Emphysematous Pyelonephritis Caused by Citrobacter freundii in a Patient with Type 2 Diabetes and Neurogenic Bladder

Huang

Journal of Medical Virology

et al. 2015

Citrobacter freundii, a Gram-negative bacterium, causes many opportunistic infections. Bacteriophage phiCFP-1 was isolated and characterized by its ability to lyse the multidrug-resistant clinical C. freundii strain P10159. Transmission electron microscopy showed that the phage has an icosahedral head and a short tail, making it a Podoviridae family member. In a single-step growth experiment, phiCFP-1 exhibited an eclipse period of 20 min and a burst size of 100 particles per cell. Its genome assembled as a circular molecule when genomic sequencing was completed. However, based on genome content and organization, it was categorized as a classic T7-related phage, and such phages are known to have linear genomes with direct terminal repeats. With the quick and simple method established herein, the 38,625-bp linear double-stranded DNA with 229-bp direct terminal repeats was accurately identified. The genome contained 43 putative open reading frames and no tRNA genes. Using a proteomics-based approach, seven viral and two host proteins from purified phiCFP-1 particles were identified. Comparative genomics and recombination analyzes revealed close genetic relatedness among phiCFP-1, phiYeO3-12/vB_YenP_AP5 (from Yersinia enterocolitica O3), and phiSG-JL2 (from Salmonella enterica).

Section: Introductionmentioning

confidence: 99%

Characterization of phiCFP‐1, a virulent bacteriophage specific for Citrobacter freundii

Huang

Journal of Medical Virology

et al. 2015

Curr Bladder Dysfunct Rep

“…Anaerobic organisms have been cultured including Clostridium and fungi such as Candida. Bacteraemia is reported in approximately 50 % of patients [9][10][11]. Microscopically, the kidney demonstrates gas filled pockets, necrosis, abscess formation, areas of infarction and thrombosis within blood vessels [8].…”

Section: Introductionmentioning

confidence: 99%

Emphysematous Pyelonephritis: a Review of a Rare Condition

Mahesan

Reddy

Chetwood

et al. 2015

Emphysematous pyelonephritis (EPN) is a rare condition which is potentially life threatening. It is characterised by gas formation within the collecting system, renal parenchyma and/or perirenal tissues. Diabetes is the single most common risk factor for the development of EPN. Other risk factors include urinary tract obstruction and immunocompromise. Escherichia Coli is the most common pathogen. EPN is characterised by fever, loin pain and systemic upset. Gold standard diagnosis and classification of EPN is made with contrast CT. Classification can be used as a prognostic indicator for mortality and to guide management. EPN may be managed conservatively or surgically. Patients managed conservatively are resuscitated and administered with intravenous antibiotics. Intravenous fluid, glucose control for diabetics and acid base balance are vital components for primary management. For those in whom conservative management is unsuccessful, a parenchymal drain may be considered to drain gas or a collection of pus. Patients with hydronephrosis will benefit from a nephrostomy or JJ stent insertion. Patients who have failed minimally invasive surgical intervention or who have a number of risk factors predisposing them to EPN should undergo either immediate or delayed nephrectomy. With treatment for EPN now moving away from nephrectomy towards less invasive interventions, mortality rates for EPN are improving but remaining high.

“…6,7 Although E. coli is the most common reported pathogen, Proteus, Pseudomonas, Klebsiella, Enterobacter, Candida, and Citrobacter freundii species have also been reported as the causative organism. 8,9 Though in present case blood cultures reports were sterile, but 24 hour urine culture report showed Klebsiella pneumoniae as the causative agent.…”

Section: Discussionmentioning

confidence: 59%

Emphysematous pyelonephritis: a rare case report

2017

Emphysematous pyelonephritis (EPN) is a rare and life threatening infection of kidney characterized by gas in the renal parenchyma and surrounding tissues. It occurs mostly in patients with diabetes mellitus and has a predilection for females. It is associated with a high mortality in the absence of rapid and effective treatment; therefore, aggressive medical management, early intervention or surgical approach is recommended. Reported here is a case of a 52-year female with previous medical history of diabetes presented with uncontrolled hyperglycaemia, fever and dysuria with right sided flank pain. She was diagnosed with emphysematous pyelonephritis and successfully treated. As emphysematous pyelonephritis is a life-threatening infection, it should always be considered in the differential diagnosis for a patient with fever with abdominal pain or suspected pyelonephritis particularly in a diabetic.