Rare Cause of Nosocomial Urinary Tract Infection in Non Catheterised Patient

Abstract

Background: Leuconostoc Mesenteroides are member of the Streptococcae family and currently has been recognized as potential pathogen.this cause describes a nosocomial infection caused by Leuconostoc Mesenteroides in an patient affected by pulmonary Mucoromycosis.

Case Report: A 59 year old diabetic and hypertensive male patient was admitted in infectious diseases department with complaint of intermittent cough with hemoptysis,breathlessness since 6 months,then patient was evaluated and found to have pulmonary Mucoromycosis and hence patient was started on antifungal treatment, during the treatment patient started complaining of burning micturition and increased frequency from 3 days, then patient was suspected to have hospital acquired urinary tract infection and investigated accordingly. Urine routine analysis revealed 12-16 pus cells and ultrasound abdomen showed cystitis, hence patient was started on Piperacillin and tazobactam after sending urine for culture. Automated and conventional culture methods showed culture of Leuconostoc Mesenteroides.

Conclusion: We concluded that infections caused by Leuconostoc Mesenteroides is serious and should be considered not only in settings of immunocompromised and on prolonged antibiotic use but also in immunocompetent patient.

Keywords: Leuconostoc Mesenteroides; Urinary tract infections; Urine culture

Introduction

The Genus Leuconostoc is composed by catalase negative and gram positive microorganisms with irregular coccoid morphology [1]. Leuconostoc species are commonly saprophytic bacteria are now emerging as one of the opportunistic pathogens [2].

Leuconostoc species belonging to the family of Streptococci are usually found on vegetables, dairy products, wine and sugar solutions [2].

Advances in the field of microbiology and awareness among the microbiologists led to an increase in the rate of identification of rare opportunistic microorganisms in humans [3].

The outbreak potential of these opportunistic pathogens and their risk of nosocomial transmission have also been documented [4].

The frequency of Leuconostoc infections may be underestimated as they are difficult to detect with routine methods and can be easily misidentified as Lactobacillus, Alpha-hemolytic streptococci Pedicoccus, Enterococcus and Lactococcus [5].

The vast majority of bacteria are susceptible to Erythromycin, Minocycline, Clindamycin, Ampicillin but are intrinsically resistant to Vancomycin [6].

This microorganism may cause endocarditis, urinary tract infections, intraabdominal infections and catheter associated blood stream infections [6].

Case Report

A 59 year old diabetic and hypertensive male patient was admitted in infectious diseases department with complaint of intermittent cough with hemoptysis, breathlessness since 6 months, then patient was evaluated and found to have pulmonary Mucoromycosis and hence patient was started on antifungal treatment, during the treatment patient started complaining of burning micturition and increased frequency from 3 days, then patient was suspected to have hospital acquired urinary tract infection and investigated accordingly. Urine routine analysis revealed 12-16 pus cells and ultrasound abdomen showed cystitis; hence patient was started on Piperacillin and tazobactam after sending urine for culture.

Diagnosis

Urine culture showed growth only of Leuconostoc Mesenteroides. The identification was done both by conventional and automated system. Automated identification was done using VITEK 2 compact (Biomerieux, France),an equipment capable of automatically identifying the microorganism and drug susceptibility, in our case showed growth of Leuconostoc Mesenteroides. Conventional culture showed growth of pure non hemolytic tiny bacterial colonies and were catalase and bile esculin negative which suggested growth of Leuconostoc Mesenteroides and drug susceptibility done by Kirby-Bauer disc diffusion method showed susceptible to Penicillin, Ampicillin, Clindamycin and resistant to chloramphenicol and vancomycin. Blood cultures were sent in view of any bacteremia and the cultures were negative.

Hence diagnosis of nosocomial urinary infection was made and as isolate is susceptible to Penicillin, therapy with Piperacillin and tazobactam was continued for 7 days and patient was cured of symptoms and repeat urine cultures showed no growth.