Published online: 2020-04-07

Letters to Editor

 mitis: An ',$%(7,&6$03/(  Unusual Causative Agent for ('7$ Urinary Tract  +(3$5,1

+%$FYDOXHV &,75$7(  Sir, )/25,'( (UTI) is one of the frequent   bacterial infection observed in clinical practice and is usually '$<6 caused by members of the Enterobacteriaceae family, in particular Escherichia coli and Gram‑positive cocci such as Figure 5: The results for adult diabetic samples spp. and Staphylococcus spp.[1] But we encountered

 a case of UTI caused by an unusual pathogen‑Streptococcus ',$%(7,&6$03/( mitis, a member of the viridans group Streptococci (VGS).  A 55‑year‑old diabetic female attended the gynaecology

('7$ outpatient department of our hospital with recurrent  +(3$5,1 burning micturition, low grade fever, and lower abdominal pain since one month. For this she had been empirically

+%$FYDOXHV &,75$7(  treated with ciprofloxacin but with no improvement. On )/25,'( examination, she had an urethrocele causing difficulty in   emptying her bladder leading to cystitis. She was diabetic, '$<6 human immunodeficiency virus (HIV) sero‑negative Figure 6: The results for adult diabetic samples and her hematological and biochemical parameters were within normal limits except for a neutrophilic leukocytosis. Booloo Sharma, Devajit Sarmah, Microscopic examination of her urine samples for two

Pavan Sonker consecutive days revealed plenty of pus cells and traces of albumin while aerobic culture of both the samples showed Department of Biochemistry, R D Gardi Medical College, significant bacterial growth (colony count > 105 CFU/ml) on Ujjain, Madhya Pradesh, India CLED agar. Isolated organisms were Gram‑positive cocci Address for correspondence: mostly in chains, negative, bile esculin negative even Dr. Booloo Sharma, after 48 hours, showed no growth on nutrient agar and were E‑mail: [email protected] nonhemolytic on 5% sheep blood agar. This bacterium was further identified asS. mitis by VITEK‑2 system with REFERENCES GP‑67card. The isolate was susceptible to amoxicillin– 1. Fitzgibbons JF, Koler RD and Jones RT, ibid, 1976;58:820‑4. clavulanic acid, ceftriaxone, gentamicin, and vancomycin 2. American Diabetes Association. Diagnosis and classification of diabetes but resistant to ampicillin, azithromycin, ciprofloxacin, and mellitus. Diabetes Care 2012;35(Suppl 1):S64‑71. ofloxacin. The sensitivity was cross checked by Hicomb 3. Sacks DB, Bruns DE, Goldstein DE, Maclaren NK, McDonald JM, Parrott M. Guidelines and recommendations for laboratory analysis MIC strips before handing out the susceptibility results. in the diagnosis and management of diabetes mellitus. Clin Chem The patient was successfully treated with amoxicillin– 2002;48:436‑72. clavulanic acid for one week along with physiotherapy. 4. Little RR, Rohlfing CL, Tennill AL, Connolly S, Hanson S. Effects of sample storage conditions on glycated hemoglobin measurement: Although the VGS is a known commensal organism in Evaluation of five different high performance liquid chromatography the human mucosa of the oral cavity, upper respiratory methods. Diabetes Technol Ther 2007;9:36‑42. tract, female genital tract, and gastrointestinal tract; it has 5. Mailankot M, Thomas T, Praveena P, Jacob J, Benjamin JR, Vasudevan DM et al. Various anticoagulants and fluoride do not affect HbA1C level. been documented to be a frequent cause of endocarditis, Ind J Clin Biochem 2012;27:209. meningitis, pneumonia, and bacteremia particularly in [2,3] Access this article online patients with immunosuppressive conditions. There are Quick Response Code: occasional reports of genito‑urinary infection by VGS, Website: [4] www.jlponline.org but UTI by S. mitis is unusual. In our case, risk factors for this infection were diabetes and the urethrocele. The patient was asymptomatic after proper antibiotic treatment DOI: 10.4103/0974-2727.119871 along with control of blood sugar. Though 16S rRNA gene sequencing is the surest method for identification of

144 Journal of Laboratory Physicians / Jul-Dec 2013 / Vol-5 / Issue-2 Letters to Editor

S. mitis, VITEK‑2 system is also one of the important aid or transient bisalbuminemia have been described in in resource poor setting. Thus, isolation and knowledge of various pathological conditions including diabetes S. mitis as a causative agent of UTI will help in avoiding mellitus, Waldenström’s macroglobulinemia, multiple misrecognition of it as a mere contaminant and ensuring myeloma, sarcoidosis, Alzheimer’s disease, pancreatic appropriate treatment. pseudocyst, nephrotic syndrome, chronic kidney disease, and also in patients receiving high doses of penicillin.[1‑5] Bichitrananda Swain, Sarita Otta Bisalbuminemia is an infrequent finding among Indians; we report three cases of bisalbuminemia of the “slow” variant Department of Microbiology, Institute of Medical which were incidentally discovered on screening serum Sciences and SUM Hospital, Siksha O Anusandhan samples for protein electrophoretic studies in last 6 months. (S”O”A) University, Bhubaneswar, Odisha, India

Address for correspondence: The first case is a 65‑year‑old female patient of type II Dr. Bichitrananda Swain, diabetes mellitus (DM) who presented with neuropathy, E‑mail: [email protected] nephropathy, nonproliferative retinopathy, and right diabetic foot. The second case is a 50‑year‑old male patient REFERENCES of type I DM who presented with chronic inflammatory demyelinating neuropathy. The third patient presented 1. Warren JW. Clinical presentations and epidemiology of urinary tract infection. with mild fever, arthralgia, and bone pains and referred In: Mobley HL, Warren JW, editors. Urinary tract ‑molecular pathogenesis and clinical management. Washington DC: American Society for investigation of multiple myeloma. Serum protein for Microbiology Press; 1996. p. 3‑27. electrophoresis was performed with an automated rapid 2. Douglas CW, Heath J, Hampton KK, Preston FE. Identity of viridans agarose gel electrophoresis system (SAS‑1 Serum Protein streptococci isolated from cases of . J Med Microbiol 1993;39:179‑82. SB, Helena Biosciences, Europe). Serum electrophoresis 3. Westling K, Ljungman P, Thalme A, Julander I. Streptococcus viridans revealed two distinct albumin bands at anodic end [Figures 1 septicaemia: A comparison study in patients admitted to the departments and 2]. The bands were of unequal relative amounts in of infectious diseases and haematology in a university hospital. Scand J Infect Dis 2002;34:316‑9. all cases. New albumin variant bands had slower mobility

4. Chou YS, Horng CT, Huang HS, Hu SC, Chen JT, Tsai ML. Reactive arthritis compared to normal albumin. The slow and normal bands following Streptococcus viridians urinary tract infection. Ocul Immunol Inflamm constituted for 20.4 and 25.7% of total serum proteins in 2010;18:52‑3. first case, 28.6 and 25.5% in second case, and 25.5 and 28.7% Access this article online in third case, respectively. In addition, first case also showed Quick Response Code: bisalbuminuria. Bisalbuminemia was noted as an incidental Website: www.jlponline.org finding in all three cases on serum protein electrophoresis. The patients’ serum samples were reexamined and remained bisalbuminemic 1 month after their first visit. DOI: 10.4103/0974-2727.119876 First case of bisalbuminemia was reported in a diabetic German in 1955. Since then, a variety of mutations and polymorphisms have been reported in literature. So far, there are 77 known mutations of the serum albumin Bisalbuminemia: A Rarely gene, with 65 of them resulting in bisalbuminemia.[5] The acquired (or transient) form of bisalbuminemia has Encountered Protein Anomaly been found in patients receiving high doses of b‑lactam antibiotics or suffering by pancreatic disease, usually Sir, complicated with ruptured pseudocysts. Hereditary Bisalbuminemia or alloalbuminemia is an inherited or bisalbuminemia, transmitted as an autosomal codominant acquired, rarely encountered serum protein anomaly, character, is a relatively rare genetic disorder (occurring with characterized by the occurrence of bicuspid electrophoretic a cumulative frequency of 1:1000-1:10,000) that is usually pattern in the albumin fraction detected on serum revealed by chance.[2] The causative genetic lesion is a point electrophoresis. It can be seen in densitometry as a bifid mutation of human serum albumin gene. mountain where albumin has two heads. These albumin mutants also called alloalbumins either have increased Albumin variations, either acquired or inherited, should electrophoretic mobility (fast type variants) or decreased always be on the radar of both clinicians and research mobility (slow type variants).[1] The presence of acquired scientists. Such new forms can possibly provide data

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