Which history findings suggest chronic Proteus infections?

Updated: Mar 03, 2020
  • Author: Shirin A Mazumder, MD, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Frequent and unexplained incidents of renal calculi may be indicative of a chronic Proteus infection. Multiple magnesium ammonium phosphate crystals are present in the urine sediment along with radio dense renal calculus. (This calculus is less radio dense than calcium oxalate.) This results in formation and precipitation of struvite crystals, a predominant component of urinary calculi and encrustations on urinary catheters.

Proteus are common among the gram-negative causes of bacteremia, with most cases secondary to UTI and often associated with urinary catheters. Community-acquired Proteus UTI in the presence of hydronephrosis or urolithiasis increases the risk of bacteremia. Proteus can persist in the urinary tract despite antibiotics and catheter exchange, potentially because of immune evasion and the protective reservoir that urinary stones may provide.


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