New Associations With Pseudomonas Luteola Bacteremia: A Veteran With A History Of Tick Bites And A Trauma Patient With Pneumonia
F Arnold, C Sciortino, K Riede
pneumonia, pseudomonas luteola, tick-borne disease
F Arnold, C Sciortino, K Riede. New Associations With Pseudomonas Luteola Bacteremia: A Veteran With A History Of Tick Bites And A Trauma Patient With Pneumonia. The Internet Journal of Infectious Diseases. 2004 Volume 4 Number 2.
Work performed at the University of Louisville Hospital and the Veterans Affairs Medical Center, Louisville, KY
Case Study 1
In November 2003, a 54-year old male with a history of tick exposures the previous week, presented to the Veterans Affairs Medical Center in Louisville, KY with a complaint of left lower leg swelling and redness at the bite sites. The patient presented with symptoms including a subjective fever, chills, general myalgias, a productive cough of clear sputum, a frontal headache, nausea, vomiting, and diarrhea for three days. He lacked neck stiffness or visual changes. His past medical history was significant for peripheral vascular disease, tobacco use with COPD and colon cancer, which required a partial colectomy in 1986. He was taking no new medications, and he had no pets.
Physical exam revealed a temperature of 101.8°F. The left lower extremity was erythematous, edematous, warm and tender in the anterior and lateral tibial areas. There was one dominant lesion approximately 1 cm in diameter having a necrotic center surrounded by several macular lesions (3-5 mm) with eschars and erythema. There was no drainage present, therefore cultures were not obtained. A serum leukocyte level was 17,000 cells/cm3 (segmented neutrophils 79%, bands 15%). A urine culture and two sets of blood cultures were taken. A tick-borne disease was suspected, hence serology was obtained. The patient was started on doxycycline and cefazolin.
The following day both blood cultures showed pleomorphic gram-negative rods by gram-stain. Cultures at 24 hours showed two yellow colony types; one smooth and one rough (figure 1).
At 48 hours, both colony types became rough, centrally raised with peripherally pitting colonies. Colonies appeared as lobate, with a “fried egg” morphology (figure 2) and a cheese-like texture.
Incidentally, the bioterrorism agent,
Cefazolin was changed to levofloxacin, and on the fourth hospital day, the patient was discharged on doxycycline (three weeks) and levofloxacin (two weeks). Follow-up blood cultures were negative, and results of the tick-borne tests were: negative for
Case Study 2
In August 2004, a healthy 47-year-old Caucasian male presented to the University of Louisville Hospital after an all-terrain vehicle rollover accident. He was admitted with multiple, left side rib fractures. The patient was hemodynamically stable with non-life threatening injuries that did not require surgical intervention.
Physical exam revealed no fever, but crepitus consistent with his injuries. His head, neck, cardiac and abdominal exams were unremarkable except for an abrasion on his forehead. Initial medical management included placement of a spinal epidural for pain management. Post-traumatic respiratory failure occurred on hospital day three requiring intubation and mechanical ventilation. Although he was weaned five days later, re-intubation was necessary. Ciprofloxacin was started when
No other reported cases have been associated with tick bites, and only two other cases have been in immunocompetent patients, both of whom also had cutaneous lesions. One patient injured his finger with a hammer in the tree clearing industry14, and the other patient had a gluteal abscess with bacteremia at the site of an injection.15 The three other cases involving skin and soft tissue infections included bacteremia in a homosexual man with facial cellulitis9, a superficial cutaneous infection over the right nasal septum in a patient with human immunodeficiency virus10, and a leg ulcer in a patient with sickle cell disease.13The antimicrobial sensitivities obtained in the present cases were similar to those reported previously (table 1).
The diversity of patient presentations complicates determining how
In summary, the environmental organism
Forest Arnold, DO, Instructor University of Louisville, Division of Infectious Diseases 512 S. Hancock St.;Carmichael Bldg., Rm 208E Louisville, KY 40292 Tel : (502)852-5131 Fax : (502)852-1147 F.Arnold@louisville.edu