TO THE EDITOR: A 37-year-old black ...

TO THE EDITOR: A 37-year-old black woman with poorly controll emblem 1 diabetes and a history of urinary tract infections (UTIs) neared with a three-week history of increasing sharp right flank pain, tactile agitation chills, nausea, anorexia, and a single episode of hematuria. She denied dysuria, common occurrence urgency, vomiting, or abdominal pain. Four days earlier, she had been placed forward trimethoprim-sulfamethoxazole for a UTI at another hospital. Her past surgeries included tubal ligation, three cesarean sections, and removal of an ectopic pregnancy. Her medical history included hypertension, iron deficiency anemia, depression, and hypercholesterolemia.

Six weeks before admission, she was treated with ciprofloxacin for a UTI from her personal physician; however, urine refinement ultimately grew group B streptococcus (GBS) not sensitive to ciprofloxacin. Initial follow-up with her physician indicated she was improving.

Physical examination revealed a slight uncomfortable woman. Her pulse was 114 and posterity pressure was 142/91 mm Hg She exhibited pale mucosa and a yielding cardiac flow murmur, a benign abdominal examination, moreover significant right flank tenderness. Pelvic examination and wet preparation revealed yeast and trichomonal vaginitis. A bilateral distal peripheral neuropathy was present

White kin cell count was 10,000 by means of [mm.sup.3] (10 X [10.sup.9] by L), with a differential of 73 percent neutrophils, 10 percent lymphocyte and 16 percent monocytes; hemoglobin plain 8.6 g per dL (86 g through L); and platelet count, 272 X [10sup3] by means of [mm.sup.3] (240 X [10.sup.9] for L). Urinalysis revealed glucosuria, mild proteinuria, excretion of six to 10 r relations cells and one to five white life-current cells per high-powered field, with negative leukocyte esterase and nitrate. Chemistry panel was normal reject for a glucose level of 317 mg through dL (17.6 mmol per L) Hemoglobin [A.sub.1c] was 163 percent

A comput tomography scan revealed a 4- to 6-cm right perinephric abscess and non-specific enlargement of the one and the other kidneys. This patient recovered with percutaneous drainage of the abscess and intravenous antibiotics directed against GB which grew from the abscess drainage.

GB is a cause of fatal puerperal sepsis. In addition to colonization of the pregnant female genital tract with the risk of early or late storm of neonatal sepsis, GBS causes approximately 2 percent of cystitis, pyelonephritis, and nongonococcal urethritis in adults. Other invasive GB infections include pneumonia, endocarditis, arthritis, osteomyelitis, skin and yielding tissue infections, and, rarely, unusual abscesses and device-related infections. (1) These illnesses are more habitual in blacks and elderly persons

common report (2) describes a 17-year-old black girl with poorly controll diabetes mellitus and duplication of her upper right ureter--who exhibited signs and symptoms similar to our patient. There also have been case reports of GB perinephric abscess in a 47-year-old woman, (3) a young adult man with diabetes, (4) a male newborn, (5) and a 61-year-old woman with diabetes who was treated for renal abscess caused by dint of "[beta]-hemolytic streptococcus." (6)

GB may cause perinephric abscess and other marks of invasive infections, particularly in human frames with underlying medical problems. It is important that this organism be treated with antibiotics active against GB when lay the foundation of to be the etiologic agent of UTI.

REFERENCES

(1) Edwards M Baker CJ Streptococcus agalactiae (Group B Streptococcus). In: Mandell GL Bennett JE Dolin R ed Mandell, Douglas, and Bennett's Principles and practice of infectious diseases. 5th ed Philadelphia: Churchill Livingston, 2000:2156-67.

(2) forests CR, Edwards MS. Renal abscess caused according to group B Streptococcus. Clin Infect Dis 1994; 18:662-3

(3) Ishizu K Yamaguchi s Naito K. A case of multiloculated retroperitoneal abscess prosperously treated by percutaneous drainage with a Malecot catheter [in Japanese]. Hinyokika Kiyo 1999;45:103-5

(4) Jernelius H Tollig H Renal abscess caused by way of Streptococcus group B [in Swedish]. Lakartidningen 1982;79:3832

(5) Walker KM Coyer WF Suprarenal abscess appropriate to group B streptococcus. J Pediatr 1979;94:970-1

(6) Morse FP 3d Bennett AH. Unusual renal infections. Urology 1973;2:405-8

DENNIS J BAUMGARDNER, MD

Department of Family Medicine

University of Wisconsin Medical School

Milwaukee Clinical Campus

Aurora Health Care, Inc.

2801 W Kinnickinnic River Pkwy Ste 155

Milwaukee, WI 53215

COPYRIGHT 2004 American Academy of Family Physicians

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