Foul Smelling Urine in a 7-year-old Boy Caused by Aerococcus urinae

Abstract

To the Editors: Aerococcus urinae is an infrequently reported Gram-positive coccus mostly associated with urinary tract infection in elderly females. Sporadically, the organism has been described as the cause of severe infections.1 We report a young boy who had malodorous urine as the only sign of colonization with A. urinae. This 7-year-old boy was seen at the outpatient clinic because he exuded a bad odor. He was in good health and his medical history was unremarkable. Urinating was not painful and he had no fever. His mother described that after the boy urinated the whole house smelled bad. The general practitioner had found no leucocyturia or nitrite in the urine. Because it was believed that the smell occurred from smegma from under the preputium, a circumcision had been performed but this had no effect on the odor. At physical examination, he was a healthy boy with normal weight and height. The examination, including the genitals, was normal. A metabolic screen was reported normal. Repeated urine cultures consistently revealed significant growth (105 colony forming units/mL) of alpha hemolytic colonies identified as A. urinae. A course of 7 days treatment with co-trimoxazole was given and the smell disappeared. A follow-up urine culture was negative. Echography of the urinary tract revealed no abnormalities. This boy had repeatedly A. urinae in his urine with a foul smell as the only sign. A single course of antibiotics totally resolved the problem of the malodor. A. urinae is reported in about 0.2–0.3% of urine specimens sent in for culture. More than 90% of the patients are females >65 years of age. Most patients have a local or systemic underlying condition, predisposing to urinary tract infection.1 There is no relation between odor and urinary tract infections in the elderly.2 In young patients, A. urinae is reported rarely; we found only 1 article reporting pyelonephritis in a 12-year-old boy who had a history of pyeloplasty for vesicoureteral reflux.3 Our patient had no signs of an underlying disease. Although co-trimoxazole resistance has been described as a key feature in the identification of A. urinae, it was found recently that this is an in vitro effect. Most strains are susceptible to co-trimoxazole.4 A foul smell in children can be a result of bad hygiene, certain food stuffs, undesired loss of urine or feces or even of a metabolic disease. Although some do believe that the malodor of urine is a sign of an urinary tract infection, it has been demonstrated that this is not always true.5 Tjalling W. de Vries, MD, PhD Department of Pediatrics Medical Centre Leeuwarden Leeuwarden, The Netherlands Afke H. Brandenburg, MD, PhD Izore, Centre for Infectious Diseases Leeuwarden, The Netherlands