Endocarditis caused by Actinobaculum schaalii, Austria.
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ABSTRACT:
SUBMITTER: Hoenigl M
PROVIDER: S-EPMC3321920 | biostudies-literature | 2010 Jul
REPOSITORIES: biostudies-literature
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Endocarditis caused by Actinobaculum schaalii, Austria.
Hoenigl Martin M Leitner Eva E Valentin Thomas T Zarfel Gernot G Salzer Helmut J F HJ Krause Robert R Grisold Andrea J AJ
Emerging infectious diseases 20100701 7
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Project description:BACKGROUND: Actinobaculum schaalii was first described as a causative agent for human infection in 1997. Since then it has mainly been reported causing urinary tract infections (UTI) in elderly individuals with underlying urological diseases. Isolation and identification is challenging and often needs molecular techniques. A. schaalii is increasingly reported as a cause of infection in humans, however data in children is very limited. CASE PRESENTATION: We present the case of an 8-month-old Caucasian boy suffering from myelomeningocele and neurogenic bladder who presented with a UTI. An ultrasound of the urinary tract was unremarkable. Urinalysis and microscopy showed an elevated leukocyte esterase test, pyuria and a high number of bacteria. Empiric treatment with oral co-trimoxazole was started.Growth of small colonies of Gram-positive rods was observed after 48?h. Sequencing of the 16S rRNA gene confirmed an A. schaalii infection 9?days later. Treatment was changed to oral amoxicillin for 14?days. On follow-up urinalysis was normal and urine cultures were negative. CONCLUSIONS: A.schaalii is an emerging pathogen in adults and children. Colonization and subsequent infection seem to be influenced by the age of the patient. In young children with high suspicion of UTI who use diapers or in children who have known abnormalities of their urogenital tract, infection with A. schaalii should be considered and empiric antimicrobial therapy chosen accordingly.
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Project description:Actinobaculum schaalii can cause urinary tract infections and septicemia but is difficult to identify by cultivation. To obtain a fast diagnosis and identify A. schaalii, we developed a TaqMan real-time quantitative PCR. Routine urine samples were obtained from 177 hospitalized patients and 75 outpatients in Viborg County, Denmark, in 2008-2009. The PCR detected A. schaalii in 22% of samples from patients >60 years of age. This assay showed that A. schaalii is more common than implied by routine cultivation. In 90% of PCR-positive urine samples, other common uropathogens were identified. This finding suggests that A. schaalii is a common, undetected, bacterial pathogen. Our results suggest that A. schaalii may be a more common pathogen than previously thought, especially in patients with unexplained chronic urinary tract infections, who are often treated with trimethoprim or ciprofloxacin, to which A. schaalii is resistant.
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