Skip to main content
SpringerLink
Log in

Aerococcus urinae: a possible reason for malodorous urine in otherwise healthy children

  • Case Report
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Recently, Aerococcus urinae, primarily recognized as a common pathogen in elderly women, has been reported to cause an extremely unpleasant odour of the urine in paediatric patients similar to trimethylaminuria (fish odour syndrome). Herein, we present a case of A. urinae urinary tract colonization in a 12-year-old otherwise healthy boy, who finally refused micturition outside from his home environment as a result of the unpleasant odour. Within the last year, three cases (including our own) of A. urinae colonization causing foul-smelling urine in healthy children have been published, suggesting that this condition might be as frequent as trimethylaminuria. In case of polymicrobial growth in a urine specimen, A. urinae as the leading pathogen will usually be missed by routine bacteriological investigation. Novel bacteriological techniques such as MALDI-TOF MS provide a rapid tool to recognize this pathogen in urine. Conclusion: As treatment of A. urinae infection is simple, we recommend that in healthy children with malodorous urine, this pathogen is excluded before the initiation of costly metabolic investigations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

A. urinae :

Aerococcus urinae

FMO3:

Flavine-containing monooxigenase-3

MALDI-TOF MS:

Matrix-assisted laser desorption ionization time of flight mass spectrometry

TMA:

Trimethylamine

References

  1. Bos LD, Sterk PJ, Schultz MJ (2013) Volatile metabolites of pathogens: a systematic review. PLoS Pathog 9:e1003311

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. De Vries TW, Brandenburg AH (2012) Foul smelling urine in a 7-year-old boy caused by Aerococcus urinae. Pediatr Infect Dis J 31:1316–1317

    Article  PubMed  Google Scholar 

  3. Ferreira L, Sanchez-Juanes F, Gonzalez-Avila M, Cembrero-Fuciños D, Herrero-Hernãndez A, Gonzãlez-Buitrago JM, Muñoz-Belido JL (2010) Direct identification of urinary tract pathogens from urine samples by matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol 48:2110–2115

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Gibb AP, Sivaraman B (2013) A second case of foul smelling urine in a boy caused by Aerococcus urinae. Pediatr Infect Dis J 32:1300–1301

    Article  PubMed  Google Scholar 

  5. Messenger J, Clark S, Massick S, Bechtel M (2013) A review of trimethylaminuria: (fish odor syndrome). J Clin Aesthet Dermatol 6:45–48

    PubMed Central  PubMed  Google Scholar 

  6. Mitchell SC, Smith RL (2001) Trimethylaminuria: the fish malodor syndrome. Drug Metab Dispos Biol Fate Chem 29:517–521

    CAS  PubMed  Google Scholar 

  7. Murray TS, Muldrew KL, Finkelstein R, Hampton L, Edberg SC, Cappello M (2008) Acute pyelonephritis caused by Aerococcus urinae in a 12-year-old boy. Pediatr Infect Dis J 27:760–762

    Article  PubMed  Google Scholar 

  8. Rasmussen M (2013) Aerococci and aerococcal infections. J Infect 66:467–474

    Article  PubMed  Google Scholar 

  9. Sierra-Hoffman M, Watkins K, Jinadatha C, Fader R, Carpenter JL (2005) Clinical significance of Aerococcus urinae: a retrospective review. Diagn Microbiol Infect Dis 53:289–292

    Article  PubMed  Google Scholar 

  10. Subcommittee on Urinary Tract Infection SCOQI, Management, Roberts KB (2011) Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 128:595–610

    Article  PubMed  Google Scholar 

  11. Treacy E, Johnson D, Pitt JJ, Danks DM (1995) Trimethylaminuria, fish odour syndrome: a new method of detection and response to treatment with metronidazole. J Inherit Metab Dis 18:306–312

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

NR is supported by a career advancement grant of the University of Basel. The authors would like to thank Dr. Reno Frei for performing the MALDI-TOF MS in the microbiology laboratory at the Basel University Hospital and for helpful comments on the manuscript. They would also like to thank Dr. Martina Huemer, working as an external metabolic consultant at the University Children’s Hospitals of Zurich and Basel, for her support in initiating the metabolic urine analysis and for her helpful comments on the manuscript. Finally, the authors would like to thank Dr. Claus-Dieter Langhans for performing the GCMS analysis at the metabolic laboratory of the Heidelberg University Hospital and for his helpful comments on the manuscript.

Conflict of interest

The authors declare that there are no conflicts of interest.

Author information

Authors and Affiliations

  1. Nephrology Unit, University Children’s Hospital Basel, Spitalstrasse 33, CH-4056, Basel, Switzerland

    Nina Lenherr & Christoph Rudin

  2. Private Practice, Weierestr. 17, Magden, CH-Aargau, Switzerland

    Anita Berndt

  3. Infectious Diseases Unit, University Children’s Hospital Basel, The University of Basel, Basel, Switzerland

    Nicole Ritz

  4. Department of Paediatrics, The University of Melbourne, Parkville, Melbourne, VIC, Australia

    Nicole Ritz

Authors
  1. Nina Lenherr
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anita Berndt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicole Ritz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christoph Rudin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christoph Rudin.

Additional information

Communicated by Beat Steinmann

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lenherr, N., Berndt, A., Ritz, N. et al. Aerococcus urinae: a possible reason for malodorous urine in otherwise healthy children. Eur J Pediatr 173, 1115–1117 (2014). https://doi.org/10.1007/s00431-014-2348-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-014-2348-9

Keywords

Search

Navigation