{"title":"一名患有输尿管结石的年轻成年人的放线菌肾盂肾炎:病例报告。","authors":"Jayaweera Arachchige Asela Sampath Jayaweera, Gerard Ranasinghe","doi":"10.18683/germs.2024.1422","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong><i>Actinotignum schaalii</i> is a Gram-positive coccobacillus, and a member of the normal human microbiota. <i>A. schaalii</i> is considered as an emerging pathogen causing urinary tract infections among the elderly. Because of an anaerobic growth requirement and lack of knowledge on pathogenic potential following conventional microbiology laboratory techniques, <i>A. schaalii</i> is difficult to identify.</p><p><strong>Case report: </strong>A previously well 24-year-old male presented to a tertiary care unit with fever, left flank pain, and dysuria for two days. He was initially treated with empiric oral ciprofloxacin by the general practitioner. Following admission, blood cultures and urine cultures were done, and empirical intra-venous piperacillin-tazobactam was started. X-ray of the pelvis revealed left-sided pyelonephritis and left ureteric calculi. A nephrostomy tube was inserted to relieve the obstruction which drained pus and was sent to microbiology laboratory in aerobic and anaerobic blood culture bottles. Two days later blood culture flagged positive for Gram-positive bacilli from the anaerobic bottle, and the pus from enriched anaerobic culture grew <i>A. schaalii</i>. The urine culture remained negative. By VITEK 2 anaerobic card and MALDI-TOF analysis, it was identified as <i>A. schaalii.</i> Following clinical improvement, he was discharged with oral doxycycline. Ureteric calculus was removed and remained sterile following 16s DNA analysis.</p><p><strong>Conclusions: </strong>The urine Gram staining may have a role in detecting and considering anaerobic media to isolate <i>A. schaalii.</i> The novel diagnostic platforms are important to speciate the pathogen. Also, the lack of pathogen-specific breakpoints for antimicrobial susceptibilities made it a problem to decide on appropriate therapy.</p>","PeriodicalId":45107,"journal":{"name":"GERMS","volume":null,"pages":null},"PeriodicalIF":1.7000,"publicationDate":"2024-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11333836/pdf/","citationCount":"0","resultStr":"{\"title\":\"<i>Actinotignum schaalii</i> pyelonephritis in a young adult with ureteric calculus: case report.\",\"authors\":\"Jayaweera Arachchige Asela Sampath Jayaweera, Gerard Ranasinghe\",\"doi\":\"10.18683/germs.2024.1422\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong><i>Actinotignum schaalii</i> is a Gram-positive coccobacillus, and a member of the normal human microbiota. <i>A. schaalii</i> is considered as an emerging pathogen causing urinary tract infections among the elderly. Because of an anaerobic growth requirement and lack of knowledge on pathogenic potential following conventional microbiology laboratory techniques, <i>A. schaalii</i> is difficult to identify.</p><p><strong>Case report: </strong>A previously well 24-year-old male presented to a tertiary care unit with fever, left flank pain, and dysuria for two days. He was initially treated with empiric oral ciprofloxacin by the general practitioner. Following admission, blood cultures and urine cultures were done, and empirical intra-venous piperacillin-tazobactam was started. X-ray of the pelvis revealed left-sided pyelonephritis and left ureteric calculi. A nephrostomy tube was inserted to relieve the obstruction which drained pus and was sent to microbiology laboratory in aerobic and anaerobic blood culture bottles. Two days later blood culture flagged positive for Gram-positive bacilli from the anaerobic bottle, and the pus from enriched anaerobic culture grew <i>A. schaalii</i>. The urine culture remained negative. By VITEK 2 anaerobic card and MALDI-TOF analysis, it was identified as <i>A. schaalii.</i> Following clinical improvement, he was discharged with oral doxycycline. Ureteric calculus was removed and remained sterile following 16s DNA analysis.</p><p><strong>Conclusions: </strong>The urine Gram staining may have a role in detecting and considering anaerobic media to isolate <i>A. schaalii.</i> The novel diagnostic platforms are important to speciate the pathogen. Also, the lack of pathogen-specific breakpoints for antimicrobial susceptibilities made it a problem to decide on appropriate therapy.</p>\",\"PeriodicalId\":45107,\"journal\":{\"name\":\"GERMS\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2024-03-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11333836/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"GERMS\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.18683/germs.2024.1422\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/3/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"GERMS","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.18683/germs.2024.1422","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/3/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0
摘要
简介放线菌(Actinotignum schaalii)是一种革兰氏阳性球菌,也是正常人体微生物群中的一员。放线菌被认为是导致老年人尿路感染的新病原体。由于需要厌氧生长,而且缺乏传统微生物学实验室技术对致病潜能的了解,因此很难识别沙雷氏菌:病例报告:一名 24 岁的男性因发烧、左侧腹痛和排尿困难两天到一家三级医院就诊。他最初接受了全科医生提供的经验性口服环丙沙星治疗。入院后进行了血培养和尿培养,并开始静脉注射哌拉西林-他唑巴坦。骨盆 X 光片显示左侧肾盂肾炎和左侧输尿管结石。插入肾造瘘管以缓解梗阻,排出的脓液装在需氧和厌氧血液培养瓶中送往微生物实验室。两天后,厌氧瓶中的革兰氏阳性杆菌血培养呈阳性,厌氧培养富集的脓液中长出了沙雷氏菌。尿液培养仍为阴性。通过 VITEK 2 厌氧卡和 MALDI-TOF 分析,确定其为 A. schaalii。临床症状好转后,他口服强力霉素后出院。输尿管结石被取出,经 16s DNA 分析后仍无菌:结论:尿液革兰氏染色可用于检测和考虑厌氧培养基,以分离裂头蚴。新型诊断平台对确定病原体非常重要。此外,由于缺乏抗菌药敏感性的病原体特异性断点,因此很难决定适当的治疗方法。
Actinotignum schaalii pyelonephritis in a young adult with ureteric calculus: case report.
Introduction: Actinotignum schaalii is a Gram-positive coccobacillus, and a member of the normal human microbiota. A. schaalii is considered as an emerging pathogen causing urinary tract infections among the elderly. Because of an anaerobic growth requirement and lack of knowledge on pathogenic potential following conventional microbiology laboratory techniques, A. schaalii is difficult to identify.
Case report: A previously well 24-year-old male presented to a tertiary care unit with fever, left flank pain, and dysuria for two days. He was initially treated with empiric oral ciprofloxacin by the general practitioner. Following admission, blood cultures and urine cultures were done, and empirical intra-venous piperacillin-tazobactam was started. X-ray of the pelvis revealed left-sided pyelonephritis and left ureteric calculi. A nephrostomy tube was inserted to relieve the obstruction which drained pus and was sent to microbiology laboratory in aerobic and anaerobic blood culture bottles. Two days later blood culture flagged positive for Gram-positive bacilli from the anaerobic bottle, and the pus from enriched anaerobic culture grew A. schaalii. The urine culture remained negative. By VITEK 2 anaerobic card and MALDI-TOF analysis, it was identified as A. schaalii. Following clinical improvement, he was discharged with oral doxycycline. Ureteric calculus was removed and remained sterile following 16s DNA analysis.
Conclusions: The urine Gram staining may have a role in detecting and considering anaerobic media to isolate A. schaalii. The novel diagnostic platforms are important to speciate the pathogen. Also, the lack of pathogen-specific breakpoints for antimicrobial susceptibilities made it a problem to decide on appropriate therapy.