title: Kidney allograft pyelonephritis caused by Salmonella enterica serovar Schwarzengrund.
abstract: Kidney transplant recipients (KTRs) taking immunosuppressive drugs have a 20-fold greater risk of nontyphoidal Salmonella (NTS) infection than the healthy adult population. Among KTRs, the urinary tract is the most common site of infection. However, few cases of urinary tract infection caused by NTS have been documented in KTRs, and only one in Japan. Furthermore, it frequently induces acute allograft rejection with high mortality. Salmonella enterica subsp. enterica serovar Schwarzengrund (S. Schwarzengrund) is now among the more common Salmonella serovars isolated in Japan and is likely to be invasive. We present a case of a 45-year old female with vesicoureteral reflux to her transplanted kidney who developed kidney allograft pyelonephritis caused by S. Schwarzengrund. She was admitted to our hospital with fever, urodynia, lower abdominal pain, gross hematuria, and cloudy urine. Urine cultures were positive for S. Schwarzengrund. Exposure to cats, especially stray cats, were identified as the most likely source. We administered antibiotics for 4 weeks (ceftriaxone then amoxicillin, each for 2 weeks) and educated her about pet safety. She experienced no recurrence of infection or clinical kidney allograft rejection for 3 months post-treatment. NTS should be considered as a possible pathogen of urinary tract infection among KTRs, especially in cases with animal exposure or structural urologic abnormalities. When the pathogen is NTS, appropriate antibiotics and treatment periods are essential for preventing recurrence and allograft rejection after the completion of treatment.
authors.affiliation: Department of Nephrology, Shizuoka General Hospital, Shizuoka, Japan. Electronic address: pa2.kenta@gmail.com.
authors.forename: Kenta
authors.initials: K
authors.lastname: Ito
authors.affiliation: Department of Nephrology, Shizuoka General Hospital, Shizuoka, Japan.
authors.forename: Haruomi
authors.initials: H
authors.lastname: Nishio
authors.affiliation: Department of Nephrology, Shizuoka General Hospital, Shizuoka, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Iwatani
authors.affiliation: Department of Nephrology, Shizuoka General Hospital, Shizuoka, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Yamada
authors.affiliation: Department of Nephrology, Shizuoka General Hospital, Shizuoka, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Okawa
authors.affiliation: Department of Nephrology, Shizuoka General Hospital, Shizuoka, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Nephrology, Shizuoka General Hospital, Shizuoka, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Murakami
authors.affiliation: Department of Nephrology, Shizuoka General Hospital, Shizuoka, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Matsuo
authors.affiliation: Department of Nephrology, Shizuoka General Hospital, Shizuoka, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Matsuo
authors.affiliation: Department of Nephrology, Shizuoka General Hospital, Shizuoka, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Nephrology, Shizuoka General Hospital, Shizuoka, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Mori
authors.affiliation: Department of Nephrology, Shizuoka General Hospital, Shizuoka, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Mori
mesh_terms: D064591:Allografts; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002415:Cats; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D011704:Pyelonephritis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D012480:Salmonella Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D019779:Salmonella enterica; D014552:Urinary Tract Infections; D014718:Vesico-Ureteral Reflux
chemical_list: D000900:Anti-Bacterial Agents
keywords: Kidney transplantation; Nontyphoidal Salmonella; Pyelonephritis; Recipient; Salmonella Schwarzengrund; Urinary tract infection