Group B streptococcus cystitis presenting in a diabetic patient with a massive abdominopelvic abscess: a case report

Abstract

IntroductionStreptococcus agalactiae or group B streptococcus is a Gram-positive pathogen that is typically associated with neonatal disease and infection in pregnant women. Group B streptococcus also causes invasive infections in non-pregnant adults including urinary tract infections. The spectrum of urinary tract infections caused by group B streptococcus includes cystitis, pyelonephritis, urosepsis and asymptomatic bacteriuria, which is particularly common among elderly individuals. A rare form of invasive group B streptococcus infection in adults is secondary abscess. Here, we present the first reported case of a patient who developed an unusual, massive abdominopelvic abscess secondary to acute group B streptococcus urinary tract infection.Case presentationA 46-year-old African-American woman presented to the University Emergency Department complaining of urinary tract infection symptoms and severe abdominal pain. Diagnostic imaging by transvaginal ultrasound and computed tomography revealed a massive peripherally-enhancing, low-attenuating fluid collection within her pelvis. The patient’s abdominopelvic abscess was drained by ultrasound-guided drainage and this yielded a septic aspirate that was culture positive for abundant S. agalactiae. A recent history of urinary tract infection symptoms in the patient suggested that her abscess developed secondary to cystitis. Complete resolution of the abscess as a favorable outcome was achieved in this case following surgical drainage and appropriate antimicrobial therapy.ConclusionAcute bacterial urinary tract infection leading to an abdominopelvic abscess has not previously been reported in the literature. This case report defines a new disease etiology associated with acute streptococcal cystitis and it will be of interest in cases of urinary tract infections where there is an association with abdominal and/or pelvic pain. A brief review of the literature on unusual secondary abscesses due to group B streptococcus is provided alongside this case to highlight the clinical significance and prognoses of these rare infections. Finally, this case emphasizes the requirement to distinguish unusual etiologies of pyogenic abscesses in order to guide successful clinical management and to treat patients with antibiotics active against the causal organism.

Pathogenesis of Streptococcus urinary tract infection depends on bacterial strain and β-hemolysin/cytolysin that mediates cytotoxicity, cytokine synthesis, inflammation and virulence

“…The mean duration of urinary frequency and urgency in non-pregnant women is 3–4 days 5 . Uncomplicated cystitis usually resolves quickly 9 , however, this form of S. agalactiae UTI can be difficult to treat in the setting of complications or patient co-morbidities 10 . A recent review of the overall burden of S. agalactiae UTI underscores the importance of these infections as a major public-health concern, with approximately 160,000 cases in the United States annually 11 .…”

First Described Case of Group BStreptococcusPelvic Abscess in a Patient with No Medical Comorbidities

“…Published cases of deep-seeded GBS abdominal or pelvic abscesses were reported in patients with previous comorbidities, mostly diabetes, and involved an infection of the kidney [ 12 – 14 ], bladder [ 15 ], prostate [ 16 ], adrenal gland [ 17 ], liver [ 18 ], and uterus [ 19 ]. One case of sporadic GBS abdominal abscess was recently described in 2015 [ 20 ].…”

Argentinian multicenter study on urinary tract infections due to Streptococcus agalactiae in adult patients

“…GBS is also the cause of other conditions, such as cystitis, pyelonephritis and urosepsis, with neurogenic bladder as a potential risk factor. In addition, a rare invasive infection has been described in one patient suffering from an unusual, massive abdominopelvic abscess secondary to acute GBS UTI [4].…”