Pneumococcal urinary antigen test: A tool for pneumococcal aortitis diagnosis?

Abstract

IntroductionAortitis is rare. The etiological diagnosis is difficult but essential for treatment. Even with appropriate treatment mortality remains high. We present a case of pneumococcal aortitis followed by a brief review of the literature.Presentation of CaseIn this case, the aortic disease was characterized by multiple inflammatory aneurysms. Blood cultures were negative but urine was tested for the presence of pneumococcal urinary antigen postoperatively was positive. Treatment consisted of antibacterial therapy and both surgical and endovascular procedures. The patient was discharged and is well.DiscussionPreoperative determination of etiology is crucial in implementing a specific treatment. Pneumococcus is a common bacterium in infectious aortitis. Identification of the causative microbe is necessary to guide antimicrobial therapy. Blood cultures are frequently sterile. The pneumococcal urinary antigen test may be more sensitive than blood cultures, as is the case in pneumococcal pneumonia.ConclusionsThe pneumococcal urinary antigen test may was a useful diagnostic tool in establishing the cause for aortitis in this case. Its potential value should be assessed in furthers studies.

Catastrophic Perforation In Streptococcus Pneumoniae Aortitis: Complications Of Infective Endocarditis In The Current Antimicrobial Era

“… 4 , 8 , 9 , 13 , 17 Associated risk factors for abdominal and thoracic IA include old age, male sex, congenital abnormalities of the aorta, corticosteroid use, immunosuppressive agents, alcoholism, tobacco dependency, hypertension, dyslipidemia, chronic kidney disease and diabetes. 8 , 10 , 16 , 18 In this case, it is perceived that a combination of delay in seeking medical attention, severity of the infection and multiorgan involvement contributed to poor outcomes.…”

“…Due to low bacterial inoculum, use of antimicrobials, and vascular wall microabscesses not directly in contact with the bloodstream, in about 10–75% of cases the microorganisms is detected primarily from surgical cultures. 10 In case of prior antimicrobial use, molecular diagnostic techniques such as polymerase chain reaction (PCR) may be beneficial. The most sensitive imaging modality is computerized tomography (CT) angiography.…”

“… 7 , 9 Interestingly, one case developed despite pneumococcal vaccination. 9 Another case reported early diagnosis of IA due to positive urinary pneumococcal antigen, followed by confirmation via surgical specimens 10 ( Table 4 ). Once IA is suspected, prompt management is essential.…”