Acute glomerulonephritis secondary to Streptococcus anginosus

BMJ Case Rep. 2018 Mar 9:2018:bcr2017223314. doi: 10.1136/bcr-2017-223314.

Abstract

Streptococcus anginosus is a clinically important pathogen that is emerging globally but remains poorly investigated. Here, we report the first case of acute glomerulonephritis resulting from infection with S. anginosus Glomerulonephritis is typically caused by S. pyogenes and reports secondary to other strains including S. zooepidemicus and S. constellatus exist. Infection with S. anginosus in this patient was associated with acute nephritis (haematuria, oedema and hypertension), nephrotic syndrome and progressive azotemia. There was activation of the complement system. The presence of low C1q and elevated anti-C1q binding complexes points to a potential pathogenic role. Testing for streptococcal antigens was strongly positive. Emerging nephritogenic strains of S. anginosus present a significant health concern for both developed and developing countries.

Keywords: acute renal failure; nephrotic syndrome; pneumonia (infectious disease).

Publication types

  • Case Reports

MeSH terms

  • Abdominal Pain / diagnosis*
  • Abdominal Pain / diagnostic imaging
  • Abdominal Pain / etiology
  • Abdominal Wall / pathology
  • Acute Disease
  • Aftercare
  • Anti-Bacterial Agents / therapeutic use
  • Azotemia / blood
  • Complement C1q / metabolism*
  • Complement C3 / metabolism*
  • Fasciitis, Necrotizing / metabolism*
  • Fasciitis, Necrotizing / pathology
  • Fasciitis, Necrotizing / surgery
  • Female
  • Glomerulonephritis / drug therapy
  • Glomerulonephritis / microbiology*
  • Glomerulonephritis / pathology
  • Humans
  • Kidney Diseases / microbiology*
  • Kidney Diseases / pathology
  • Middle Aged
  • Nephritis / complications
  • Nephritis / diagnosis
  • Nephrotic Syndrome / complications
  • Nephrotic Syndrome / diagnosis
  • Proteinuria / diagnosis
  • Proteinuria / urine
  • Streptococcal Infections / complications*
  • Streptococcal Infections / drug therapy
  • Streptococcal Infections / pathology
  • Streptococcus anginosus / isolation & purification*
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Complement C3
  • Complement C1q