Actinotignum schaaliiによる尿路感染症を発症した尿道下裂形成術の既往のある幼児例―本邦小児例のまとめ―

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The patient was a 2-year 1-month-old boy who had undergone hypospadias repair 2 months earlier. He was brought to us with a 2-day history of fever and pain while urinating. A neighborhood doctor noted increased levels of inflammatory markers and the patient was referred to our hospital. He was admitted to our hospital and at admission, laboratory examination revealed elevated values of the peripheral blood leukocyte count (21,900/μL; neutrophils 82.5%) and serum C-reactive protein (CRP) level (13.0mg/dL). Urinalysis revealed pyuria, with a white blood cell count of 100 or more/high power field (HPF). Microscopic examination of the urine revealed phagocytozed Gram-positive rods in the white cells. The patient was diagnosed as having urinary tract infection and initiated on treatment with vancomycin. On the third day of hospitalization, the fever resolved, the inflammatory reaction decreased, and the pyuria improved. Vancomycin was administered for 10 days, and the patient was discharged on the 12th day of admission. Actinotignum schaalii was isolated and identified by culture of a urine specimen collected via a catheter at the time of admission. In recent years, there have been some reports in Japan of urinary tract infection caused by A. schaalii in children. When urinary tract infection is suspected, microscopic examination of Gram-stained specimens of the urine is important. If Gram-positive rods are observed under the microscope, it is necessary to consider the possibility of anaerobic bacteria and immediately carry out anaerobic culture. In addition, background diseases of the urinary system, such as urinary tract malformations, appear to predispose to urinary tract infections caused by A. schaalii, and further examination is needed.