A Case of Severe Hyperammonemic Encephalopathy Caused by Urinary Tract Infection in Obstructive Uropathy

Hyperammonemia is mainly caused by diseases related to liver failure. However, there are also non-hepatic causes of hyperammonemia, such as urinary tract infection (UTI) due to urease-producing organisms. Urease production by these bacteria induces a hydrolysis of urinary urea into ammonia that can cross the urothelial cell membrane and diffuse into blood vessels, leading to hyperammonemia. Delayed diagnosis and treatment of hyperammonemia can lead to lethal encephalopathy that can cause brain damage and life-threatening conditions. In the presence of obstructive uropathy, UTI by urease-producing bacteria can lead to more severe hyperammonemia due to enhanced resorption of ammonia into the systemic circulation. In this report, we present a case of acute severe hyperammonemic encephalopathy leading to brain death due to accumulation of ammonia in blood caused by Morganella morganii UTI in a 10-year-old girl with cloacal anomaly, causing obstructive uropathy even after multiple corrections.

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Hyperammonemic encephalopathy caused by urinary tract infection with urinary retention

European Journal of Internal Medicine ◽

10.1016/j.ejim.2007.10.022 ◽

2008 ◽

Vol 19 (8) ◽

pp. e78-e79 ◽

Cited By ~ 26

Author(s):

Shoichiro Sato ◽

Chiaki Yokota ◽

Kazunori Toyoda ◽

Masaki Naganuma ◽

Kazuo Minematsu

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Urinary Retention ◽

Hyperammonemic Encephalopathy

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Hyperammonemic encephalopathy secondary to diphtheroid urinary tract infection in a patient with prune belly syndrome

Critical Care Medicine ◽

10.1097/00003246-199104000-00022 ◽

1991 ◽

Vol 19 (4) ◽

pp. 578-579 ◽

Cited By ~ 6

Author(s):

BRAHM GOLDSTEIN ◽

MARILYN R. BROWN ◽

WILLIAM C. HULBERT ◽

RONALD RABINOWITZ

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Prune Belly Syndrome ◽

Hyperammonemic Encephalopathy ◽

Prune Belly

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Urinary Tract Infection as a Cause of Hyperammonemic Encephalopathy

General Medicine ◽

10.14442/general.16.95 ◽

2015 ◽

Vol 16 (2) ◽

pp. 95-98 ◽

Cited By ~ 1

Author(s):

Ryosuke Miyauchi ◽

Yosuke Matsuda ◽

Yasuharu Tokuda

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Hyperammonemic Encephalopathy

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Urinary tract infection in the adult

10.1093/med/9780199592548.003.0175 ◽

2015 ◽

Author(s):

Neil Sheerin

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Clinical Diagnosis ◽

Life Threatening ◽

Human Infections

Infection of the urinary tract is one of the commonest human infections. It can vary in severity from asymptomatic colonization, through self-limiting but distressing lower tract infection, to life-threatening sepsis. Any site in the urinary tract can be affected. The site of infection determines the pattern of symptoms, but this is also influenced by the age at presentation. The age at presentation and the nature of symptoms will not only suggest a clinical diagnosis, but also guide investigation and treatment. This chapter acts as an introduction to others in this section which address the different presentations of infections of the lower and upper urinary tracts in adults.

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Faculty Opinions recommendation of Impact of urinary tract infection on inpatient healthcare for congenital obstructive uropathy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717956775.793461362 ◽

2012 ◽

Author(s):

Chris Cooper ◽

Douglas Storm

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Obstructive Uropathy

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Virulence Factors of Different Candida Species Isolated From Patients With Urinary Tract Infection and Obstructive Uropathy

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.321.8559 ◽

1969 ◽

Vol 32 (1) ◽

Cited By ~ 1

Author(s):

Faris Q Alenzi

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Virulence Factors ◽

Candida Species ◽

Obstructive Uropathy

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An Unusual Case of Urinary Tract Infection in a Pregnant Woman WithPhotobacterium damsela

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/idog/2006/80682 ◽

2006 ◽

Vol 2006 ◽

pp. 1-3 ◽

Cited By ~ 10

Author(s):

Jesus R. Alvarez ◽

Sangeeta Lamba ◽

Keisha Y. Dyer ◽

Joseph J. Apuzzio

Keyword(s):

Urinary Tract Infection ◽

Pregnant Woman ◽

Urinary Tract ◽

Tract Infection ◽

Unusual Case ◽

Pregnant Female ◽

Detailed History ◽

Prompt Treatment ◽

Life Threatening

We describe a case of a urinary tract infection with an unusual pathogen, Photobacterium damsela, in a pregnant female. This pathogen has been described as having a virulent life threatening nature, so a detailed history and prompt treatment is needed.

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Prevalence, aetiology, antimicrobial susceptibility testing, and predictors of urinary tract infection among neonates with clinical sepsis: a cross-sectional study

Egyptian Pediatric Association Gazette ◽

10.1186/s43054-021-00088-6 ◽

2022 ◽

Vol 70 (1) ◽

Author(s):

Yasintha S. Lugira ◽

Fransisca D. Kimaro ◽

Mkhoi L. Mkhoi ◽

Samuel G. Mafwenga ◽

Angelina A. Joho ◽

...

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Klebsiella Pneumoniae ◽

Antimicrobial Agents ◽

Cross Sectional Study ◽

Cross Sectional ◽

Clinical Sepsis ◽

Predicting Factors ◽

Life Threatening

Abstract Background Urinary tract infection (UTI) is the most common and life-threatening bacterial infection among neonates. This study aimed to determine the prevalence, aetiology, and susceptible antimicrobial agents among neonates with UTI. Methods This was a cross-sectional analytical hospital-based study that included 152 neonates with clinical sepsis who were admitted at Dodoma regional referral hospital from January to June 2020. Bacterial growth of 1 × 103 colony forming units/mL of a single uropathogen was used to define the presence of UTI. Statistical analysis was performed using SPSS version 23.0 and multivariate analysis was used to determine the predicting factors of UTI. P <0.05 was regarded statistically significant. Results The prevalence of UTI was 18.4% (28/152). Klebsiella pneumoniae 64.3% (18/28) and Enterobacter spp. 35.7% (10/28) were the bacterial agents isolated. The bacterial isolates were 90%, and 60% sensitive to ciprofloxacin and amikacin, respectively. Low Apgar score (AOR = 12.76, 95% CI = 4.17–39.06, p<0.001), prolonged labour (AOR = 5.36, 95% CI = 1.28–22.52, p = 0.022), positive urine nitrite test (AOR = 26.67, 95% CI = 7.75–91.70, p<0.001), and positive leucocyte esterase test (AOR = 6.64, 95% CI = 1.47–29.97, p = 0.014) were potential predictors of UTI. Conclusion The prevalence of UTI confirmed by urine culture among neonates that were included in the present study indicates that this problem is common in the population where the study was conducted. Klebsiella pneumoniae and Enterobacter spp. were the uropathogens which were isolated. Ciprofloxacin, nitrofurantoin, and amikacin were sensitive to the isolated uropathogens.

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