Hyperammonemia and Impaired Consciousness Caused by Non-Urease-Producing Actinotignum schaalii in Obstructive Urinary...

Area of Science:

• Urology
• Infectious Diseases
• Nephrology

Background:

• Hyperammonemia is typically associated with urease-producing bacteria in urinary tract infections (UTIs).
• Actinotignum schaalii (A. schaalii) is a gram-positive bacillus that can cause UTIs.

Observation:

• An 87-year-old woman presented with hyperammonemia and impaired consciousness due to a UTI.
• Urine analysis revealed alkaline urine (pH 8.5) and gram-positive bacilli suggestive of A. schaalii.
• The patient experienced rapid improvement in consciousness and ammonia levels after bladder decompression.

Findings:

• This case demonstrates that non-urease-producing bacteria, such as A. schaalii, can cause hyperammonemia.
• Bacteria may acquire urease activity in the urinary tract environment.
• A. schaalii was identified as the causative agent in this patient's UTI and hyperammonemia.

Implications:

• Hyperammonemia in UTIs necessitates considering both urease-producing and non-urease-producing bacteria.
• Prompt diagnosis and appropriate antimicrobial treatment are crucial for managing hyperammonemia associated with UTIs.
• Gram-positive bacilli in UTIs warrant careful identification and selection of targeted antibiotic therapy.