Letter to the Editor
Urinary tract infection by Streptococcus thoraltensis
Infección urinaria por Streptococcus thoraltensis
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Able to ferment glucose producing lactic acid.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Streptococcus thoraltensis (S. thoraltensis)</span> is an unusual <span class="elsevierStyleItalic">species of Streptococcus</span>, rarely isolated in humans, although it has been identified in samples from patients with pneumonia, chorioamnionitis and sepsis. A series of cases of urinary tract infection secondary to <span class="elsevierStyleItalic">S. thoraltensis</span> is reported.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The first case was a 75-year-old female patient with a history of colon polyps with dysplasia and angiodysplasia, type 2 diabetes mellitus and systemic arterial hypertension, both under treatment; NYHA III congestive heart failure and anticoagulated atrial fibrillation.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was admitted for hypovolemic shock and AKIN I acute kidney injury secondary to bleeding from the upper gastrointestinal tract, requiring blood transfusion and transurethral catheterisation (TUC); 10 days after its placement, she had a febrile episode and urinary symptoms, with leukocytosis at the expense of neutrophilia, general urine examination with scant bacteria, WBCs 0-5 per field, and development of <span class="elsevierStyleItalic">S. thoraltensis</span> in urine culture. She was treated with levofloxacin and imipenem during her hospitalisation and the urinary catheter was removed 18 days after its placement. She was discharged due to improvement.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The second case, also a 70-year-old woman with systemic arterial hypertension and chronic stable angina, with a history of double J catheter placement for left renal lithiasis. She was admitted for generalised abdominal pain VAS 10/10, radiating to the back and chest, accompanied by vomiting of biliary contents and dyspnoea. Progressed to haemodynamic instability, requiring vasopressors and urinary catheterisation; hydronephrosis secondary to left renal lithiasis was documented. Eight days after catheterisation, she began to experience urinary symptoms, with urine culture showing <span class="elsevierStyleItalic">S. thoraltensis</span>; antibiotic treatment was started with meropenem and metronidazole. The progression was favourable; the urinary catheter was removed 25 days after its placement, at the patient’s discharge.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The third case was a 54-year-old female patient with systemic arterial hypertension and type 2 diabetes mellitus. Admitted for acute coronary syndrome with anteroseptal ST elevation. During her stay in hospital she had haemodynamic instability, cardiogenic shock and AKIN III acute kidney injury, with TUC. Twelve days after TUC she developed fever and urinary tract infection was identified. <span class="elsevierStyleItalic">S. thoraltensis</span> were detected in urine culture, so management with meropenem and metronidazole was started. TUC was removed 25 days after discharge.</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">S. thoraltensis</span> is a gram-positive coccus, which was first isolated and described in 1997 by Devriese from the intestinal tract of pigs.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> The pathogenic role in humans is uncertain.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Few cases of <span class="elsevierStyleItalic">S. thoraltensis</span> in humans have been reported so far. The first case was reported in 2015, in a patient diagnosed with chorioamnionitis and a history of occupational exposure to pigs. In 2019, a case of pneumonia and bacteraemia caused by <span class="elsevierStyleItalic">S. thoraltensis</span> was reported,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> another case of a patient with sepsis studied for fever of unknown origin<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and a case of prosthetic aortic valve infective endocarditis described in 2020.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">A case of <span class="elsevierStyleItalic">S. thoraltensis</span> in the urine culture of a male patient under study protocol for fever was reported at the Argentine Society of Infectious Diseases Conference in 2019. In our reported series, there is no history of exposure to farm animals, but there is a history of TUC, so it is important to avoid unnecessary use of urinary catheters, observe correct placement technique and maximise urinary catheter care to reduce the risk of urinary tract infection.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The proper practice of taking timely cultures facilitates and guides the therapeutic decision, so it is essential to continue with this type of approach. Multidisciplinary work will always have better results, and effective communication between the treating physician and epidemiology is essential to identify rare pathogens. It is important to report these cases with unusual bacteria development in order to investigate whether these are isolated cases or an emerging pathogen.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0055" class="elsevierStylePara elsevierViewall">No funding of any kind was received for this paper.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">We declare that there is no actual, potential or potentially perceived conflict of interest (financial, professional or personal) that could result in bias in the publication of this paper.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Género <span class="elsevierStyleItalic">Streptococcus</span>: una revisión práctica para el laboratorio de microbiología" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. 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