Identification of Probable Urinary Tract Infection in Children Using Low Bacterial Count Thresholds in Urine Culture

Objectives: To assess the proportion of children, symptomatic for urinary tract infection (UTI), with urine culture showing single bacterial species >104 CFU/mL, and to compare patient and disease characteristics between children having low counts (from >104-105 CFU/mL) and those with counts >105 CFU/mL. Methods: Prospective observational study, enrolling symptomatic children aged 1 month to 12 years. Mid-stream clean-void or catheter collected urine were cultured. Children with single species >104 CFU/mL were scheduled for imaging studies, following age criteria of Indian Society of Pediatric Nephrology guidelines. The main outcome was proportion with single bacterial species >104 CFU/mL in urine culture. Results: Of 216 children (132 males) with median (IQR) age of 24 (12, 48) months, 38 (17.6%) showed single species growth >104 CFU/mL. Of these, 29 (13.4%) were diagnosed as UTI at cutoff >105 CFU/mL, and an additional 9 (4.2%) were found to have ‘probable low-count UTI’ (from >104 to 105 CFU/mL). One child in the latter group had bilateral hydroureteronephrosis, vesico-ureteral reflux and renal scarring. There was largely no difference in parameters between children with low counts and those with counts >105 CFU/mL. Conclusion: An additional proportion of symptomatic children with probable urinary tract infection and possible underlying urological abnormalities may be identified by lowering bacterial colony count cutoff to >104 CFU/mL, in clean-voided and catheter-based urine samples.

Bacillus cereus causing intratumoral brain abscess.

We report a case of intratumoral brain abscess due to Bacillus cereus in an adult male patient, which was managed successfully with excision of lesion and piperacillin‑tazobactam for the duration of 5 weeks. To the best of our knowledge, this is a first case report of B. cereus infection leading to intratumoral brain abscess in a patient with a history of steroid administration by the intravenous route.

Chlamydia trachomatis serovar G infection in a bisexual male with urethritis.

We report a case of Chlamydia trachomatis serovar G urogenital tract infection in a 33-year-old human immunodefi ciency virus-1 (HIV-1) seropositive Indian bisexual male. This case highlights the emergence of a new serovar in India. The patient was tested positive for C. trachomatis by both cryptic plasmid and ompA gene polymerase chain reaction (PCR). On further characterization using polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) and ompA gene sequencing, the strain was found to be C. trachomatis serovar G. His spouse was also found to be infected with C. trachomatis serovar G. Phylogenetic analysis was performed on the clinical isolates obtained from both partners and were found to be identical to the isolates available in GenBank. The sexual network could not be traced further. Detection of a new genotype suggests importation of a new strain into the population probably by sexual contact with a person from a geographical area where the strain is common. Identifying circulating genotypes in the community can assist in developing strategies for improved sexually transmitted disease control.

Genital Mycoplasma and Chlamydia trachomatis infections in patients with genital tract infections attending a tertiary care hospital of North India.

Limited data are available on the prevalence of genital mycoplasmas and Chlamydia trachomatis (CT) among Indian patients with genital tract infections. The objectives of the study were to determine the prevalence of Ureaplasma urealyticum (UU), Mycoplasma hominis (MH), Mycoplasma genitalium (MG), and CT in patients with genital tract infections. The antimicrobial susceptibilities of UU and MH were also assessed. Endocervical swabs/urethral swabs and first void urine samples of patients (n = 164) were collected. UU and MH were detected by culture and multiplex polymerase chain reaction (PCR). MG and CT were identified by PCR. Ureaplasma isolates were further biotyped and serotyped. Antimicrobial susceptibility was done by microbroth dilution method. UU, MH, MG, and CT were detected in 15.2%, 5.4%, 1.2%, and 6% patients, respectively. Ureaplasma parvum serovar 3/14 was the most prevalent. All isolates of UU and MH were uniformly susceptible to doxycycline and josamycin. Routine screening for these pathogens and antimicrobial susceptibility testing is warranted to prevent sequel of infections and formulate treatment guidelines.