Urinary tract infection due to Streptococcus pneumoniae and its relationship with nephrourological malformations

Abstract

Urinary tract infections (UTIs) are one of the most frequent bacterial conditions in children, being enterobacteria the predominant etiologic agents. Streptococcus pneumoniae is an exceptional cause of UTI in the pediatric population.

Objective: To report the case of a UTI caused by Streptococcus pneumoniae, and to discuss the need for urinary tract imaging studies based on a literature review.

Clinical Case: A 2-year-old girl with megaureter and left hydronephrosis diagnosed in the context of a recurrent UTI, with poor adherence to prophylactic treatment, was hospitalized due to a new episode of febrile UTI without response to outpatient treatment with a broad-spectrum antibiotic. Streptococcus pneumoniae was isolated in the urine culture. She received parenteral therapy with ceftriaxone with good clinical course and, due to UTI caused by an atypical germ added to her history of renal malformation, prophylaxis was reinitiated and imaging studies were completed. Voiding cystourethrogram showed left grade V vesicoureteral reflux. Renal scintigraphy showed severe functional compromise of the left kidney, thus, surgical indication was considered. This case, along with 16 additional cases identified in a literature review, revealed that 12 of them (70%) showed concomitant renal-urological conditions.

Conclusion: UTIs caused by Streptococcus pneumoniae are frequently associated with renal-urological alterations, which suggest the need to study the urinary tract in these patients.