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Isolation of Neisseria spp. from the urine of pediatric patients
3. Salata, R. A. et al. 1989. Infections due to Lancefield group C streptococci. Medicine (Baltimore) 68:225-239. 4. Bradley, S. F. et al. 1991. Group C streptococcal bacteremia: analysis of 88 cases. Rev. Infect. Dis. 13:210-280. 5. Mc Coy, H. E. et al. 1991. Streptokinases produced by pathogenic group C streptococci demonstrate species-specific plasminogen activation. J. Infect. Dis. 164:515-521. 6. Ortel, T. L., J. Kallianos, and J. A. Gallis. 1990. Group C streptococcal arthritis: case report and review. Rev. Infect. Dis. 12:829-837. 7. Barnham, M., A. Ljundgren, and M. Mc Intyre. 1987. Human infection with Streptococcus zooepidemicus (Lancefield group C): three case reports. Epidemiol. Infect. 98:183-190. 8. Ike, R. W. 1990. Septic arthritis due to group C streptococcus: report and review of the literature. J. Rheumatol.
17:1230-1236. 9. Sobrino, J. et al. 1991. Septic arthritis secondary to group C streptococcus typed as S. equisimilis (letter). J. Rhenmatol. 18:485--486. 10. Hahn, G. and I. Nyberg. 1976. Identification of agglutinationof antibody sensitized protein-Acontaining staphylococci. J. Clin. Microbiol.4:99-101. 11. Facldana, R. R. and J. A. Washington lI. 1991. Streptococcus and related catalase-negative gram-positive cocci, p. 238-257. In A. Balows et al. (eds.), Manual of clinical microbiology, 5th ed. American Society for Microbiology, Washington, D.C. 12. Hayden, G. F. et al. 1992. Latex agglutination testing directly from throat swabs for rapid detection of betahaemolytic streptococci from Lancefield group C. J. Clin. Microbiol. 30:716-719. 13. Piscitelli, S. C. et al. 1992. Streptococ-
Isolation of Neisseria spp. from the Urine of Pediatric Patients
phytic" organisms have been isolated rarely from the urinary tract and in those cases, pathogenicity was not well established (1). We report a case of urinary tract infection in which Neisseria mucosa was isolated alone or as part of mixed flora from five urine samples collected by different methods.
H. Lopardo A. Nufliez E. Rubeglio Hospital de Pediatrfa "Prof. Dr. Juan P. Garrahan " Buenos Aires Laboratorio de Microbiologfa
J. Peflaloza Servicio de Nefrologia R. Callejo N. Leardini lnstituto Nacional de Microbiologfa "Carlos Malbrdn" Divisitn Bacteriologfa Especial Buenos Aires, Argentina Neisseria other than Neisseria meningitidis and Neisseria gonorrhoeae are normal inhabitants of the human nasopharynx. However, cases of meningitis, endocarditis, pneumonia, cellulitis, and sepsis caused by "nonpathogenic" Neisseria have been reported (1). Some of these infections have occurred in both healthy and immunocompromised pediatric patients (1--4). These "sapro-
ClinicalMicrobiologyNewsletter16:33994
Case R e p o r t A 9-yr-old boy with a pyeloureteral bilateral double system and in chronic renal failure underwent a left ureteropyelic anastomosis surgical procedure and was discharged with a nephrostomy and a transanastomotic catheter. While he was receiving prophylactic treatment with trimethoprimsulfamethoxazole, he became febrile and 105 CFU/ml each of a viridans group Streptococcus and N. mucosa were isolated from urine. Antimicrobial treatment with cefalexin (50 mg/kg b.i.d.) was prescribed, but the patient may have been noncompliant. N. mucosa was isolated from four subsequent urine cultures during the following 3 mo. It was recovered in mixed cultures twice along with 105 CFU/ml of Escherichia coli and once along with 104 © 1994 ElsevierScienceInc.
cus milleri group: renewed interest in an elusive pathogen. Eur. J. Clin. Microbiol. Infect. Dis. 11:491--498. 14. Galas, H. A. 1990. Viridans and 13hemolytic (non-group A, B, and D) streptococci, p. 1563-1572. In G. Mandell, R. G. Douglas, and J.E. Bennett (eds.), Principles and practice of infectious diseases, 3rd ed. Churchill Livingstone, Inc., New York.
15. Espinosa, F. J. et al. 1990. Endoearditis mitral por Streptococcus betahemolitico grupo C (S. equisimilis) (letter). Enf. Infecc. Microbiol, Clin. 8:534. 16. Barnham, M. et al. 1989. Group C streptococci in human infection: a study of 308 isolates with clinical correlations. Epidemiol. Infect. 102:379-390. 17. Stanun, A. M. and C.G. Cobbs. 1980. Group C streptococcal pneumonia: report of a fatal case and review of the literature. Rev. Infect. Dis, 2:889--898.
CFU/ml Kiebsieila oxytoca; another time it was recovered alone. In all these cultures, colony counts for N. mucosa were more than 105 CFU/ml. One of these samples was obtained by catheterization through the nephrostomy, whereas the others were cleancatch specimens. The Neisseria was eradicated after completion of the treatment with cefalexin, but Xanthomonas maltophilia replaced it as a urinary pathogen. After a new surgical procedure, the patient is currently free of urinary tract infections. When N. mucosa was initially isolated, it was thought to be a strain of Acinetobacter because of its colonial morphology and because it is more commonly associated in this setting. Nevertheless, the following test results suggested that the organism belonged to the genus Neisseria: it was oxidase positive, showed no growth on MacConkey agar, was nonmotile, and fermented glucose. It was confirmed as a coccus because it did not exhibit elongation when observed in a Gram-stained smear performed with organisms that grew at the edge of the inhibition zone produced by penicillin disks. Other test 0196-4399/94/$0.00+ 07.00
23
i
results that identified this organism were no growth on Thayer-Martin agar, growth on chocolate agar at 22°C, fermentation of glucose, maltose, sucrose, and fructose, but not of lactose, reduction of nitrate, and its being negative for DNAse. These reactions correspond to those ofN. mucosa (5). Through the microdilution method (Sceptor, Becton-Dickinson, Cockeysville, MD), this organism was found to be susceptible to cefalexin and other cephalosporins (MIC <8 btg/ml). It showed moderately high MICs for penicillin and ampicillin (2 ~tg/ml and 4 ttg/ml, respectively) (6). MICs of other antimicrobial agents were as follows: clindamycin >16 ttg/ml, ampiciUin-sulbactam 1 ~tg/ml, amoxicillin-clavulanic acid 2 ttg/ml, doxycycline 0.5 ~tg/ml, and erythromycin 4 ~tg/ml. Comments The isolation o f Neisseriae as part of mixed urinary cultures is not convincing of their pathogenic role. However,
Editors Mary Jane Ferraro Paul A. Granato Josephine A. Morello P,.J. Zabransky © 1994 Elsevier Science Inc. ISSN 0196-4399 CMNEEJ 16(3)17-24, 1994
the isolation ofN. mucosa from five urine specimens collected at different times from different urinary tract sites of a patient who had severe urological and nephrological underlying diseases indicates that this organism is able to at least colonize the human bladder. To our knowledge this is the first reported case of urinary tract infection in which N. mucosa was involved. Whether Neisseria spp. are invasive organisms remains a dilemma in cases like the one reported here. Nevertheless, their increased resistance to some antimicrobial agents, such as ampicillin or Irimethoprim-sulfamethoxazole, may enhance their chance to appear more frequently as opportunistic pathogens. References 1. Herbert, D. A. and J. Ruskin. 1981. Are the "nonpathogenic" Neisseriae pathogenic? Am. J. Clin. Pathol. 75:739-743. 2. Demmler, G. J., R. S. Couch, and L. H. Taber. 1985. Neisseria subflava bacteremia and meningitis in a child: report of
a case and review of the literature. Pediatr. Infect. Dis. 4:286-288. 3. Hussain, Z., R. Lannigan, and T. W. Austin. 1988. Pulmonary cavitation due to Neisseria mucosa in a child with chronic neutropenia. Eur. J. Clin. Microbiol. Infect. Dis. 7:17.5-176. 4.
Feder, H. M. and R. A. Garibaldi. 1984. The significance of nongonococcal, nonmeningococcal Neisseria isolates from blood cultures. Rev. Infect. Dis. 6:181-188.
5. Morello, J. A., W. M. Janda, and G. V. ~ . 1991. Neisseria and Branhamel/a, p. 258--276. In A. Balows et al. (eds.), Manual of clinical microbiology, 5th ed. American Society for Microbiology. Washington, DC. 6. National Committee for Clinical Laboratory Standards. 1991. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. Approved standard. M7-A2. National Committee for Clinical Laboratory Standards. Villanova, PA.
General Information Subscription information can be found inside the front cover. This newsletter has been registered with the Copyright Clearance Center, Inc. Consent is given for copying articles for personal or internal use, or for the personal or internal use of specific clients. This consent is given on the condition that the copier pay through the Center the per-copy fee stated in the code on the first page for copying beyond that permitted by the US Copyright Law. If no code appears on an article, the author has not given breed consent to copy and permission to copy must be obtained directly from the author. This consent does not extend to other kinds of copying, such as for general distribotioo, resale, advertising and promotional purposes, or for creating new collective works. Address orders, changes of address, and claims for missing issues to Journal Fulfillment ~ e n t ,
Elsevier
Science Inc,, 655 Avenue of the Americas, New York, NY 10010. Claims formissin8 issues can be honot~.~l
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only up to three months for domestic addresses and six months for foreign addresses. Duplicate copies will not be sent to replace ones undelivered doe to fallme to notify Elsevier of change of address. PosUnaster. Send address changes to Clinical Microbiology Newsletter, Elsevier Science Inc., 655 Avenue of the Americas, New York, NY 10010. Editorials and lelters printed in this newsletter are published for the interest of the readers and do not necesuu'ily reflect the opinions of the editors.
0196-4399(199tO201)16:O3;1-A
Clinical Microbiology Newsletter is abstracted in Tropical Diseases Bulletin and Abstracts on Hygiene and Communicable Diseases. I
24
0196-4399/94/$0.00 + 07.00
© 1994 Elsevier Science Inc.
Clinical Microbiolosy Newsleuer 16:3,1994
17:1230-1236. 9. Sobrino, J. et al. 1991. Septic arthritis secondary to group C streptococcus typed as S. equisimilis (letter). J. Rhenmatol. 18:485--486. 10. Hahn, G. and I. Nyberg. 1976. Identification of agglutinationof antibody sensitized protein-Acontaining staphylococci. J. Clin. Microbiol.4:99-101. 11. Facldana, R. R. and J. A. Washington lI. 1991. Streptococcus and related catalase-negative gram-positive cocci, p. 238-257. In A. Balows et al. (eds.), Manual of clinical microbiology, 5th ed. American Society for Microbiology, Washington, D.C. 12. Hayden, G. F. et al. 1992. Latex agglutination testing directly from throat swabs for rapid detection of betahaemolytic streptococci from Lancefield group C. J. Clin. Microbiol. 30:716-719. 13. Piscitelli, S. C. et al. 1992. Streptococ-
Isolation of Neisseria spp. from the Urine of Pediatric Patients
phytic" organisms have been isolated rarely from the urinary tract and in those cases, pathogenicity was not well established (1). We report a case of urinary tract infection in which Neisseria mucosa was isolated alone or as part of mixed flora from five urine samples collected by different methods.
H. Lopardo A. Nufliez E. Rubeglio Hospital de Pediatrfa "Prof. Dr. Juan P. Garrahan " Buenos Aires Laboratorio de Microbiologfa
J. Peflaloza Servicio de Nefrologia R. Callejo N. Leardini lnstituto Nacional de Microbiologfa "Carlos Malbrdn" Divisitn Bacteriologfa Especial Buenos Aires, Argentina Neisseria other than Neisseria meningitidis and Neisseria gonorrhoeae are normal inhabitants of the human nasopharynx. However, cases of meningitis, endocarditis, pneumonia, cellulitis, and sepsis caused by "nonpathogenic" Neisseria have been reported (1). Some of these infections have occurred in both healthy and immunocompromised pediatric patients (1--4). These "sapro-
ClinicalMicrobiologyNewsletter16:33994
Case R e p o r t A 9-yr-old boy with a pyeloureteral bilateral double system and in chronic renal failure underwent a left ureteropyelic anastomosis surgical procedure and was discharged with a nephrostomy and a transanastomotic catheter. While he was receiving prophylactic treatment with trimethoprimsulfamethoxazole, he became febrile and 105 CFU/ml each of a viridans group Streptococcus and N. mucosa were isolated from urine. Antimicrobial treatment with cefalexin (50 mg/kg b.i.d.) was prescribed, but the patient may have been noncompliant. N. mucosa was isolated from four subsequent urine cultures during the following 3 mo. It was recovered in mixed cultures twice along with 105 CFU/ml of Escherichia coli and once along with 104 © 1994 ElsevierScienceInc.
cus milleri group: renewed interest in an elusive pathogen. Eur. J. Clin. Microbiol. Infect. Dis. 11:491--498. 14. Galas, H. A. 1990. Viridans and 13hemolytic (non-group A, B, and D) streptococci, p. 1563-1572. In G. Mandell, R. G. Douglas, and J.E. Bennett (eds.), Principles and practice of infectious diseases, 3rd ed. Churchill Livingstone, Inc., New York.
15. Espinosa, F. J. et al. 1990. Endoearditis mitral por Streptococcus betahemolitico grupo C (S. equisimilis) (letter). Enf. Infecc. Microbiol, Clin. 8:534. 16. Barnham, M. et al. 1989. Group C streptococci in human infection: a study of 308 isolates with clinical correlations. Epidemiol. Infect. 102:379-390. 17. Stanun, A. M. and C.G. Cobbs. 1980. Group C streptococcal pneumonia: report of a fatal case and review of the literature. Rev. Infect. Dis, 2:889--898.
CFU/ml Kiebsieila oxytoca; another time it was recovered alone. In all these cultures, colony counts for N. mucosa were more than 105 CFU/ml. One of these samples was obtained by catheterization through the nephrostomy, whereas the others were cleancatch specimens. The Neisseria was eradicated after completion of the treatment with cefalexin, but Xanthomonas maltophilia replaced it as a urinary pathogen. After a new surgical procedure, the patient is currently free of urinary tract infections. When N. mucosa was initially isolated, it was thought to be a strain of Acinetobacter because of its colonial morphology and because it is more commonly associated in this setting. Nevertheless, the following test results suggested that the organism belonged to the genus Neisseria: it was oxidase positive, showed no growth on MacConkey agar, was nonmotile, and fermented glucose. It was confirmed as a coccus because it did not exhibit elongation when observed in a Gram-stained smear performed with organisms that grew at the edge of the inhibition zone produced by penicillin disks. Other test 0196-4399/94/$0.00+ 07.00
23
i
results that identified this organism were no growth on Thayer-Martin agar, growth on chocolate agar at 22°C, fermentation of glucose, maltose, sucrose, and fructose, but not of lactose, reduction of nitrate, and its being negative for DNAse. These reactions correspond to those ofN. mucosa (5). Through the microdilution method (Sceptor, Becton-Dickinson, Cockeysville, MD), this organism was found to be susceptible to cefalexin and other cephalosporins (MIC <8 btg/ml). It showed moderately high MICs for penicillin and ampicillin (2 ~tg/ml and 4 ttg/ml, respectively) (6). MICs of other antimicrobial agents were as follows: clindamycin >16 ttg/ml, ampiciUin-sulbactam 1 ~tg/ml, amoxicillin-clavulanic acid 2 ttg/ml, doxycycline 0.5 ~tg/ml, and erythromycin 4 ~tg/ml. Comments The isolation o f Neisseriae as part of mixed urinary cultures is not convincing of their pathogenic role. However,
Editors Mary Jane Ferraro Paul A. Granato Josephine A. Morello P,.J. Zabransky © 1994 Elsevier Science Inc. ISSN 0196-4399 CMNEEJ 16(3)17-24, 1994
the isolation ofN. mucosa from five urine specimens collected at different times from different urinary tract sites of a patient who had severe urological and nephrological underlying diseases indicates that this organism is able to at least colonize the human bladder. To our knowledge this is the first reported case of urinary tract infection in which N. mucosa was involved. Whether Neisseria spp. are invasive organisms remains a dilemma in cases like the one reported here. Nevertheless, their increased resistance to some antimicrobial agents, such as ampicillin or Irimethoprim-sulfamethoxazole, may enhance their chance to appear more frequently as opportunistic pathogens. References 1. Herbert, D. A. and J. Ruskin. 1981. Are the "nonpathogenic" Neisseriae pathogenic? Am. J. Clin. Pathol. 75:739-743. 2. Demmler, G. J., R. S. Couch, and L. H. Taber. 1985. Neisseria subflava bacteremia and meningitis in a child: report of
a case and review of the literature. Pediatr. Infect. Dis. 4:286-288. 3. Hussain, Z., R. Lannigan, and T. W. Austin. 1988. Pulmonary cavitation due to Neisseria mucosa in a child with chronic neutropenia. Eur. J. Clin. Microbiol. Infect. Dis. 7:17.5-176. 4.
Feder, H. M. and R. A. Garibaldi. 1984. The significance of nongonococcal, nonmeningococcal Neisseria isolates from blood cultures. Rev. Infect. Dis. 6:181-188.
5. Morello, J. A., W. M. Janda, and G. V. ~ . 1991. Neisseria and Branhamel/a, p. 258--276. In A. Balows et al. (eds.), Manual of clinical microbiology, 5th ed. American Society for Microbiology. Washington, DC. 6. National Committee for Clinical Laboratory Standards. 1991. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. Approved standard. M7-A2. National Committee for Clinical Laboratory Standards. Villanova, PA.
General Information Subscription information can be found inside the front cover. This newsletter has been registered with the Copyright Clearance Center, Inc. Consent is given for copying articles for personal or internal use, or for the personal or internal use of specific clients. This consent is given on the condition that the copier pay through the Center the per-copy fee stated in the code on the first page for copying beyond that permitted by the US Copyright Law. If no code appears on an article, the author has not given breed consent to copy and permission to copy must be obtained directly from the author. This consent does not extend to other kinds of copying, such as for general distribotioo, resale, advertising and promotional purposes, or for creating new collective works. Address orders, changes of address, and claims for missing issues to Journal Fulfillment ~ e n t ,
Elsevier
Science Inc,, 655 Avenue of the Americas, New York, NY 10010. Claims formissin8 issues can be honot~.~l
Elsevier
only up to three months for domestic addresses and six months for foreign addresses. Duplicate copies will not be sent to replace ones undelivered doe to fallme to notify Elsevier of change of address. PosUnaster. Send address changes to Clinical Microbiology Newsletter, Elsevier Science Inc., 655 Avenue of the Americas, New York, NY 10010. Editorials and lelters printed in this newsletter are published for the interest of the readers and do not necesuu'ily reflect the opinions of the editors.
0196-4399(199tO201)16:O3;1-A
Clinical Microbiology Newsletter is abstracted in Tropical Diseases Bulletin and Abstracts on Hygiene and Communicable Diseases. I
24
0196-4399/94/$0.00 + 07.00
© 1994 Elsevier Science Inc.
Clinical Microbiolosy Newsleuer 16:3,1994