Haemophilus influenzae pyelonephritis in adults

Pyelonephritis and bacteremia caused by Haemophilus parainfluenzae: case-report of an unusual pathogen

We present a case of a young man with known urinary tract abnormalities who developed pyelonephritis and bacteremia caused by Haemophilus parainfluenzae. Since routine urine culture usually does not include enriched media for Haemophilus spp., the true incidence of urinary tract infections caused by H. parainfluenzae is currently unknown. Our case, however, demonstrates that H. parainfluenzae is a potential urinary pathogen, at least in patients with urinary tract anomalies. Clinical laboratories should consider expanding their culture efforts to detect unusual pathogens in patients with underlying risk factors.

Urinary cell-free DNA is a versatile analyte for monitoring infections of the urinary tract

Urinary tract infections are one of the most common infections in humans. Here we tested the utility of urinary cell-free DNA (cfDNA) to comprehensively monitor host and pathogen dynamics in bacterial and viral urinary tract infections. We isolated cfDNA from 141 urine samples from a cohort of 82 kidney transplant recipients and performed next-generation sequencing. We found that urinary cfDNA is highly informative about bacterial and viral composition of the microbiome, antimicrobial susceptibility, bacterial growth dynamics, kidney allograft injury, and host response to infection. These different layers of information are accessible from a single assay and individually agree with corresponding clinical tests based on quantitative PCR, conventional bacterial culture, and urinalysis. In addition, cfDNA reveals the frequent occurrence of pathologies that remain undiagnosed with conventional diagnostic protocols. Our work identifies urinary cfDNA as a highly versatile analyte to monitor infections of the urinary tract.

Urinary tract infections are one of the most common infections in humans. Here, the authors use urinary cell-free DNA (cfDNA) to comprehensively monitor host and pathogen dynamics in bacterial and viral urinary tract infections, and show that it is a versatile analyte for monitoring urinary tract infections.

Haemophilus Species as a Urinary Tract Pathogen

Haemophilus species, as a urinary tract pathogen, is rarely encountered. Routine urine culture pathogens are well documented to include Enterobacteriaciae, Enterococcus spp., Staphylococcus spp., Pseudomonas spp., and Candida spp. Pathogens encountered rarely in this context may include Corynebacterium ureolyticus and nonfermenting gram negative bacilli. This case study involves the finding of Haemophilus influenzae in a urine culture performed on a 4-year-old Caucasian girl and Haemophilus parinfluenzae in a 60-year-old African American man with pyelonephritis. Visualization of satellite colonies on blood agar was a key factor in finding H. influenza Awareness of the previous presence of Haemophilus spp. in a urine culture was instrumental in our finding of H. parainfluenzae 3 weeks later. These cases raise the question of how often Haemophilus spp. occur as urinary tract pathogens and under what circumstances one should actively perform cultures for them.

Bacteremic renal stone-associated urinary tract infection caused by nontypable Haemophilus influenzae: A rare invasive disease in an immunocompetent patient

Haemophilus species are known to colonize the upper respiratory tract and can cause infections. However Haemophilus influenzae has been rarely described as a cause of genitourinary tract infection. We report a 44-year-old nonimmunocompromised Japanese man with bacteremic pyelonephritis caused by a nontypable H. influenzae associated with a left ureteral calculus. The organism was isolated from both blood and urine cultures. Treatment consisted of 14 days of intravenous ceftriaxone and oral amoxicillin one after than other and insertion of a left ureteral stent. After discharge, he underwent extracorporeal shock wave lithotrity for the left ureteral calculus. He had no recrudescence of the symptoms. H. influenzae should be considered as a genitourinary pathogen among patients with certain risk factors such as anatomical or functional abnormality of genitourinary tract. Collaboration between clinicians and microbiology laboratory personnel is essential for correct identification of the organism and appropriate therapy for genitourinary tract infections due to this organism.

An unusual case of chronic prostatitis caused by Haemophilus influenzae in an elderly Saudi patient: A case report and literature review

Haemophilus influenzae has been reported on rare occasions as the cause of prostatitis and urinary tract infections. Here, we report a rare case of chronic prostatitis in a 52-year-old male with benign prostatic hypertrophy and discuss the possible underestimation of the true incidence of H. influenzae in genitourinary infections. This organism was identified only by its growth on chocolate agar, a medium that is not commonly used for urine cultures.

Clinical significance and characterization of Haemophilus influenzae type b genogroup isolates from urine samples in an adult male population

The occurrence and significance of Haemophilus spp. isolated from the genitourinary tract are not well known. Herein, we describe the clinical significance and characteristics of Haemophilus influenzae type b genogroup strains isolated from genitourinary tract specimens from an adult male veteran patient population and, in particular, their associations with prostatitis and epididymitis.

Medical Treatments and Cares for Geriatric Syndrome: New Strategies Learned from Frail Elderly

In Japan, there are 21 million older people above 65 years, and about 8% of them are frail elderly. Geriatrics is to study the frail elderly as to why they become frail elderly, and to treat patients properly or the remaining 92% older people not to become frail elderly. In order to promote health of the older people, geriatricians have to take deep insights for cares as well as medical treatments. With such a will, we find the way to prevent diseases in the older people. In this review, we describe medical treatments and cares for promoting successful aging.

Preventive Strategies for Aspiration Pneumonia in Elderly Disabled Persons

Pneumonia is the fourth leading cause of death despite the availability of potent new antimicrobials in Japan. Aspiration of oropharyngeal bacterial pathogens to the lower respiratory tract is one of the most important risk factors for pneumonia. Impairments in swallowing and cough reflexes among disabled older persons, e.g., related to cerebrovascular disease, increase the risk of pneumonia. Thus, strategies to reduce the volumes and pathogenicity of aspirated material should be pursued. Since both swallowing and cough reflexes are mediated by endogenous substance P contained in the vagal and glossopharyngeal nerves, pharmacologic therapy using angiotensin-converting enzyme inhibitors, which decrease substance P catabolism, can improve both reflexes and result in the lowering of the risk of pneumonia. Similarly, since the production of substance P is regulated by dopaminergic neurons in the cerebral basal ganglia, treatment with dopamine analogs or potentiating drugs such as amantadine can reduce the incidence of pneumonia. Furthermore, since mortality from infections correlates with cutaneous anergy, interventions that reverse these age-associated changes in the immune system are also effective. The main theme of this review is to discuss how pneumonia develops in disabled older people and to suggest preventive strategies that may reduce the incidence of pneumonia among these subjects.

Haemophilus influenzae acute pyelonephritis in the elderly

Haemophilus influenzae has rarely been implicated as the causative agent of urinary tract infections in adults. We report a case of H. influenzae pyelonephritis in a 78-year old man with benign prostatic hyperplasia and discuss the possible underestimation of the true incidence of H. influenzae in adult urinary tract infections.

Risk factors of aspiration pneumonia in Alzheimer's disease patients

BACKGROUND

Pneumonia is the reported cause of death of a high proportion of Alzheimer's disease (AD) patients.

OBJECTIVES

This study assessed swallowing function to explore the potential risk factors of aspiration pneumonia in AD patients.

METHODS

Data were gathered on 121 AD patients (mean age 78.2, SD 7.5, male/female ratio = 48/73) treated in two psychiatric hospitals. Multiple logistic regression analysis was used to estimate odds ratios for the risk of aspiration pneumonia. The following risk factors were considered: age, severity of dementia, silent brain infarction (SBI) in the basel ganglia, use of psychotropic drugs (neuroleptics and benzodiazepines), and gender. The latency time of the swallowing reflex was analyzed (1) among groups based on the severity of dementia; (2) between groups with and without SBI in the basal ganglia; (3) before and after the use of psychotropic drugs in the group without SBI in the basal ganglia, and (4) between males and females.

RESULTS

Aspiration pneumonia in ambulatory AD patients was significantly and independently associated with severe dementia, presence of SBI in the basal ganglia, intake of neuroleptics, and the male gender. The mean latency of the swallowing reflex in the severe AD group was significantly longer compared to that in the mild-to-moderate AD group. The mean latency of the swallowing reflex after the intake of neuroleptics was significantly prolonged compared to that obtained before any neuroleptic intake, whereas there was no significant difference in the mean latency of the swallowing reflex before and after benzodiazepine intake.

CONCLUSION

We recommend the use of the smallest efficacious dosage of neuroleptics especially in treating severely demented AD patients with basal-ganglia infarction. As soon as the behavioral and psychiatric problems are resolved, drug tapering or discontinuation should be considered in order to prevent life-threatening aspiration pneumonia.