APFID

Home > Case of the Week

Title : A 47 year-old male w/ painful swelling and purplish discoloration on the skin of Rt. Foot with decreased mental status
Date : January 12, 2010
Contributed by

Jeong-a Lee, MD/ Samsung Medical Center, Korea

Patient History
Age/Sex 47-year-old man
Chief complaint Painful swelling and purplish discoloration on the skin of Rt. Foot with decreased mental status
Present illness

This patient was diagnosed with diabetes mellitus 15 years ago. He neglected to control his blood glucose even though he needed hospitalization for the blood glucose control once a year for the following 4 years. At last, he stopped his insulin treatment 10 years ago. Six years later, he was hospitalized again for the blood glucose control and treatment of DM foot. At that time, diabetic retinopathy and neuropathy developed as a consequence of his negligence. He never tried to take care of himself at all even after that admission. Recently, he hasn\'t taken any medication at all and had an irregular diet. Two months before admission, soft tissue swelling developed on Rt. Lower leg. Two weeks before admission, his swollen Rt. Foot started to produce foul odor and then the skin overlying dorsum of the foot changed to purple. The day before admission, his mental status was not clear, as for those results he was transported to Samsung Medical Center.

Past medical history

DM for 15 years DM retinopathy for 5 years Hypertension for 5 years On 15th Jun 2004: percutaneous nephro-lithotomy to remove Staghorn stone Family History : Father and mother : DM(+), HT(+) Social history : Heavy drinker-more than 10 bottles of bear everyday

Physical examination

Initial vital sign: BT 36 oC BP 117/62 mmHg PR 88bpm RR 20 breaths per minute Confused mentality Dehydrated tongue Swollen Rt, foot with gangrenous change Dorsalis pedis pulse: weak


Initial laboratory findings

WBC 51,980(segmented neutrophil 95%) Hb 5.3g/dl Platelet 228x10 3/µl BUN/Cr 122.6/13.73 mg/dl ABGA pH 7.148 pCO2 12.8 mmHg pO2 135.9 mmHg HCO3 4.3 BE -22.

Radiologic findings
Hospital course

 
Question - ID Case of the Week ( January 12, 2010 )
Different microorganisms were isolated from blood and tissue culture. What would be the etiologic agents of this infection?
 
Correct Answer

 Ergathella lenta from blood
 Group G   B-hemolytic streptococcus from tissue culture

 
Review

 

 

Ergathella lenta

- Anaerobic Gram-positive nonsporulating bacilli
- Genus : Eggerthella
- Species : E. lenta, E. hongkongensis, E. sinensis
- On the basis of 16S rRNA gene analysis and G+C content comparisons, Eubacterium lentum was transferred to the new genus Eggerthella in 1999, with Eggerthella lenta as the only and type species
- normal flora in the human intestine
- has been isolated from appendix tissues, peritoneal fluid; intra-abdominal, peritoneal,
and palatal abscesses; and intestinal tumors, and implicated in causing infections in the female genital tract, periodontal disease, and sinusitis

  • Journal of Medical Microbiology 2004,53,1247-1253

     Anaerobic, non-sporulating, Gram-positive bacilli bacteraemia characterized by 16S rRNA gene Sequencing
    - Among 165 blood culture isolates of anaerobic, Gram-positive bacilli during 4-year study period, 16 were associated with clinically significant bacteraemia. Ten of the 16
    cases of clinically significant bacteraemia were caused by Eggerthella spp., four (25 %) by Lactobacillus spp. and one (6 %) by each of Eubacterium tenue and Olsenella uli


  • Diagnostic Microbiology and Infectious Disease 2004,49,225-263
       Eggerthella hongkongensis sp. nov. and Eggerthella sinensis sp. nov., two novel Eggerthella species, account for half of the cases of Eggerthella bacteremia
    - Among 55 clinically significant blood culture isolates of anaerobic Gram-positive bacilli during 4 years, 5 were identified as E. lenta and 5 belonged to 2 novel Eggerthella
    species, proposed as E. hongkongensis and E. sinensis, respectively. Septic shock was a complication in 4 patients, and 3 patients died. The present study suggests that Eggerthella bacteremia is much more common than expected and is associated with significant morbidity and mortality.

 

 


޴ٷΰ ΰ