Acute renal failure with need for renal replacement therapy as a complication of zoonotic S. zooepidemicus infection: case report and review of the literature

Abstract

Streptococcus zooepidemicus is an animal commensal with the potential of zoonotic transmission through ingestion of contaminated dairy products, leading to outbreaks of Post-Streptococcal Glomerulonephritis (PSGN). We report for the first time acute renal failure with need for renal replacement therapy, as a complication of S. zooepidemicus bacteremia resulting from direct horse to human transmission in a young adult. Both clinical disease course and immunohistochemical staining patterns on renal biopsy had some atypical features of PSGN suggesting persistent activation of the alternative complement pathway but no known complement factor dysregulations could be identified.

Outbreak of Glomerulonephritis Caused by Streptococcus zooepidemicus SzPHV5 Type in Monte Santo de Minas, Minas Gerais, Brazil

“…No isolate was recovered in the analyzed milk or cheese samples (4). The sequence described in the current study shared sequence identity with SS1215 APSGN/England/1992 (3) and szp5058-APSGN/ Nova Serrana-MG, Brazil/1998 (22) but not with szp1028 APSGN/Romania 1968 (22)(23)(24)(25)(26)(27).…”

“…The isolates were categorized as clonal due to their indistinguishable banding patterns with high similarity (Ͼ99%) by rep-PCR, characterizing the genetic relationship between them and confirming the outbreak. Previous studies reported a milk-borne outbreak with 85 cases of sore throat and, later, APSGN in the town of Piatra Neamt, Romania (1968), where the S. zooepidemicus szpHV3 gene was identified in lymph node biopsy specimens and pharyngeal exudate of patients, in carriers, and in cow milk samples (22)(23)(24)(25)(26)(27). Fifteen years later, another outbreak attributed to S. zooepidemicus HV5 took place in North Yorkshire, England (1983).…”

“…S. zooepidemicus is an emerging and opportunistic zoonotic pathogen associated with severe and life-threatening diseases and is capable of triggering large glomerulonephritis outbreaks. It causes diseases in humans through contact with infected animals (23)(24)(25)(26) and by the consumption of milk and dairy products (3,4).…”

Pathogenicity and drug resistance of animal streptococci responsible for human infections

“…The infection occurs by eating unpasteurized dairy products, cheese, pork meat or direct contact with horses. The clinical forms described thus far include meningitis, septic arthritis, endocarditis, glomerulonephritis, streptococcal toxic shock syndrome, pneumonia, pharyngitis, lymphadenitis, osteomyelitis, rheumatic fever, and skin and soft tissue infections [68,84,90,91]. Table 6 presents details of selected cases of SEZ infections in humans.…”