Recurring hyperammonemic encephalopathy induced by bacteria usually not producing urease

BMC Research Notes

Lucio Marinelli¹  Roberta Marchese¹  Silvia Stara¹  Chiara Borzone¹  Valentina Calabrò¹  Elisabetta Traverso¹  Christian Cordano¹ 

[1] Institute of Neurology, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Largo Daneo 3, 16132 Genova, Italy

关键词: Urinary tract infections;    Urea-splitting bacteria;    Urinary retention;    Neurogenic bladder;    Urease;    Hyperammonemic encephalopathy;   

Others  :  1132657
DOI  :  10.1186/1756-0500-7-324

 received in 2014-01-09, accepted in 2014-05-26,  发布年份 2014

【 摘 要 】

Background

Hyperammonemic encephalopathy may occur when urease-positive bacteria in the urinary tract produce ammonium which directly enters systemic circulation. Predisposing conditions such as a neurogenic bladder can increase both urinary tract infection and urine stagnation.

Case presentation

We describe the case of a 66 years old woman with a neurogenic bladder who twice developed hyperammonemic encephalopathy following urinary tract infection. During the second episode Escherichia coli and Enterococcus faecalis have been isolated in the urine. The neurologic examination showed psychomotor slowing, weak photomotor reflex, nystagmus in the lateral gaze and asterixis. The EEG showed triphasic waves which disappeared along with clinical recovery.

Conclusion

Escherichia coli and Enterococcus faecalis are commonly considered urease-negative bacteria. Although frequently involved in urinary tract infections, their role in causing hyperammonemic encephalopathy have not been previously reported. Moreover, despite only one case with a neurogenic bladder have been described so far, our is the first patient with reoccurring hyperammonemic encephalopathy secondary to urinary tract infections.

【 授权许可】

   
2014 Cordano et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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