### Microbiology Gram-positive cocci. It may be mistaken for a viridans *[[Streptococcus]]*. *A. christensenii*, *A. sanguinicola*, *A. urinae*, *A. urinaehominis*, *A. viridans*. It is one of the few streptococci that can also grow in clusters. Can be misidentified. For example, there was the elderly male admitted with the somewhat abrupt of severe back pain and fevers. He is found to have an alpha *[[Streptococcus]]* in the urine and was thought to have [[Pyelonephritis]] as the cause of his symptoms. Then his blood cultures were positive for *[[Aerococcus]] urinae*, and they called me with the question of how to treat the two infections. It is not two infections, I said. *[[Aerococcus]]* is an alpha *[[Streptococcus]]*. He had not only an infection on his aortic valve but an infection in his spine and both iliopsoas muscles. ### Epidemiologic Risks The Wikipedia says > "They were subsequently found in hospital environments and meat-curing brines." What do those have in common? Got me. And the organism has been found in dust, but the normal habitat of human pathogenic *Aerococci* is unknown. Usually causes disease in the elderly [^1]. If you isolate an alpha streptococcus in the urine, it is likely *[[Aerococcus]]* although the lab may not bother to identify it unless they have a MALDI-TOV or similar technology. MALDI-TOV, by the way, is not a salute. ### Syndromes Usually causes [[cystitis]], especially in elderly demented men [^2]. *A*. *urinae* and *A*. *sanguinicola* cause the occasional [[cystitis]] and [[endocarditis]]. Case reports of this and that here and there. ### Treatment Penicillin. With [[endocarditis]], maybe combined with an aminoglycoside. > All isolates (of [[Aerococcus]] urinae and [[Aerococcus]] sanguinicola) were found susceptible to all six antimicrobial agents: penicillin, [[cefotaxime]], [[meropenem]], [[vancomycin]], [[linezolid]], and rifampicin [^3]. Resistant to quinolones and [[trimethoprim]], standard first-line therapy for a bladder infection. ### Notes If Larry the Lobster comes in sick? [^5] *[[Aerococcus]] viridans var. homari* causes Gaffkaemia: > ...lethargy (typically seen as a drooping tail), anorexia and a pink colour on the ventral side of the abdomen, which gives the disease its alternative common name of red tail disease. When lobsters are moribund, they may lie on their sides, and frequently lose appendages [^4] Probably from his steroid use. ### Pushwhisperers [What\'s in a name? A rose by any other name would smell as sweet.](http:/pusware.com/PW2/WhatsInAName.html) [Audio. The Gobbet 'o Pus Podcast] (http://www.pusware.com/gobbet/gopw24.mp3) [Odd bacteria in bad places.](http:/pusware.com/PW6/OddBacteriaBadPlaces.html) [Audio. The Gobbet 'o Pus Podcast] (http://www.pusware.com/gobbet/gop779.mp3) [Significance] (http:/pusware.com/PW8/Significance.html) [Audio. The Gobbet 'o Pus Podcast] (http://www.pusware.com/gobbet/gop969.mp3) [Urine and the Heart] (http:/pusware.com/PW8/UrineHeart.html) [Audio. The Gobbet 'o Pus Podcast] (http://www.pusware.com/gobbet/gop986.mp3) ### Rationalizations [^1]: Shelton-Dodge K, Vetter EA, Kohner PC, Nyre LM, Patel R. Clinical significance and antimicrobial susceptibilities of [[Aerococcus]] sanguinicola and [[Aerococcus]] urinae. Diagn Microbiol Infect Dis. 2011 Aug;70(4):448-51. doi: 10.1016/j.diagmicrobio.2010.09.001. PMID: 21767701. [^2]: Erik Senneby, Birger Eriksson, Erik Fagerholm, Magnus Rasmussen, Bacteremia with _Aerococcus sanguinicola_: Case Series with Characterization of Virulence Properties, _Open Forum Infectious Diseases_, Volume 1, Issue 1, Spring 2014, ofu025, [https://doi.org/10.1093/ofid/ofu025](https://doi.org/10.1093/ofid/ofu025) [^3]: Carkaci D, Nielsen XC, Fuursted K, Skov R, Skovgaard O, Trallero EP, Lienhard R, Åhman J, Matuschek E, Kahlmeter G, Christensen JJ. _Aerococcus urinae_ and _Aerococcus sanguinicola_: Susceptibility Testing of 120 Isolates to Six Antimicrobial Agents Using Disk Diffusion (EUCAST), Etest, and Broth Microdilution Techniques. Open Microbiol J. 2017 Sep 21;11:160-166. doi: 10.2174/1874285801711010160. PMID: 29151992; PMCID: PMC5676010. [^4]: https://en.wikipedia.org/wiki/Gaffkaemia [^5]: https://nickelodeon.fandom.com/wiki/Larry_the_Lobster