Abstract
Streptococcus pneumonia is a gram-positive bacteria most commonly associated with respiratory tract infections such as acute otitis media, sinusitis, and pneumonia. While a common cause of upper respiratory infections, the current Infectious Diseases Society of America (IDSA) guidelines on Urinary Tract Infections (UTIs) do not cite S. pneumoniae as a cause for UTIs in children. In addition, previous research associating S. pneumonia with UTIs has been scarce. We report the case of a three-year-old girl presenting to the emergency room with abdominal pain, vomiting, and fever. Her clinical picture was consistent with right sided pyelonephritis. A urine analysis (UA) was conducted which showed trace leukocyte esterase, 150mg/dL ketones, 21-50 WBCs, and negative nitrites. A blood culture returned positive for Streptococcus pneumoniae along with right kidney hydronephrosis on ultrasound. This patient presented with a full clinical picture of pyelonephritis, fever, leukocytosis, elevated CRP and Procalcitonin levels, and later found to be S. pneumoniae positive. Although the urine culture did not grow any definitive single bacteria as a causative agent, due to the presentation of pyelonephritis along with CVA tenderness, dysuria, and a positive blood culture, we conclude the patient was exhibiting urosepsis due to S. pneumoniae. Upon discovering previous case reports noting S. pneumoniae as a possible agent for UTIs, we believed this bacterium to be contributing to the patient’s symptoms. While S. pneumoniae has only been a rarely reported cause of UTIs, we believe there is sufficient evidence that demonstrates S. pneumoniae to at least be considered a possible contributing cause of UTIs, especially if the patient has a coinciding septic picture.
 Contributors: Daniel Lubarsky (a) (1) Daniel Garcia (b) and Deepa Mukundan (c)
 (a) M.D. Candidate, Class of 2021, The University of Toledo Heath Science Campus, Toledo, OH, USA, (b) Department of Pediatrics, University of Toledo Health Science Campus, Toledo, OH, USA , and (c) Department of Pediatric Infectious Disease, The University of Toledo Heath Science Campus, Toledo, OH, USA
Highlights
Streptococcus pneumonia is a gram-positive bacterium most commonly associated with respiratory tract infections such as acute otitis media, sinusitis, and pneumonia
According to guidelines released by the American Academy of Pediatrics (AAP), a urinary tract infections (UTIs) is defined as bacteriuria (>105 CFU/mL) of one uropathogen along with dysuria, pyuria, and urgency (4)
After examining 53,499 urine samples from children, 43 (0.08%) positive for Streptococcus pnuemoniae, the report concluded that Streptococcus pneumoniae was more likely to be a contaminant from perineal colonization (6)
Summary
A three-year-old female with no significant past medical history presented to the emergency room with abdominal pain, emesis, and fever. Due to the persistent abdominal pain and emesis, she was taken to an outside emergency room. A complete blood count (CBC) showed 41.9 103 WBCs (88% neutrophils) and 505 103 platelets with all other values within normal limits. Upon further questioning the patient was positive for subjective fever, right ear pain, abdominal pain, vomiting, and back pain along with dysuria. A bagged urine culture specimen from the outside emergency room demonstrated >80,000 colony forming units of mixed flora suggesting contamination and the blood culture returned positive for Streptococcus pneumoniae. Based on clinical findings of fever, abdominal pain, vomiting and CVA tenderness, a complete retroperitoneal ultrasound was done to examine for pyelonephritis. 10-day course of Amoxicillin for urosepsis due to Streptococcus pneumoniae and discharged
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