Scandinavian Journal of Urology and Nephrology

ISSN: 0036-5599 (Print) 1651-2065 (Online) Journal homepage: http://www.tandfonline.com/loi/isju19

Urinary Tract Infection Caused by Haemophilus

Influenzae : A Case Report

Bernd Stegmayr & Anna Stina Malmborg

To cite this article: Bernd Stegmayr & Anna Stina Malmborg (1988) Urinary Tract Infection
Caused by Haemophilus Influenzae : A Case Report, Scandinavian Journal of Urology and
Nephrology, 22:1, 75-77, DOI: 10.1080/00365599.1988.11690388

To link to this article: http://dx.doi.org/10.1080/00365599.1988.11690388

Published online: 31 Mar 2016.

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 Sca nd JUral N e phrol22 :75-77, 1988

URINARY TRACT INFECTION CAUSED BY

HA EMOPHILUS INFLUENZAE
A Case Report

B e rnd Stegm ay r a nd Ann a Sti n a Malmborg

From th e Division of Nephrology, Depa rtm ent of Internal Medicine,

Unive rsity H ospital Umea, S-90 1 85 Umea , and Clinical Microbiology,
Huddinge University Hospital, S tockholm , Sweden

(Subm itted fo r publica ti o n March 21, 1986)

Abstract. In a patient wi th freq ue nt sympto ms of urin ary li ve ly a ure thral stricture develo ped and was treated wit h di-
Downloaded by [La Trobe University] at 05:53 15 June 2016

tract infectio n durin g th e past -5 yea rs and stead ily de-
teriorating renal fun ctio n , standard urine cultures were
mostly negative. Followin g microscopy of fres hly voided,
gram-stai ned urin e, cultu re o n haematin agar plates in cu-
bated in 10% COl result ed in isolati o n of Haemophilus in -
jluenzae. Augmented culture proced ures may id entify th e
ca use of symptoms in simila r cases.
Key words: urin ary tract infection , Haemophilus influ -
enzae.
Th e re a re fe w we ll -docum e nted re ports o f urin a ry
tract infection du e to Haemophilus influe nzae. Th e
co nditio n was firs t describ ed in ad ult s (1) , a nd s ub -
sequ e ntly in c hildre n (5, 6, 10, 11). A to t a l of nine
adu lt m ales with H. influenzae as th e pathoge n in
urin a ry tract infe ction ha ve hith e rt o been re po rt ed
(1 , 3). M ost o f th ese m e n h ad chro ni c di sease o f th e
urin a ry tract , e.g. h yd ro ne phrosis, uro lithi asis o r
ure te ra l re flu x.
We now re port o n a m a n with progress ive re na l
failure associa ted with sympto m s of c hroni c urina ry
tract infecti o n in add itio n t o in fravesical obstructi o n .
CASE RE PORT
A 71-year-<>ld man had been treated with sa lvarsa n form a-
la rial attacks at age 20 and 26 yea rs. At age 29 he was clin-
ically suspected to have pyelonephritis with deterioration of
renal fun ction . Reco rds conce rnin g th e renal fun ction were
available from the age of 58. At that time th e creatinine
clearance was 50 ml/min/1.73 ml body surface area . An in-
traveno us pyelogram (IVP) showed diminished excretion
bilaterally. The papillae were of un even appearance and th e
kidney size was symm etrica lly red uced. Urine cu ltures were
negative .
At the age of 64 the patient had po llakiuri a, urgency of
mi cturition and nycturi a, a nd transurethral resection
(TU R) of 12 g prostatic ti ssue was pe rformed. Postope ra-
lations. Urine cultures remain ed negati ve . Th e sympto ms
persisted, a nd a yea r late r a seco nd TU R was perfo rmed ,
now with remova l of 10 g prosta ti c ti ssue. Postopera tive
urin e cultures yielded S taphylococcus epidermidis (> I05)
bacte ri a/ml) . Histo logic stud y of prostatic ti ssue from both
resections revea led be ni gn hyperplasia as well as chroni c in-
fl amm atory changes. Beca use of clinical signs of prostatiti s,
th e pa ti ent was treated wi th ampicillin for 4 months. Ure th-
ral dilati ons were pe rfo rm ed to reli eve recurrent stricture.
At age 69 th e pati ent had urin ary rete ntio n , with residu al
vo lumes of c. 300 mi. IVP now showed mild di latio n of the
ureters. After 3 months with an indwelling ca th eter, a third
TU R was performed . Th e hi stologic di agnosis was the sa me
as before. Urine cultures grew en terococci as we ll as
S taphylococcus aureus (> 105/ml) , and epididymitis was
treated with doxycycline for 14 days. Th ereaft er the pati e nt
compl ained of urge ncy of micturition , pollakissuria, nyc-
turia and total impotence. The re nal function showed
further deterioration (Fig . 1). A year late r he was treated
wi th amoxicillin 250 mgx2 for 10 days because of pyuri a,
but there was not growth on urine cultures. The symp-
tom s were reli eved , but recurred a year la ter , again with
negative cultures. A similar episode occurred afte r anoth-
er year. The renal fun ctio n was by now grossly impaired
and the pa tient was ad mitted to the Depa rtment of Neph-
rology.
Several samples of urin e were cultured on CLED agar
and 5% ho rse blood aga r, all with negativ e results, and se-
vere symptoms of urinary tract infection pers isted . W e
then examined a gram-stained smear from uncentrifuged
midstrea m urine and found abundant gram-negative, thin
rod-shaped bacteria.
The sa me portion of urine was cultured on a n aerobic
blood aga r plate with a streak of S. aureus as well as on a
haematin aga r plate in cubated in 10% col and on an
anaerobic blood agar plate, in addition to the standa rd
medium. After overnight incubation at 37°C, more than I~
bacte ri a/ml grew on haematin aga r. The bacteria were short
gram-nega tive rods and showed the satellite phenom enon
on th e blood aga r plate streaked wit h S. aureus. The strain
was identifi ed as H. influenzae by require ment of both X
and V factors. Classification accord ing to Kilian (8) showed
biotype IV, and serotyping showed type b . The nitrocefi n

Scand J Uro/ N ephro/ 22

 76 B. Stegmayr and A. S. Malm borg
1000
Ssoo
g
::1.
0). 600
c c
c
:;:; 400
...ug
E 200
2 T T T /\A
JJ oL---~~........::.Oz:::.·~-...........:w.:. . . .~:...._~~~:
:.
58 60 ~ 68
A G E • years
Urine
- 1-
Downloaded by [La Trobe University] at 05:53 15 June 2016
Culture
test for beta- lactamase production was negative. Disc diffu-
sion tests showed susceptibility of the strain to ampicillin ,
trimethoprim , sulphamethoxazole, nitrofurantoin, nalidixic
acid , mecillinam, gentamicin and cefaclor.
Ampicillin was given for 14 days, 0.5 gx3. The patient's
temperatu re norm alized and other symptoms disa ppeared.
Creatinine clearance at the start of treatment was 8 mllmin.
The renal fun cti on was temporarily stabilized, but did not
recover. Six months later diarrhoea occurred, the renal
function deteriorated even furth er and long-term di alysis
was instituted. · urine in p atients with chronic uro pa thies. 2) H . in-
CONC LUSIONS
Urina ry tract infection due to H. influenzae seems to
be rare in men . But a lthough fe w cases have been re-
ported , it is possible th at such infection is more com-
mon than is generally recognized , as st andard
techniques of urine culture do not permit isol ation of
H . influenzae. Because of the rarity of Haemophilus
sp ecies as urinary tract p athogens, however, routine
culture of all urine samples on special medi a is not
justifie d (2) .
Most p atients with urinary tract infection due to
H. influenzae have und e rlying abnormalities of these
organs (3 , 5 , 11). In the present case, outflow
obstruction could have been one underlying cau se of
Haemophilus infection . A plausible site for recurre nt
infections with this orga nism could have been th e
prostate gland . Histologic examination of resected
prostatic tissue on all occasions showed chronic in-
flammatory changes as well as prostatic hyperplasia.
Prostatic secretion was not investigated for H. in-
fluenzae in our p atie nt , but other authors isolated
the organism from this source (5 , 7) . Bacteria per-
Scand J Uro/ Nephrol 22
50
40
30 Fig. 1. Changes in serum creatinine
(0 - 0 ) and creatinine clearance
20 .E (GFR , t::.-t::.), times of transureth-
:::::....
E
ral prostatic resecti on (TUR) and re-
sults of standard urine cultures:
t!A 10 cr. -= no or insignificant bacteri al
growth , 1 = S. epidermidis, 2=S. au-
U.
reus, 3=enterococci . Op =cholecys-
. :. .~~~~-~~....... o ~ tectomy.
72
H.1nftuenzoe
-treolmert -
sisting in the prostate u su ally reinfect the bladder,
with symptoms recurring after day s or month s (4 ,
9) . In several reported cases of urina ry tra ct infec-
tion caused b y H . influenzae there was a history of
renal failure du e to chronic pyelonephritis (5), simi-
lar to that in our patient.
This case provides support fo r th e followin g con-
clusions. 1) H. injluenzae may be isolated from the
fluenzae can cause chronic urinary tract infection and
the reby contribute to renal failure . 3) Standard urine
culture does not reveal this orga nism . 4) Urine from
pa tients with progressive renal failure, signs of uri-
nary tract infection and repeatedly negative standard
cultures should. be studied with additional culture
techniques, es pecially if microscopy o f freshl y voided
urine reveals abnormality.
REFE R E NCE S
1. Albright F, Dienes L, Sulkowitch HW. Pyelonephritis
with nephrocalcinosis caused by Haemophilus influen-
zae and alleviated by sulfa nileamide: report of two
cases. J Am Med Assoc 1938; 110: 357-360.
2. Burns TR , Hinds DB , Hawkins E. Haemophilus or-
ganisms: Urinary tract pathogens in children. Diagn
Microhiol Infect Dis 1984; 2: 251- 253.
3. Chen WN , Richards R, Carpenter R , Ramachander.
Haemophilus influenzae as an agent of urinary tract in-
fection . West Ind Med J 1976; 25: 158-161.
4. Editorial. Chronic bacterial prostatitis. Lancet 1983;
1(8321) :393-394.
5. Gabre-Kidan T, Lipsky BA , Plorde JJ. Haemophilus
influenzae as a cause of urinary tract infections in men.
Arch Intern Med 1984; 144(8): 1623-1627.
6. Granoff DM , Roskes R , Carpenter R , Ramachander

N. Haemophilus influenzae as an age nt of urinary tract
infectio n. West Indian Med J 1976; 25: 15&-161.
7. Hall GD , Washington JA. Hae mophi1us influ e nzae in
genitourin ary tract infections. Diagn Microbio1 Infect
Dis 1983 ; 1(1) : 65-70.
8. Kilia n M. A taxonomic study of the genus
Haemophilus. J Gen Microbiol 1974; 93:9-62.
9. Madsen , PO , Jense n KM -E, lvarsen P. Chronic bacte-
Downloaded by [La Trobe University] at 05:53 15 June 2016
Haemophilus infection of the urinary tract 77
ri al prostatitis: theo retical and experim e ntal considera-
tio ns. Urol Res 1983; 11(1) : 1-5.
10. Roge rs KB , Zinneman K, Foster WP. The isolation and
identification of Ha emophilus sp. from unusua1lesio ns
in childre n. J Clin Pathol 1960; 13:519--524.
II. Schuit KE . Isolation of Haemophilus in urine cultures
from childre n. J Pedi at 1979; 95:565-566.
Scand J Urol Nephrol 22