ABSTRACT:Urinary tract infection is a rare disease when it caused by actinomyces, the major causative agents of this disease are Actinomyces israelii and A. gerencseriae anaerobic bacteria. A. israelii is a normal commensal species part of the microbiota species of the lower reproductive tract of women. They are also normal commensals among the gut flora of the caecum. Chronic antibiotic treatment of actinomycosis with penicillin as the drug of choice is the prevailing recommendation. We displayed acase of urinary tract actinomycosis of a young female presented with Dull RT loin pain and lower urinary tract symptoms mainly frequency and urgency but no significant voiding symptom. However, she was suffering from previous symptoms and diagnosed as a renal stone of 18 mm in diameter. Abdominal ultrasound shown multiple RT hydronephrosis, upper third hydrouretermultiplestones largest one wasof 35 mm in diameteralong with 3 cm round vesicle calculus (Fig. 1). All stones were redioluscent in KUB x-ray. She underwent RT double J insertion then twomonths later RT P.C.N.L (Percutaneous nephrolithotomya).
Vesiclestone and mechanical lithotripter were just like “white chees and spoon”. All laboratory investigations concerning
culture and immunological assays revealed negative results. Patient lost for several months to reappear again complaining
from sever RT loin pain, nausea, vomiting and fever, KUB and ultrasound revealed RT renal stones, hydronephrosis and no
double J stent (slipped spontaneously earlier).
The patient passed out a single elongated stone, her urine became of milky color. All attempts to isolate the causative agent were disappointing, till it was sent for diagnosis to the Department of Medical Microbiology, College of Medicine, Al-Nahrain
University, when diagnosed as Actinomyces spp., the patient underwent treatment for six weeks with intra-muscular injectable antibiotic (Benzathine penicillin 3.6 millions I.Uin 2 divided doses, then shifted to oral treatment in form of Doxycycline 100 mg twice daily and Amoxicillin 500mg 4 times daily, which is recommended for 12 months.
Tap water is the main source of urinary tract infection in Iraq, in particularly actinomycosis, when this case was presented with symptoms of urinary tract infection. Renal stones with an appearance of cheese and spoon during lithotripsy operation is the main characteristic feature of actinomycosis especially, when the urine sample appears milky. Benzathine penicillin injection then shifting to combination of oral doxycycline and ampicillin are the best drug of choice in such case.
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May 2020
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