ABSTRACT
Resumen Actinotignum schaalii es un patógeno emergente en pacientes ancianos con patologías del tracto urinario. Se describen dos casos de bacteriemias por A. schaalii. Caso 1: Paciente de 79 años, con antecedente de hiperplasia benigna prostética. Ingresó a la guardia por síndrome febril, dolor abdominal y disuria. Caso 2: Paciente de 95 anos con adenomectomía prostética, uretrostomía por estrechez uretral e hiperplasia benigna prostética. Ingresó por síndrome febril, tos productiva, infiltrados bilaterales con imagen paracardíaca derecha y derrame pleural. En ambos pacientes se aisló A. schaalii en hemocultivos, identificado por espectrometría de masas MALDI-TOF MS. Solo en el caso 1 se confirmó que el foco de la bacteriemia fue urinario. Es importante sospechar la presencia de este patógeno emergente en infecciones urinarias con sedimento patológico, sin desarrollo en medios de cultivo tradicionales, para garantizar un tratamiento empírico adecuado, ya que la mayoría de los aislamientos presentan resistencia a ciprofloxacina y trimetoprima-sulfametoxazol.
Abstract Actinotignum schaalii is an emerging pathogen in elderly patients with urinary tract pathologies. Two cases of A. schaalii bacteremia are described. Case 1: 79-year-old patient with a history of benign prostatic hyperplasia. He was admitted to the ward for febrile syn-drome, abdominal pain, and dysuria. Case 2: 95-year-old patient with prostatic adenomectomy, urethrostomy due to urethral stricture, and benign prostatic hyperplasia. He was admitted due to febrile syndrome, productive cough, bilateral infiltrates with right paracardiac image, and pleural effusion. In both patients, A. schaalii was isolated in blood cultures, identified by MALDITOF-MS mass spectrometry. Only in case 1 was it confirmed that the focus of bac-teremia was urinary. It is important to suspect this emerging pathogen in urinary infections with pathological sediment without developing in traditional culture media to ensure ade-quate empirical treatment. Since most of the isolates show resistance to ciprofloxacin and trimethoprim-sulfamethoxazole.
ABSTRACT
Actinotignum schaalii is an emerging uropathogen; however, routine culture protocols and usual phenotypic methods do not allow for easy detection and identification. Herein, we report the first Korean case of urinary tract infection caused by A. schaalii in a 79-year-old patient with prostate cancer. A gram-positive rod bacterium was isolated from the patient's urine after 2 days of culture and identified as A. schaalii using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry and DNA target sequencing.
Subject(s)
Aged , Humans , DNA , Mass Spectrometry , Prostatic Neoplasms , Urinary Tract Infections , Urinary TractABSTRACT
(MALDI-TOF MS) has been used in clinical diagnostic laboratories for the identification of microorganisms. It has a relevant advantage compared to other methods in terms of speed to provide results, being an alternative for addressing restrictions in clinical diagnosis as it may replace or complement existing identification techniques. This is especially important because some rare microorganisms would be identified only by higher cost techniques which are not widely available, such as genetic sequencing. Thus, the present paper reports two cases in which uncommon microorganisms were identified effectively and quickly. (AU)