Actinobaculum schaalii an emerging pediatric pathogen?

Abstract

BackgroundActinobaculum schaalii was first described as a causative agent for human infection in 1997. Since then it has mainly been reported causing urinary tract infections (UTI) in elderly individuals with underlying urological diseases. Isolation and identification is challenging and often needs molecular techniques. A. schaalii is increasingly reported as a cause of infection in humans, however data in children is very limited.Case presentationWe present the case of an 8-month-old Caucasian boy suffering from myelomeningocele and neurogenic bladder who presented with a UTI. An ultrasound of the urinary tract was unremarkable. Urinalysis and microscopy showed an elevated leukocyte esterase test, pyuria and a high number of bacteria. Empiric treatment with oral co-trimoxazole was started.Growth of small colonies of Gram-positive rods was observed after 48 h. Sequencing of the 16S rRNA gene confirmed an A. schaalii infection 9 days later. Treatment was changed to oral amoxicillin for 14 days. On follow-up urinalysis was normal and urine cultures were negative.ConclusionsA.schaalii is an emerging pathogen in adults and children. Colonization and subsequent infection seem to be influenced by the age of the patient. In young children with high suspicion of UTI who use diapers or in children who have known abnormalities of their urogenital tract, infection with A. schaalii should be considered and empiric antimicrobial therapy chosen accordingly.

Actinobaculum schaalii causing urinary tract infections: report of four cases from Argentina

“…As previously published, A. schaalii shows diminished susceptibility to the antibiotics commonly used in UTIs, particularly, ciprofloxacin or trimethoprimsulfamethoxazole, but it is highly susceptible to β-lactam antibiotics [3,11,19]. Even though the length of the antimicrobial course for UTIs is not clearly established, it should include a β-lactam antibiotic, such as penicillin, amoxicillin or a cephalosporin (especially cefuroxime) for uncomplicated or complicated UTIs for at least two weeks since treatment failure has been observed with short course therapy [10].…”

“…In the literature we found UTIs report cases not only in elderly patients with underlying genitourinary tract diseases [2], but also in children less than 17 years old [3]. In our study, the included patients were from different ages ( Table 1) with only one without predisposing conditions for UTI.…”

“…schaalii was first described in 1997 and since then many reports have been published indicating A. schaalii as a causative agent for urinary tract infections [1,3]. The common risk factors are prostatic hyperplasia, urinary catheter, and urethral stenosis [3,14].…”

“…This pathogen has been reported to be responsible for UTIs mainly in elderly patients with underlying urological predisposing factors [1,2] and also in pediatric patients [3]. Two other species from the genus Actinobaculum, A. massiliae and A. urinale, have also been detected in urine and other clinical specimens such as blood and pus from a superficial skin infection [4,5,6].…”

“…Two other species from the genus Actinobaculum, A. massiliae and A. urinale, have also been detected in urine and other clinical specimens such as blood and pus from a superficial skin infection [4,5,6]. Besides UTIs, other infections have been reported with A. schaalii as the causative agent, including bacteremia, vertebral osteomyelitis and perineal necrotizing cellulitis [7,8,9], A. schaalii appears to be an emerging pathogen, in relation with UTIs in the last decade [1,2,3,10].…”