Aerococcus urinae (A. urinae) is an unusual urinary tract pathogen [1][2][3], which is also reported in case of endocarditis [1,[3][4][5], septicemia [6][7][8][9], balanitis and phlegmon [1], lymphadenitis [10], and spondylodiscitis [11] in elderly patients with local or systemic predisposing conditions such as neutropenia and prostatic diseases. A. urinae is a grampositive, catalase-negative, microaerophilic, alpha-hemolytic coccus, growing predominately in tetrads and clusters. A. urinae is usually susceptible to b-lactam antibiotics and resistant to sulfonamides and aminoglycosides. Susceptibility to trimethoprim and cotrimoxazole is variable [9].This paper presents three case reports of the serious A. urinae infections, two associated with bacteremia and to our knowledge the first case recorded of spontaneous bacterial peritonitis (SBP).
Case 1A 67-year-old male with preexisting chronic liver disease [due to hepatitis C virus (HCV) infection] was admitted to the hospital with a history of fever, abdominal pain, nausea, and vomiting. On admission, he had a temperature of 37.8°C, diffuse ascites, abdominal distention and splenomegaly. The other physical examinations were normal. The laboratory results were as follows: peripheral white blood count 15,800 mm -1 , hemoglobin level 11.3 g/dl, hematocrit 33.5%, and C-reactive protein (CRP) 18 mg/l. Abnormal biochemical findings were as follows; alanine aminotransferase 52 IU/l, aspartate aminotransferase 121 IU/l, c-glutamyl transpeptidase 78 IU/l, albumin 2.7 g/dl, and the protrombin time 14.6 s. Ascitic fluid findings were as follows; leukocyte count of 1,480 mm -1 (with 78% neutrophilis), total proteins 0.65 g/dl, albumin of 0.25 g/dl. Serum/ascites albumin gradient (SAG) was 2.45 g/dl. The finding of a low albumin and a moderately high leukocyte count in the ascitic fluid supported the diagnosis of spontaneous peritonitis. Antibodies for hepatitis B surface antigen (anti-HBs) and HCV (Anti-HCV) were all found to be positive. Abdominal ultrasonography (US) revealed chronic parenchymal liver diseases, splenomegaly, and ascites. After ascitic fluid and urine specimens was taken for the culture, the patient was treated empirically with cefepime 2 · 1 g iv. The urine culture was sterile and the ascitic fluid culture was positive, showing a pure culture of A. urinae. On the third day of the therapy, the control paracentesis was made and we observed that the leukocyte count had decreased to 130 mm -1 . The patient's conditions had improved and the therapy was continued for 7 days.
Case 2A 61-year-old female with stage IIIA multiple myeloma was admitted to our hospital with a 7-day history of high fever (39°C). The physical examination was unremarkable except that hepatomegaly was observed. The laboratory results as follows: leukocyte count 4,660 mm -1 , hemoglobin level 7.8 g/dl, hematocrit 21%, and CRP 261 mg/l. Laboratory findings including electrolytes, glucose, liver, renal, and thyroid function tests were reported as normal. After blood and urine specimens were ta...
