|Ewingella americana: an emerging true pathogen.|
|Jump to Full Text|
|PMID: 22762003 Owner: NLM Status: PubMed-not-MEDLINE|
|Infections caused by Ewingella americana have been rarely reported in the literature. Most of the cases that have been reported were among the immunocompromised patients. We report a case of E. americana causing osteomyelitis and septic arthritis of the shoulder joint in a previous intravenous drug abuser. The causative pathogen was identified by synovial fluid analysis and culture.|
|Syed Hassan; Syed Amer; Chetan Mittal; Rishi Sharma|
Related Documents :
|23736383 - Triterpenoids.
21216373 - Anthropometry of hand in sex determination of dismembered remains - a review of literat...
23442453 - Insect bite reactions.
|Type: Journal Article Date: 2012-06-14|
|Title: Case reports in infectious diseases Volume: 2012 ISSN: 2090-6633 ISO Abbreviation: Case Rep Infect Dis Publication Date: 2012|
|Created Date: 2012-07-04 Completed Date: 2012-08-23 Revised Date: 2013-04-01|
Medline Journal Info:
|Nlm Unique ID: 101573243 Medline TA: Case Rep Infect Dis Country: Egypt|
|Languages: eng Pagination: 730720 Citation Subset: -|
|Division of Internal Medicine, Henry Ford Hospital, Detroit, MI 48202, USA.|
|APA/MLA Format Download EndNote Download BibTex|
Journal ID (nlm-ta): Case Rep Infect Dis
Journal ID (iso-abbrev): Case Rep Infect Dis
Journal ID (publisher-id): CRIM.ID
Publisher: Hindawi Publishing Corporation
Copyright © 2012 Syed Hassan et al.
Received Day: 28 Month: 3 Year: 2012
Accepted Day: 9 Month: 5 Year: 2012
Print publication date: Year: 2012
Electronic publication date: Day: 14 Month: 6 Year: 2012
Volume: 2012E-location ID: 730720
PubMed Id: 22762003
|Ewingella Americana: An Emerging True Pathogen|
|Division of Internal Medicine, Henry Ford Hospital, Detroit, MI 48202, USA
|Correspondence: *Syed Hassan: email@example.com
[other] Academic Editors: L. M. Bush and B. Moreira
Ewingella americana is a rare gram negative, lactose fermenting, oxidase negative, catalase positive, indole negative, facultative anaerobic bacillus first described from clinical specimens in 1983 by Grimont et al. , as a new group in the Enterobacteriaceae family. It rarely causes human infections and has been identified from various clinical samples including sputum , conjunctiva [3, 4], blood [5–8], wound , and peritoneal dialysate . Interestingly, it has also been isolated from the intestinal contents of snails and slugs , fresh nutria carcasses , vacuum packaged meat , and mushrooms  as well.
This case report is the first clinical description of E. americana causing osteomyelitis and septic arthritis of the shoulder joint.
A 50-year-old male was admitted to the hospital, with gradual onset of pain and swelling in the right shoulder since 4 days. He denied fever, chills, or rigors. His past medical history was significant for hypertension and intravenous drug abuse. His last use of heroin was 2 months ago with an unsterilized needle contaminated by saliva, in the right arm. Physical examination revealed limited range of motion of right shoulder secondary to pain. Radiograph of the right shoulder was suggestive of osteomyelitis. A computed topographic scan of the shoulder revealed multifocal, intraarticular abscess formation involving the right upper extremity. It also showed erosion of the humeral head and the glenohumeral joint, consistent with septic arthritis (Figure 1). Arthrocentesis was done, and the cell count of the synovial fluid showed white blood cell count of 9.4 × 109/L (90% neutrophils, 1% bands). Cultures of the synovial fluid grew Ewingella americana. The antimicrobial susceptibility test carried out by disk diffusion method showed susceptibility to amikacin, ampicillin, cefazolin, gentamicin, piperacillin tazobactam, tobramycin, and trimethoprim sulfamethoxazole while was resistant to ciprofloxacin.
The patient was started on ceftriaxone 2 gm intravenous every 24 hours. He continued to improve and was discharged home to complete 6 weeks of intravenous antibiotic therapy. He was followed 4 weeks later in the outpatient clinic and showed resolution of infection which was confirmed both clinically and by imaging. The antibiotic course was completed with no complications.
Clinical infections due to E. americana have been reported to cause peritonitis , conjunctivitis [3, 4], bacteremia , and pneumonia [2, 15]. Colonization in wound  and sputum  were also reported in patients without causing clinical infection. Sepsis [5–8] and even death from Waterhouse-Friderichsen syndrome due to E. Americana  has also been reported.
E. Americana is seen in patients who were immunosuppressed due to diabetes mellitus , bone marrow transplantation, chemotherapy , end stage renal disease , and use of mercaptopurine . Although, a few cases of E. americana have been reported earlier causing conjunctivitis [3, 4] and Waterhouse-Friderichsen syndrome  in previously healthy individuals, this is the first case of osteomyelitis involving the joint due to intravenous drug abuse. Based on this observation, clinicians may want to consider Ewingella Americana as an emerging true pathogen.
Since little information exists on the ecological niche of this organism, in our case we speculate on the source of contamination as saliva from the patient's mouth. Kati et al.  proposed domestic water to be a source of infection in peritonitis of a patient undergoing peritoneal dialysis. A contaminated ice bath was identified as the probable source in an outbreak of E. americana bacteremia, in patients who had undergone cardiovascular or peripheral vascular surgery . Maertens et al.  speculated on inadequate hand hygiene as the source of infection. E. americana is an organism without nutritional needs that can survive in water and citrate solution and preferably grows at 4°C.
The only risk factor in our patient was that he was an intravenous drug abuser while using unsterilized needles for his heroin injections; he might have inoculated the pathogen into his blood causing transient blood stream infection which ultimately seeded into his shoulder joint.
To our knowledge, this case is the first report of osteomyelitis and septic arthritis caused by E. americana infection. Earlier reports suggested E. americana causing infections in immunocompetent host; however, in our case the infections were certainly favored by intravenous injections with contaminated material.
Informed consent is obtained from the patient for publication of this paper.
|1.||Grimont PAD,Farmer JJ III,Grimont F,Asbury MA,Brenner DJ,Deval C. Ewingella Americana gen. nov., sp.Nov., a new enterobacteriaceae isolated from clinical specimensAnnales de l’Institut Pasteur. MicrobiologieYear: 1983134139522-s2.0-49049125172|
|2.||Ryoo NH,Ha JS,Jeon DS,Kim JR,Kim HC. A case of pneumonia caused by Ewingella Americana in a patient with chronic renal failureJournal of Korean Medical ScienceYear: 20052011431452-s2.0-1484431731515716620|
|3.||Da Costa PS,Tostes MM,de Carvalho Valle LM. A case of keratoconjunctivitis due to Ewingella Americana and a review of unusual organisms causing external eye infectionsThe Brazilian Journal of Infectious DiseasesYear: 2000452622672-s2.0-003429333511063558|
|4.||Heizmann WR,Michel R. Isolation of Ewingella Americana from a patient with conjunctivitisEuropean Journal of Clinical Microbiology and Infectious DiseasesYear: 199110119579592-s2.0-0026341601|
|5.||Pien FD,Farmer JJ,Weaver RE. Polymicrobial bacteremia caused by Ewingella americana (family Enterobacteriaceae) and an unusual Pseudomonas speciesJournal of Clinical MicrobiologyYear: 19831837277292-s2.0-00205233676630449|
|6.||Devreese K,Claeys G,Verschraegen G. Septicemia with Ewingella americanaJournal of Clinical MicrobiologyYear: 19923010274627472-s2.0-00266718961400980|
|7.||Maertens J,Delforge M,Vandenberghe P,Boogaerts M,Verhaegen J. Catheter-related bacteremia due to Ewingella americanaClinical Microbiology and InfectionYear: 2001721031042-s2.0-003526211511298155|
|8.||Pien FD,Bruce AE. Nosocomial Ewingella americana bacteremia in an intensive care unitArchives of Internal MedicineYear: 198614611111122-s2.0-00225884463942442|
|9.||Bear N,Klugman KP,Tobiansky L,Koornhof HJ. Wound colonization by Ewingella americanaJournal of Clinical MicrobiologyYear: 19862336506512-s2.0-00226288393958154|
|10.||Kati C,Bibashi E,Kokolina E,Sofianou D. Case of peritonitis caused by Ewingella americana in a patient undergoing continuous ambulatory peritoneal dialysisJournal of Clinical MicrobiologyYear: 19993711373337342-s2.0-003287020110523587|
|11.||Muller HE,Fanning GR,Brenner DJ. Isolation of Ewingella Americana from mollusksCurrent MicrobiologyYear: 19953152872902-s2.0-00295566267580799|
|12.||Lyon WJ,Milliet JB. Microbial flora associated with Louisiana processed frozen and fresh nutria (Myocastor coypus) carcassesJournal of Food ScienceYear: 2000656104110452-s2.0-0033758598|
|13.||Helps CR,Harbour DA,Corry JEL. PCR-based 16S ribosomal DNA detection technique for Clostridium estertheticum causing spoilage in vacuum-packed chill-stored beefInternational Journal of Food MicrobiologyYear: 1999521-257652-s2.0-003285128210573392|
|14.||Reyes JE,Venturini ME,Oria R,Blanco D. Prevalence of Ewingella americana in retail fresh cultivated mushrooms (Agaricus bisporus, Lentinula edodes and Pleurotus ostreatus) in Zaragoza (Spain)FEMS Microbiology EcologyYear: 20044732912962-s2.0-154230148219712317|
|15.||Pound MW,Tart SB,Okoye O. Multidrug-resistant Ewingella Americana: a case report and review of the literatureAnnals of PharmacotherapyYear: 20074112206620702-s2.0-3684900904517956962|
|16.||Tsokos M. Fatal Waterhouse-Friderichsen syndrome due to Ewingella Americana infectionAmerican Journal of Forensic Medicine and PathologyYear: 200324141442-s2.0-003737282912604997|
Previous Document: EUS-FNA for a Pancreatic Neuroendocrine Tumor in a Four-Year-Old Daughter of a Woman Exposed to Radi...
Next Document: Ovarian Pregnancy following Intracytoplasmic Sperm Injection and Embryo Transfer: A Case Report.