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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
CASE REPORT  
Year : 2018  |  Volume : 29  |  Issue : 4  |  Page : 976-978
Hematuria secondary to aeromonas infection in a kidney transplant recipient


1 Department of Pharmacology, Government Medical College, Srinagar, Jammu and Kashmir, India
2 Department of Nephrology, Apollo Hospital, New Delhi, India

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Date of Submission18-May-2017
Date of Acceptance26-Jul-2017
Date of Web Publication28-Aug-2018
 

   Abstract 

Urinary tract infection is the most common bacterial infection occurring in renal transplant recipients and is associated with significant morbidity. The etiology and site of origin of hematuria in the transplant recipient is similar to that of the general population. Aeromonas species have been found to cause infection in immunocompromised hosts including patients of chronic kidney disease. To the best of our knowledge, there has not been any case report regarding the infection of Aeromonas in kidney transplant recipients.

How to cite this article:
Hussain SS, Farhat S, Jasuja S. Hematuria secondary to aeromonas infection in a kidney transplant recipient. Saudi J Kidney Dis Transpl 2018;29:976-8

How to cite this URL:
Hussain SS, Farhat S, Jasuja S. Hematuria secondary to aeromonas infection in a kidney transplant recipient. Saudi J Kidney Dis Transpl [serial online] 2018 [cited 2020 Aug 4];29:976-8. Available from: http://www.sjkdt.org/text.asp?2018/29/4/976/239635

   Introduction Top


Urinary tract infection (UTI) has been found to be the most common infection seen after kidney transplantation and is seen in 30–40% of recipients during the first four months after transplantation.[1],[2] Varying incidence rates have been reported by different studies, the majority of organisms cultured were Gram-negative (76%) with approximately 33% of infections being caused by Escherichia coli and 20% by Enterococcus and Klebsiella enterobacter.[3] Aeromonas species are oxidase producing Gram-negative rods and are widely distributed in fresh and saltwater and also can be found in food.[4] Human infections caused by Aeromonas most commonly occur in the community settings, but infrequently can be healthcare acquired.[5],[6] Aeromonas genitourinary tract infection though found mostly to develop in immune compromised patients but has been rarely reported in literature..[7]


   Case Report Top


We present the case report of a 42-year-old male patient who had undergone kidney transplant 10 years back. The patient was on two-drug maintenance immunosuppressant protocol comprising of tacrolimus and mycophenolate mofetil. During the routine follow-up, the patient was observed to have isolated microscopic hematuria [Table 1]. The repeated urine examination done on several occasions revealed the same results. In view of his hematuria; the patient was thoroughly investigated to look for the cause of hematuria. The phase contrast microscopy of the urine revealed that <20% of the red blood cells (RBCs) were dysmorphic, which was not significantly in favor of kidney-related pathology. The serum creatinine (1.1 mg/dL) and tacrolimus level (3.8 mg/dL) of the patient were within the normal range, adding to the fact that there may have been some extra renal cause for the hematuria of the patient. Further investigation that comprised ultrasonography and color Doppler of the transplanted kidney was also found to be normal. The urological consultation was sought to rule out any extra renal cause for the microscopic hematuria. The desired investigations which included urinary cytology for malignant cells and computed tomography scan of the kidney, ureter, and bladder did not yielded to any concrete diagnosis. However, the urine culture which was reported after 48 h revealed the growth of Aeromonas microorganism in the urine of patient. On culture sensitivity testing, the organism was found to be sensitive to ciprofloxacin besides other antibiotics [Table 2]. The patient was subsequently evaluated for genitourinary tuberculosis, which included mycobacterium tuberculosis (MTB) polymerase chain reaction, acid-fast bacillus culture and gene-expert for MTB, all of them were reported to be negative. In view of the Aeromonas culture report and microscopic hematuria, the patient was advised oral ciprofloxacin 250 mg twice daily for 14 day. The urine examination repeated after the antibiotic course was found to negative for any RBCs [Table 1].
Table 1: Urine examination, routine.

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Table 2: Aerobic culture and sensitivity (urine).

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   Discussion Top


UTI, is one of the most common forms of bacterial infection to occur after renal transplantation.[8] The etiology and site of origin of hematuria in the transplant recipient is similar to that of the general population. However, 12% incidence of hematuria in these patients is obviously much higher than that in the general population. E. coli is the most common uropathogen, whereas Enterococcus species, Pseudomonas, coagulase-negative staphylococci, and Enterobacter are the other organisms that have been reported to cause infection in renal transplant patients.[8],[9] In a study carried out by Elkehili et al, the most common causative microorganism was found to be E. coli (38.7%), followed by Klebsiella (25.8%), Staphylococcus (25.8%), and others (9.7%).[10] The population based incidence of human Aeromonas infections in the literature is not clear worldwide. One report form California from the 1980's reports annual incidence of 10.6 cases of Aeromonas infections per million population.[11] In a more recent report from southern Taiwan between 2008 and 2010, the incidence of Aeromonas bacteremia was reported as 76 cases per million inhabitants, much higher than the earlier study.[12] There are various case reports of Aeromonas infections in chronic kidney diseases patients and presentations tend to vary with dialysis modalities. Systemic infections appear to be more common in patients undergoing hemodialysis.[13] To the best of our knowledge, there has not been any report of aeromonas-induced hematuria in post kidney transplant patients.

Conflict of interest: None declared.

 
   References Top

1.
Chan L, Wang W, Kam I. Outcomes and complications of renal transplantation. In: Schrier RW, editor. Diseases of the Kidney and Urinary Tract. 7th ed. Philadelphia: Williams and Wilkins; 2001. p. 2871-925.  Back to cited text no. 1
    
2.
Valera B, Gentil MA, Cabello V, Fijo J, Cordero E, Cisneros JM. Epidemiology of urinary infections in renal transplant recipients. Transplant Proc 2006;38:2414-5.  Back to cited text no. 2
    
3.
Takai K, Tollemar J, Wilczek HE, Groth CG. Urinary tract infections following renal transplantation. Clin Transplant 1998;12:19-23.  Back to cited text no. 3
    
4.
Nishikawa Y, Kishi T. Isolation and characterization of motile aeromonas from human, food and environmental specimens. Epidemiol Infect 1988;101:213-23.  Back to cited text no. 4
    
5.
Cookson BD, Houang ET, Lee JV. The use of a biotyping system to investigate an unusual clustering bacteraemias caused by aeromonas species. J Hosp Infect 1984;5:205-9.  Back to cited text no. 5
    
6.
Mellersh AR, Norman P, Smith GH. Aeromonas hydrophila: An outbreak of hospital infection. J Hosp Infect 1984;5:425-30.  Back to cited text no. 6
    
7.
Chao CM, Gau SJ, Lai CC. Aeromonas genitourinary tract infection. J Infect 2012;65:573-5.  Back to cited text no. 7
    
8.
Pellé G, Vimont S, Levy PP, et al. Acute pyelonephritis represents a risk factor impairing long-term kidney graft function. Am J Transplant 2007;7:899-907.  Back to cited text no. 8
    
9.
Memikoğlu KO, Keven K, Sengül S, Soypaçaci Z, Ertürk S, Erbay B. Urinary tract infections following renal transplantation: A single-center experience. Transplant Proc 2007; 39:3131-4.  Back to cited text no. 9
    
10.
Elkehili IM, Kekli AB, Zaak AS, Salem EL. Urinary tract infection in renal transplant recipients. Arab J Nephrol Transplant 2010;3: 53-5.  Back to cited text no. 10
    
11.
King GE, Werner SB, Kizer KW. Epidemiology of aeromonas infections in California. Clin Infect Dis 1992;15:449-52.  Back to cited text no. 11
    
12.
Wu CJ, Chen PL, Tang HJ, et al. Incidence of aeromonas bacteremia in Southern Taiwan: Vibrio and salmonella bacteremia as comparators. J Microbiol Immunol Infect 2014;47: 145-8.  Back to cited text no. 12
    
13.
Davis WA 2nd, Kane JG, Garagusi VF. Human aeromonas infections: A review of the literature and a case report of endocarditis. Medicine (Baltimore) 1978;57:267-77.  Back to cited text no. 13
    

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Correspondence Address:
Dr. Syed Sajad Hussain
Department of Pharmacology, Government Medical College, Jammu and Kashmir, Srinagar
India
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DOI: 10.4103/1319-2442.239635

PMID: 30152438

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    Abstract
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