Cell wall deficient bacteria as a cause of idiopathic hematuria

Idiopathic hematuria in the absence of bacteriuria is a medical challenge. Routine cultures of catheterized bladder and endoscopically obtained ureteral urine specimens from a 22-year-old woman with a 6-week history of hematuria showed no growth after 24 to 48 hours of incubation. However, bacterial...

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Bibliographic Details
Published inThe Journal of urology Vol. 150; no. 2 Pt 1; p. 483
Main Authors Domingue, G J, Thomas, R, Walters, F, Serrano, A, Heidger, Jr, P M
Format Journal Article
LanguageEnglish
Published United States 01.08.1993
Subjects
Adult
Bacteriuria - drug therapy
Bacteriuria - microbiology
Female
Hematuria - etiology
Hematuria - microbiology
Humans
L Forms
Staphylococcal Infections - complications
Staphylococcal Infections - drug therapy
Staphylococcal Infections - microbiology
Streptococcal Infections - complications
Streptococcal Infections - drug therapy
Streptococcal Infections - microbiology
Streptococcus agalactiae
Urinary Tract Infections - drug therapy
Urinary Tract Infections - microbiology
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Summary:Idiopathic hematuria in the absence of bacteriuria is a medical challenge. Routine cultures of catheterized bladder and endoscopically obtained ureteral urine specimens from a 22-year-old woman with a 6-week history of hematuria showed no growth after 24 to 48 hours of incubation. However, bacterial variants were grown on enriched media. Colonies were typical cell wall deficient/defective bacteria. Phase and electron microscopy of cystoscopic urine specimens obtained by retrograde ureteral catheterization as well as phase microscopy of the cultures revealed the classic morphology of these organisms. When the variant cultures were subcultured the organisms reverted to their related walled forms, that is Streptococcus agalactiae and Staphylococcus haemolyticus. Because the colonies of these organisms showed various patterns of biochemical reactivity, each phenotype was tested against 15 antimicrobials. Collectively, all biotypes had a common susceptibility to only nitrofurantoin. The patient was treated with nitrofurantoin for 6 weeks. Four days after initiation of therapy she had complete remission of hematuria. During the next 3 years she remained well and free of hematuria.
ISSN:0022-5347
DOI:10.1016/S0022-5347(17)35523-4