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June 28, 1999

Haemophilus influenzae Pyelonephritis in Adults

Arch Intern Med. 1999;159(12):1363. doi:10.1001/archinte.159.12.1363

The following letter, which appeared in the February 8, 1999, issue of the ARCHIVES (1999;159:316), was inadvertently published with an incomplete author listing. The letter is reproduced in full below with all authors given proper credit.

Haemophilus influenzae Pyelonephritis in Adults

Haemophilus influenzae has rarely been implicated as the causative agent of urinary tract infections in adults. The isolation of H influenzae from a urine sample was first reported in 1898 when Kretz1 recovered influenzae bacillus from the urine sample of a 36-year-old man with hematuria and polyuria. Since then, only 20 cases have been reported that implicate H influenzae as the cause of adult urinary tract infections.2-6 We report an additional case of H influenzae pyelonephritis in a 90-year-old man and discuss the possible underestimation of the true incidence of H influenzae in urinary tract infections.

A 90-year-old man was seen in the emergency department with complaints of fever, dysuria, and left-sided flank pain of 2 days' duration. His medical history was notable only for symptomatic prostatic enlargement, for which he was being treated with phenoxybenzaline. Positive findings on physical examination included a temperature of 38.3°C and suprapubic and left-sided costovertebral angle tenderness. A clean voided urine specimen revealed 25 to 30 white blood cells and several gram-negative coccobacilli per oil immersion field. Subsequent growth yielded more than 105 colony-forming units per milliliter of β-lactamase-negative H influenzae sensitive to ampicillin. Moreover, 2 blood culture bottles yielded β-lactamase-negative H influenzae, also sensitive to ampicillin. The patient defervesced with resolution of his dysuria and costovertebral angle pain and tenderness following treatment with ampicillin.

Haemophilus species colonize the upper respiratory tract where they may spread to cause infections of the surrounding tissues such as the lower respiratory, meninges, epiglottis, and middle ear.6Haemophilus influenzae has rarely been implicated as the causative agent in urinary tract infections in adults, most cases afflicting men with anatomical or functional genitourinary abnormalities.2-6 The true incidence of H influenzae genitourinary infection is unknown. The apparent rarity of H influenzae urinary tract infection may be ascribed to 3 factors: the bacteriologic media commonly used for the recovery of uropathogens do not support the growth of this organism; the organism is not generally part of the genitoperineal flora; and growth of H influenzae is inhibited by urine even when it is supplemented with the necessary growth factors.5 Furthermore, the incidence of culture-negative pyelonephritis in patients who have not received prior antibiotics is unknown. Haemophilus influenzae is likely a more common pathogen in urinary tract infections than is currently appreciated. Perhaps more sensitive culture techniques and greater physician awareness to the genitourinary pathogenicity of H influenzae, particularly in male patients with anatomical or functional genitourinary abnormalities, would enhance the detection of H influenzae urinary tract infection.

James M. Reichman, MD Ron Alcalay, MD Galia Spectre, MD Jerusalem, Israel

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