal passage of S. aureus. This review discusses the epidemiology and pathogenesis of SABU in patients with SAB and identifies knowledge gaps. The literature search was restricted to the English language. The prevalence of SABU in patients with SAB is 7.8%-39% depending on the study design. The main risk factor for SABU is urinary tract catheterization. SABU in SAB patients is associated with increased mortality. Given present evidence, hematogenous seeding-as seen in animal models-and the development of micro-abscesses best describe the translocation of S. aureus from blood to urine. Virulence factors that might be involved are adhesion factors, sortase A, and coagulase, among others. Other potential routes of bacterial translocation (eg, transcytosis, paracytosis, translocation via "Trojan horses") were identified as knowledge gaps.

Streptococcus pneumoniae as an agent of urinary tract infections - a laboratory experience from 2010 to 2014 and further characterization of strains

Streptococcus pneumoniae is a rare cause of urinary tract infection. Between January 2010 and December 2014, 26 urine samples from 18 different patients contained S. pneumoniae at the Department for Infectious Diseases, University Hospital of Heidelberg. Patient age varied between three and 72 years. 13 patients were male and five were female. Past medical histories of 16 patients were available. Eight patients had a past medical history of renal transplant and four patients had other renal dysfunctions. Further analyses of the isolates revealed that the aspect of colonies is more resembling S. mitis than invasive isolates of S. pneumoniae. Optochin disk diameters tend to be 14 mm or smaller. Identification using MALDI-TOF or VITEK2 identification cards was accurate. Only 2 isolates showed a decreased susceptibility towards penicillin (MIC = 0.5 mg/L). Eight different serotypes were identified using a PCR approach as well Neufeld-Quellungs reaction.

Streptococcus pneumoniae as a uropathogen in children with urinary tract abnormalities

We describe 3 children with urinary tract abnormalities and large numbers of Streptococcus pneumoniae in their urine, along with a brief review of previously reported cases. These findings strongly suggest that S. pneumoniae is a uropathogen, especially in children with urinary tract abnormalities.

Streptococcus pneumoniae in urinary tracts of children with chronic kidney disease

Streptococcus pneumoniae is not commonly considered an agent of urinary tract infections. We report 3 children with urinary tract abnormalities who had high numbers of S. pneumoniae in their urine (>10⁴ CFU/mL) and varying clinical symptoms.

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.

Antigen detection in pneumococcal pneumonia

Streptococcus pneumoniae remains the commonest proven cause of community-acquired pneumonia in patients admitted to hospital, but no currently available diagnostic method can be regarded as a gold standard. Microscopy of sputum is usually considered insensitive and poorly specific, and more invasively-obtained specimens are not routinely collected. Cultures of blood and respiratory secretions, and countercurrent immunoelectrophoresis (CIE) and particle agglutination-based assays for capsular polysaccharides in serum and urine specimens, are specific but less than ideally sensitive. Some workers have reported specificity problems when immunoassays are applied to respiratory secretions. New diagnostic methods include detection of pneumococcal C polysaccharide in sputum and urine by ELISA and particle-agglutination assays, and these appear promisingly sensitive and specific in preliminary studies. Clinical assessments are now required to define the role of these techniques in guiding the treatment of individual patients.

Pneumococcosuria in children

Streptococcus pneumoniae was present, in pure or mixed culture, in 43 (0.08%) of 53,499 urine cultures submitted from a pediatric population over a 4-year period. Data were analyzed from 28 children, from whom 78% of these positive cultures originated. Ninety-six percent of the children were female, and the median age was 3 years (range, 0.4 to 17 years). Only five children had S. pneumoniae as the sole organism cultured from the urine, and all five had only a single urine culture. Urine from the other 23 children contained other organisms as well. Small numbers of pneumococci were found in most urines: 74% contained less than 10(4) CFU/ml and 93% contained less than 10(5) CFU/ml. There was no association between genitourinary symptoms and pneumococcosuria, and complete resolution of symptoms occurred in both treated and untreated children. Pneumococcosuria could not be explained by pneumococcal bacteremia. We conclude that pediatric pneumococcosuria is not associated with urinary tract infections in children, or with pneumococcal bacteremia or invasive disease elsewhere. Pneumococcosuria probably reflects contamination of urine specimens with S. pneumoniae from perineal colonization.