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Do Not Miss the Diagnosis of Urinary Tract Infection in Infants With COVID-19

Do Not Miss the Diagnosis of Urinary Tract Infection in Infants With COVID-19 Letters to the Editor The Pediatric Infectious Disease Journal • Volume 41, Number 6, June 2022 4. Khan S, Wong TT, Prasad N, et al. with diagnostic impression of cervical 10–19 white blood cells per high power Streptococcus pseudoporcinus: case reports lymphadenitis. He was treated with amoxi- field, and Gram staining of her urine sample and review of the literature. Case Rep Infect showed Gram-negative rods. cillin + clavulanate, and he was discharged Dis. 2020;2020:4135246. Intravenous ampicillin and cefo- on the 5th day of readmission upon clinical 5. Edwards MS, Nizet V, Baker CJ. Group B taxime were administered, and she became improvement with maintenance of antibi- streptococcal infections. In: Wilson CB, Nizet afebrile on the following day. In addition, the otic use until consultation with a pediat- V, Maldonado YA, eds. Remington and Klein´s Infectious Diseases of the Fetus and Newborn urine culture of a sample obtained through ric infectious disease specialist in 7 days. Infant. 8th ed. Saunders; 2016:411. catheterization revealed Escherichia coli and The workup for immunodeficiency showed Enterococcus faecalis (1 × 10 colony-form- unremarkable results for immunoglobu- ing unit/mL), and the blood and cerebrospi- lins, complement and immunophenotyp- Do Not Miss the nal fluid cultures were negative. On day 4, ing, except for CD4 levels, which were cefotaxime was stopped, but ampicillin was below the third percentile. He was referred DiagNosis of UriNary t ract continued for 7 days because the causative for follow-up with pediatric immunology iNfectioN iN iNfaNts With pathogens were susceptible to ampicillin. because of severe and atypical infection by Subsequently, renal and bladder ultrasonog- a microorganism with low pathogenicity. coViD-19 raphy showed no abnormal findings. This is a rare clinical presentation Böncüoğlu et al have mentioned that since no other similar case in the same nonspecific symptoms, such as fever, leth- To the Editors: age group was reported. Most existing argy, poor feeding, vomiting, tachypnea, and e read with great interest the arti- case reports are related to maternal-fetal tachycardia, were similar in COVID-19 and Wcle by Böncüoğlu et al present- complications or infections in immunosup- 1,2 bacterial sepsis. In addition, UTI in infants ing a case of COVID-19 with bacterial pressed patients. There are few descrip- presents the same nonspecific findings. In sepsis caused by Enterobacter cloacae in tions in the literature of severe involvement the case presented by Böncüoğlu et al, the a 34-day-old infant. We agree with their of other organs, such as cases of endocar- patient had bacterial sepsis with Enterobac- conclusion that clinicians should be aware ditis, pneumonia with empyema and cellu- 4 ter cloacae, which is known to cause UTI. of the development of bacterial sepsis litis in adult patients. 5 UTI can progress to bacteremia. Even if the during severe acute respiratory syndrome It is assumed that there was a proba- SARS-CoV-2 diagnostic test is positive, cli- coronavirus 2 (SARS-CoV-2) infection in ble infection of this infant through the birth nicians should be aware of bacterial infec- infants. However, pediatricians should also canal. Late-onset infection after intrapar- tions, such as bacteremia and UTI, espe- be aware of urinary tract infections (UTIs). tum GBS acquisition has been described, cially in cases where the patient becomes ill Here, we present the case of a 20-day-old manifesting as cellulitis and adenitis, most a few days after the diagnosis of COVID-19. female infant with COVID-19 and UTI. commonly involving the face or subman- A 20-day-old Japanese female dibular area, a similar presentation to this ACKNOWLEDGMENTS infant with no previous perinatal history patient. We hope that this report will con- We thank Editage [http://www.edit- was admitted to our hospital with fever and tribute to greater knowledge and manage- age.com] for editing and reviewing this irritability. The patient and her parents had ment of pediatric patients affected by S. manuscript for the English language. COVID-19, which was confirmed by a posi- pseudoporcinus infection. tive polymerase chain reaction (PCR) test 6 Takuma Ohnishi, MD days and 10 days before admission, respec- Daniela Otoni Russo, MD Yoji Uejima, MD tively. When they underwent PCR test, her Barbara Araújo Marques, MSc Satoshi Sato, MD, PhD parents had fever and cough; however, she Tainá Diana Rodrigues, MD Yutaka Kawano, MD, PhD was asymptomatic, therefore, remained at Department of Pediatric Infectology and Eisuke Suganuma, MD, PhD home without any medical support. After Department of Pediatric Division of Infectious Diseases, becoming febrile and irritable, she was Hospital Infantil João Paulo II Immunology and Allergy transferred to our hospital for treatment and Belo Horizonte Saitama Children’s Medical Center investigation. On arrival, her body tempera- Minas Gerais, Brazil Saitama, Japan ture, heart rate, respiratory rate, and blood pressure were 38.2°C, 180 bpm, 33/min, REFERENCES Giovanna de Souza Fernandes, MD and 80/43 mm Hg, respectively. Further- Pedro Henrique Oliveira do 1. Böncüoğlu E, Kiymet E, Yilmaz Çelebi M, et more, the physical examination revealed al. Do not miss the diagnosis of bacterial sepsis Nascimento, MD no notable findings, and her blood and cer - in infants with COVID-19. Pediatr Infect Dis J. Federal University of Ouro Preto ebrospinal fluid test results were within the 2022;41:e31–e32. Minas Gerais, Brazil normal range. However, urinalysis showed 2. Chen Y, Peng H, Wang L, et al. Infants born to mothers with a new coronavirus (COVID-19). This research was supported by a grant from the Front Pediatr. 2020;8:104. REFERENCES Kawano Masanori Memorial Public Interest 3. Subcommittee on Urinary Tract Infection. 1. Bekal S, Gaudreau C, Laurence RA, et al. Incorporated Foundation for Promotion of Reaffirmation of AAP Clinical Practice Streptococcus pseudoporcinus sp. nov., a novel Pediatrics. Guideline: The diagnosis and management species isolated from the genitourinary tract of The authors have no conflicts of interest to disclose. of the initial urinary tract infection in febrile women. J Clin Microbiol. 2006;44:2584–2586. Informed consent was obtained from the parents. infants and young children 2-24 months of age. Address for correspondence: Takuma Ohnishi, MD, 2. Stoner KA, Rabe LK, Austin MN, et al. Pediatrics. 2016;138: e20163026. Division of Infectious Diseases, Immunology Incidence and epidemiology of Streptococcus 4. Ellen RW. Cystitis and pyelonephritis. In: Cherry and Allergy, Saitama Children’s Medical Center, pseudoporcinus in the genital tract. J Clin JD, Harrison GJ, Kaplan SL, et al. eds. Feigin 1-2 Shintoshin, Chuo-ku, Saitama-shi, Saitama, Microbiol. 2011;49:883–886. and Cherry’s Textbook of Pediatric Infectious Japan. E-mail: prince1999and7@a2.keio.jp. Diseases. 8th ed. Elsevier; 2019:395–408. 3. Grundy M, Suwantarat N, Rubin M, et al. Differentiating Streptococcus pseudoporci- Copyright © 2022 Wolters Kluwer Health, Inc. All 5. Ohnishi T, Mishima Y, Matsuda N, et al. nus from GBS: could this have implica- rights reserved. Clinical characteristics of pediatric febrile tions in pregnancy? Am J Obstet Gynecol. ISSN: 0891-3668/22/4106-e274 urinary tract infection in Japan. Int J Infect 2019;220:490.e1–490.e7. DOI: 10.1097/INF.0000000000003524 Dis. 2021;104:97–101. e274 | www.pidj.com © 2022 Wolters Kluwer Health, Inc. All rights reserved. Copyright © 2022 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The Pediatric Infectious Disease Journal Wolters Kluwer Health

Do Not Miss the Diagnosis of Urinary Tract Infection in Infants With COVID-19

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Wolters Kluwer Health
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Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
ISSN
0891-3668
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1532-0987
DOI
10.1097/inf.0000000000003524
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Abstract

Letters to the Editor The Pediatric Infectious Disease Journal • Volume 41, Number 6, June 2022 4. Khan S, Wong TT, Prasad N, et al. with diagnostic impression of cervical 10–19 white blood cells per high power Streptococcus pseudoporcinus: case reports lymphadenitis. He was treated with amoxi- field, and Gram staining of her urine sample and review of the literature. Case Rep Infect showed Gram-negative rods. cillin + clavulanate, and he was discharged Dis. 2020;2020:4135246. Intravenous ampicillin and cefo- on the 5th day of readmission upon clinical 5. Edwards MS, Nizet V, Baker CJ. Group B taxime were administered, and she became improvement with maintenance of antibi- streptococcal infections. In: Wilson CB, Nizet afebrile on the following day. In addition, the otic use until consultation with a pediat- V, Maldonado YA, eds. Remington and Klein´s Infectious Diseases of the Fetus and Newborn urine culture of a sample obtained through ric infectious disease specialist in 7 days. Infant. 8th ed. Saunders; 2016:411. catheterization revealed Escherichia coli and The workup for immunodeficiency showed Enterococcus faecalis (1 × 10 colony-form- unremarkable results for immunoglobu- ing unit/mL), and the blood and cerebrospi- lins, complement and immunophenotyp- Do Not Miss the nal fluid cultures were negative. On day 4, ing, except for CD4 levels, which were cefotaxime was stopped, but ampicillin was below the third percentile. He was referred DiagNosis of UriNary t ract continued for 7 days because the causative for follow-up with pediatric immunology iNfectioN iN iNfaNts With pathogens were susceptible to ampicillin. because of severe and atypical infection by Subsequently, renal and bladder ultrasonog- a microorganism with low pathogenicity. coViD-19 raphy showed no abnormal findings. This is a rare clinical presentation Böncüoğlu et al have mentioned that since no other similar case in the same nonspecific symptoms, such as fever, leth- To the Editors: age group was reported. Most existing argy, poor feeding, vomiting, tachypnea, and e read with great interest the arti- case reports are related to maternal-fetal tachycardia, were similar in COVID-19 and Wcle by Böncüoğlu et al present- complications or infections in immunosup- 1,2 bacterial sepsis. In addition, UTI in infants ing a case of COVID-19 with bacterial pressed patients. There are few descrip- presents the same nonspecific findings. In sepsis caused by Enterobacter cloacae in tions in the literature of severe involvement the case presented by Böncüoğlu et al, the a 34-day-old infant. We agree with their of other organs, such as cases of endocar- patient had bacterial sepsis with Enterobac- conclusion that clinicians should be aware ditis, pneumonia with empyema and cellu- 4 ter cloacae, which is known to cause UTI. of the development of bacterial sepsis litis in adult patients. 5 UTI can progress to bacteremia. Even if the during severe acute respiratory syndrome It is assumed that there was a proba- SARS-CoV-2 diagnostic test is positive, cli- coronavirus 2 (SARS-CoV-2) infection in ble infection of this infant through the birth nicians should be aware of bacterial infec- infants. However, pediatricians should also canal. Late-onset infection after intrapar- tions, such as bacteremia and UTI, espe- be aware of urinary tract infections (UTIs). tum GBS acquisition has been described, cially in cases where the patient becomes ill Here, we present the case of a 20-day-old manifesting as cellulitis and adenitis, most a few days after the diagnosis of COVID-19. female infant with COVID-19 and UTI. commonly involving the face or subman- A 20-day-old Japanese female dibular area, a similar presentation to this ACKNOWLEDGMENTS infant with no previous perinatal history patient. We hope that this report will con- We thank Editage [http://www.edit- was admitted to our hospital with fever and tribute to greater knowledge and manage- age.com] for editing and reviewing this irritability. The patient and her parents had ment of pediatric patients affected by S. manuscript for the English language. COVID-19, which was confirmed by a posi- pseudoporcinus infection. tive polymerase chain reaction (PCR) test 6 Takuma Ohnishi, MD days and 10 days before admission, respec- Daniela Otoni Russo, MD Yoji Uejima, MD tively. When they underwent PCR test, her Barbara Araújo Marques, MSc Satoshi Sato, MD, PhD parents had fever and cough; however, she Tainá Diana Rodrigues, MD Yutaka Kawano, MD, PhD was asymptomatic, therefore, remained at Department of Pediatric Infectology and Eisuke Suganuma, MD, PhD home without any medical support. After Department of Pediatric Division of Infectious Diseases, becoming febrile and irritable, she was Hospital Infantil João Paulo II Immunology and Allergy transferred to our hospital for treatment and Belo Horizonte Saitama Children’s Medical Center investigation. On arrival, her body tempera- Minas Gerais, Brazil Saitama, Japan ture, heart rate, respiratory rate, and blood pressure were 38.2°C, 180 bpm, 33/min, REFERENCES Giovanna de Souza Fernandes, MD and 80/43 mm Hg, respectively. Further- Pedro Henrique Oliveira do 1. Böncüoğlu E, Kiymet E, Yilmaz Çelebi M, et more, the physical examination revealed al. Do not miss the diagnosis of bacterial sepsis Nascimento, MD no notable findings, and her blood and cer - in infants with COVID-19. Pediatr Infect Dis J. Federal University of Ouro Preto ebrospinal fluid test results were within the 2022;41:e31–e32. Minas Gerais, Brazil normal range. However, urinalysis showed 2. Chen Y, Peng H, Wang L, et al. Infants born to mothers with a new coronavirus (COVID-19). This research was supported by a grant from the Front Pediatr. 2020;8:104. REFERENCES Kawano Masanori Memorial Public Interest 3. Subcommittee on Urinary Tract Infection. 1. Bekal S, Gaudreau C, Laurence RA, et al. Incorporated Foundation for Promotion of Reaffirmation of AAP Clinical Practice Streptococcus pseudoporcinus sp. nov., a novel Pediatrics. Guideline: The diagnosis and management species isolated from the genitourinary tract of The authors have no conflicts of interest to disclose. of the initial urinary tract infection in febrile women. J Clin Microbiol. 2006;44:2584–2586. Informed consent was obtained from the parents. infants and young children 2-24 months of age. Address for correspondence: Takuma Ohnishi, MD, 2. Stoner KA, Rabe LK, Austin MN, et al. Pediatrics. 2016;138: e20163026. Division of Infectious Diseases, Immunology Incidence and epidemiology of Streptococcus 4. Ellen RW. Cystitis and pyelonephritis. In: Cherry and Allergy, Saitama Children’s Medical Center, pseudoporcinus in the genital tract. J Clin JD, Harrison GJ, Kaplan SL, et al. eds. Feigin 1-2 Shintoshin, Chuo-ku, Saitama-shi, Saitama, Microbiol. 2011;49:883–886. and Cherry’s Textbook of Pediatric Infectious Japan. E-mail: prince1999and7@a2.keio.jp. Diseases. 8th ed. Elsevier; 2019:395–408. 3. Grundy M, Suwantarat N, Rubin M, et al. Differentiating Streptococcus pseudoporci- Copyright © 2022 Wolters Kluwer Health, Inc. All 5. Ohnishi T, Mishima Y, Matsuda N, et al. nus from GBS: could this have implica- rights reserved. Clinical characteristics of pediatric febrile tions in pregnancy? Am J Obstet Gynecol. ISSN: 0891-3668/22/4106-e274 urinary tract infection in Japan. Int J Infect 2019;220:490.e1–490.e7. DOI: 10.1097/INF.0000000000003524 Dis. 2021;104:97–101. e274 | www.pidj.com © 2022 Wolters Kluwer Health, Inc. All rights reserved. Copyright © 2022 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.

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The Pediatric Infectious Disease JournalWolters Kluwer Health

Published: Jun 6, 2022

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