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<article xml:lang="KO" article-type="case-report">

<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">Lab Med Online</journal-id>
<journal-id journal-id-type="publisher-id">LMO</journal-id>
<journal-title>Laboratory Medicine Online</journal-title>
<issn pub-type="epub">2093-6338</issn>
<publisher>
<publisher-name>The Korean Society for Laboratory Medicine</publisher-name>
</publisher>
</journal-meta>

<article-meta>

<article-id pub-id-type="doi">10.3343/lmo.2012.2.3.170</article-id>

<article-categories>
<subj-group>
<subject>Case Report</subject>
<subj-group>
<subject>Clinical Microbiology</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Asymptomatic Bacteriuria Caused by <italic>Haemophilus influenzae</italic> in a Kidney Transplant Recipient</article-title>
</title-group>

<contrib-group>

<contrib contrib-type="author">
<name>
<surname>Kim</surname>
<given-names>Hyun-Ki</given-names>
</name>
<degrees>M.D.</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>Ji</surname>
<given-names>Misuk</given-names>
</name>
<degrees>M.D.</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>Paek</surname>
<given-names>Seong-Mi</given-names>
</name>
<degrees>M.T.</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>An</surname>
<given-names>Dongheui</given-names>
</name>
<degrees>M.D.</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>

<contrib contrib-type="author" corresp="yes">
<name>
<surname>Sung</surname>
<given-names>Heungsup</given-names>
</name>
<degrees>M.D.</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>Park</surname>
<given-names>Su-Kil</given-names>
</name>
<degrees>M.D.</degrees>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>Kim</surname>
<given-names>Mi-Na</given-names>
</name>
<degrees>M.D.</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>

</contrib-group>

<aff id="A1"><label>1</label>Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.</aff>
<aff id="A2"><label>2</label>Department of Internal Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.</aff>

<author-notes>
<corresp>
Corresponding author: Heungsup Sung, M.D. Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-4499, Fax: +82-2-478-0884, <email>sung@amc.seoul.kr</email>
</corresp>
</author-notes>

<pub-date pub-type="ppub">
<month>07</month>
<year>2012</year>
</pub-date>
<pub-date pub-type="epub">
<day>01</day>
<month>07</month>
<year>2012</year>
</pub-date>
<volume>2</volume>
<issue>3</issue>
<fpage>170</fpage>
<lpage>173</lpage>
<history>
<date date-type="received">
<day>26</day>
<month>10</month>
<year>2011</year>
</date>
<date date-type="rev-recd">
<day>21</day>
<month>12</month>
<year>2011</year>
</date>
<date date-type="accepted">
<day>26</day>
<month>12</month>
<year>2011</year>
</date>
</history>
<permissions>
<copyright-statement>&#x00A9; 2012, Laboratory Medicine Online</copyright-statement>
<copyright-year>2012</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0">
<p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="http://creativecommons.org/licenses/by-nc/3.0">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</p>
</license>
</permissions>

<abstract>
<p><italic>Haemophilus influenzae</italic> has rarely been implicated as the causative agent of urinary tract infections (UTIs). However, cases of UTIs caused by <italic>H. influenza</italic> in patients with anatomical or functional urinary tract abnormalities have been steadily reported. We report a case of asymptomatic bacteriuria caused by <italic>H. influenzae</italic> in a kidney transplant recipient. The patient was a 61-yr-old woman who visited the hospital for a routine follow-up after receiving a kidney transplant from a living-related donor; the patient showed no symptoms. Urine microscopy revealed white blood cell (WBC) count of &#x003E;30/high power field (HPF). Urine culture on blood agar showed non-hemolytic, tiny, translucent, grayish colonies with satellitism around &#x03B2;-hemolytic colonies of <italic>Staphylococcus epidermidis</italic>. The organism in the satellite colonies was identified as <italic>H. influenzae</italic> by using VITEK <italic>Neisseria/Haemophilus</italic> Identification Card (bioM&#x00E9;rieux, Marcy L'Etoile, France) and found to require both X and V factors for growth. The organism did not produce &#x03B2;-lactamase. Urine culture performed 1 week later revealed <italic>H. influenza</italic> again. The patient was not treated with antimicrobials. Urine culture performed using chocolate agar 7 weeks later did not reveal <italic>H. influenzae</italic>. Since <italic>H. influenzae</italic> does not grow in the media commonly used for urine culture such as blood agar, the use of these media could lead to underestimation of the true frequency of <italic>H. influenzae</italic>. If UTI is suspected in a patient with anatomical or functional urinary tract abnormality, chocolate agar should be considered for urine culture.</p>
</abstract>

<kwd-group>
<kwd><italic>Haemophilus influenzae</italic></kwd>
<kwd>Urinary tract infection</kwd>
<kwd>Asymptomatic bacteriuria</kwd>
<kwd>Kidney transplantation</kwd>
</kwd-group>

</article-meta>
</front>

<back>

<fn-group>
<fn fn-type="other">
  <p>This article is available from <ext-link ext-link-type="uri" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="http://www.labmedonline.org">http://www.labmedonline.org</ext-link></p>
</fn>
</fn-group>

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</back>

<floats-wrap>

<fig position="float" id="F1">
<label>Fig. 1</label>
<caption>
  <p>Colonies of <italic>Haemophilus influenzae</italic>. Non-hemolytic tiny translucent grayish colonies (arrows) were observed satelliting around colonies of <italic>Staphylococcus epidermidis</italic> on blood agar.</p>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="lmo-2-170-g001" alt-version="no"></graphic>
</fig>

<fig position="float" id="F2">
<label>Fig. 2</label>
<caption>
  <p>Use of X, V, and X+V factor disks for determining growth factor requirements. <italic>Haemophilus influenzae</italic> requires both X and V factors for growth.</p>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="lmo-2-170-g002" alt-version="no"></graphic>
</fig>

</floats-wrap>

</article>