Septic cavernous sinus thrombosis following infection of ethmoidal and maxillary sinuses: a case report

A 10-year-old boy with a unilateral septic cavernous sinus thrombosis complicating infection of the ethmoidal and maxillary sinuses is described. The causative agents identified were Eikenella corrodens and Staphylococcus aureus. The disease was cured without any sequelae.

Needle licker's osteomyelitis

Eikenella corrodens, a fastidious, slow-growing, gram-negative, facultative anaerobic bacillus may be encountered in wounds exposed to human saliva, especially human bites and head and neck infections. An unusual case of a mixed flora E corrodens and Streptococcus septic arthritis with adjacent osteomyelitis secondary to saliva contamination from licking an intravenous (i.v.) needle is presented. A literature search showed 53 previous cases of E corrodens infections in i.v. drug users. However, none of these infections affected bones or joints. The microbiology and unusual antibiotic sensitivity are presented. Recommendations for treatment include penicillin or ampicillin. Tetracycline is recommended in the penicillin-allergic patient. This is the first case that draws attention to the connection between E corrodens, i.v. drug use, and septic arthritis and osteomyelitis.

Eikenella corrodens endocarditis in an intravenous drug user: case report and literature review

A rare case of Eikenella corrodens endocarditis in an intravenous drug user is reported. Repeated blood cultures from the patient established the diagnosis of this infection. However, evaluation of the cardiac function using two-dimensional echocardiography with Doppler flow demonstrated a large pedunculated tricuspid vegetation. Also evident on this study was a dilated right ventricle with diminished contractility and regurgitation. Complete sterilization of the blood was achieved after a 2-week course of intravenous penicillin and gentamicin followed by an additional 4-week course of intravenous penicillin alone. Clinicians treating suspected IV drug users should be aware of the potential pathogenicity of this rare, facultative, anaerobic gram-negative bacillus (E corrodens). A combination of intravenous penicillin and aminoglycoside should be considered as the initial treatment followed by an additional course of intravenous penicillin for such patients with valvular vegetation.

Eikenella corrodens vertebral osteomyelitis. A case report and literature review

A debilitated 73-year-old white man was diagnosed with back pain secondary to acute hematogenous Eikenella corrodens vertebral osteomyelitis on the basis of history and physical examination, radiographs, computed tomography, magnetic resonance imaging, and open biopsy of the L3 vertebral body. A rare cause of vertebral osteomyelitis, possibly reported only once before in the world literature, E. corrodens is a facultative anaerobic gram-negative bacillus and a normal oral inhabitant. E. corrodens should be considered in the differential diagnosis of vertebral osteomyelitis and can be managed with immobilization and long-term intravenous antibiotics.

[Eikenella corrodens as a pathogen of lateral cervical abscess]

We show a case of right neck abscess, in which the Eikenella corrodens, acted as pathogen together which other microorganism. We call attention to this germ that has a slow growing in culture and generally intervene in infections in which it is assumed the presence of anaerobic germs (intrathoracic abscess, neck abscess, etc.) and the are habitually treated with clindamycin, antibiotic which Eikenella corrodens is systematically resistant (to this antibiotic).

Orbital cellulitis caused by Eikenella corrodens

Eikenella corrodens is a gram-negative, facultative anaerobic bacillus with specific culture and growth requirements and unusual antibacterial susceptibilities. It has only recently been recognized as a human pathogen. Ocular and adnexal infections with this organism are rare especially in children. We treated two children with orbital cellulitis caused by E. corrodens. One was an 8-year-old boy; the other was an 11-year-old girl. Orbital cellulitis in both patients occurred after an upper respiratory tract infection. Sinusitis and a subperiosteal abscess were present in both patients. Eikenella corrodens and Streptococcus viridans were isolated from the boy; E. corrodens was the sole isolate in the girl. Intravenous ampicillin, prolonged hospitalization, and surgical drainage of the orbit were required to control the infection in both patients. Eikenella corrodens must be considered in the differential diagnosis of orbital cellulitis in children, and ophthalmologists must become familiar with the characteristics of this peculiar organism.

Case report of an unusual cause of low back pain. Intervertebral diskitis caused by Eikenella corrodens

A 42-year-old man suffered from low back pain caused by intervertebral diskitis. The condition was diagnosed on plain roentgenogram and computed tomography scans. The infected area was biopsied and grew Eikenella corrodens, a gram-negative anaerobic rod, which grows slowly only after culture on blood agar in 5-10% carbon dioxide. This is the first reported case of E. corrodens intervertebral diskitis causing acute low back pain. Recognition of this organism in this condition emphasizes the importance of aerobic and anaerobic cultures of infected disks. The organism has unusual antibiotic sensitivities. The infection, once appropriately treated, responded rapidly.

Clinical, microbiological and immunological characteristics of subjects with "refractory" periodontal disease

The aim of the present study was to analyze the relationship between attachment loss and clinical, microbiological, and immunological parameters in a group of 21 human subjects exhibiting poor response to previous periodontal therapy. All had been treated with periodontal surgery, tetracycline, and subsequent maintenance recalls to periodontists who, upon detection of disease progression, referred the subjects to our clinic. In our clinic, each subject received oral hygiene instruction and a thorough subgingival scaling and root planing utilizing as many appointments as necessary. Clinical indices, including gingival index, bleeding on probing, suppuration, plaque index, pocket depth, and duplicate measurements of attachment level from an acrylic stent, were collected at monthly intervals. Probing measurements were performed using the Florida Probe. When significant attachment loss (0.8-1.2 mm) was detected in at least 1 site, a bacterial sample was taken from that site and from a comparably deep, but non-progressing, control site. Microbial samples were enumerated by darkfield microscopy, on selective and non-selective media, and by predominant cultivable technique. Blood samples were also collected to determine antibody levels against potential pathogens. There was no difference in the amount of plaque present in sites gaining or losing attachment, but losing sites exhibited more bleeding and suppuration. 20 of the 21 subjects were tested; of these, 17 exhibited elevated serum antibody against one or more of the following microorganisms: Actinobacillus actinomycetemcomitans, Bacteroides, gingivalis, and Eikenella corrodens. However, few, if any, of the "classical" pathogens were detected in the plaque samples obtained at the time progressive disease was diagnosed. The only exception was Streptococcus intermedius, which occurred in slightly higher numbers in active sites.

DNA probe detection of periodontal pathogens in HIV-associated periodontal lesions

Recent studies have shown that an atypical gingivitis and a rapidly progressive periodontal disease may be early-occurring opportunistic infections associated with human immunodeficiency virus (HIV) infection. This study examined the prevalence of selected periodontal pathogens associated with these HIV-related periodontal lesions. Subgingival plaque samples were obtained from both HIV-seronegative and HIV-seropositive homosexual men and from presumably uninfected heterosexual men. DNA probes were used to detect Actinobacillus actinomycetemcomitans, Bacteroides intermedius, Bacteroides gingivalis, Eikenella corrodens and Wolinella recta in the plaque. The healthy sites in both the seronegative and seropositive homosexual groups showed a greater prevalence of all test bacteria, except for E. corrodens, than did the heterosexual group. HIV-associated periodontitis sites showed a microbial profile qualitatively similar to that of conventional periodontitis, except that B. gingivalis was more prevalent in conventional periodontitis. In contrast, HIV-associated gingivitis sites exhibited a greater prevalence of all bacteria tested than conventional gingivitis sites. In fact, HIV gingivitis generally showed a bacterial profile similar to that of the HIV periodontitis lesions, except that W. recta was significantly more prevalent in HIV periodontitis. These data suggest that the HIV gingivitis lesion is a precursor to HIV periodontitis. Thus, early identification and prophylactic treatment of high-risk individuals may prevent the destruction of periodontal tissues.

[A case with acute suppurative thyroiditis due to Eikenella corrodens and alpha-Streptococcus]

A 6-year-old girl with acute suppurative thyroiditis is reported. She suffered from suppurative thyroiditis twice, and E. corrodens and alpha-streptococcus were grown from the abscess each time. They were sensitive to antibiotics used, but surgical drainage was necessary to cease to inflammation each time. E. corrodens seemed to be a causative organism with or without another organism in compromised patients and/or patients with anatomical abnormalities. The presented patient was supposed to have some anatomical abnormality such as an internal fistula from the piriform sinus connecting the perithyroidal space, however, no abnormalities were detected during these episodes.

[Knee arthritis caused by Eikenella corrodens. Apropos of a case]

We report a case of septic arthritis of the knee following an articular wound caused by a bite in a previously healthy 8-year-old girl. The causative agent was Eikenella corrodens, an opportunistic bacteria that is normally part of the commensal flora of the oral cavity. We point out that Eikenella corrodens may cause severe complications in healthy subjects and emphasize the need for considering this organism not only in infections of the hands, face and neck, but also after bites. Penicillins are consistently effective and constitute the treatment of choice.

[Acute thyroiditis caused by Eikenella corrodens and abnormality of the left pyriform sinus]

A case of suppurative thyroiditis is reported. The initial course was insidious and mimicked De Quervain subacute thyroiditis. The abscess was surgically drained. It contained numerous Eikenella corrodens bacilli. Fibroscopy of pharyngo-laryngeal region showed that the left pyriform sinus was abnormal. Surgical removal of a fistula of the fourth branchial pouch was performed in order to prevent recurrence of the thyroiditis.

Eikenella corrodens infection

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Atraumatic suppurative mediastinitis and purulent pericarditis due to Eikenella corrodens

Atraumatic suppurative mediastinitis is an uncommon infection. A case with an associated purulent pericarditis caused by Eikenella corrodens is reported.

Acute suppurative thyroiditis caused by Eikenella corrodens

Eikenella corrodens is a slow-growing facultative anaerobe present in the normal oral flora. Two children have been described with acute suppurative thyroiditis with E corrodens as the major pathogen. Staphylococci are the most frequently identified pathogens in acute suppurative thyroiditis. Penicillin or ampicillin are the drugs of choice for infections caused by E corrodens. Anatomic defects should be searched for in children with acute suppurative thyroiditis.

Eikenella corrodens as a cause of recurrent and persistent infections of the head and neck

Four patients had Eikenella corrodens infections involving the head and neck in different ways. The organism is discussed as a pathogen in mixed infections and as the predominant organism in other processes. As part of the resident microflora of mucous membrane surfaces, it is an important potential pathogen in a number of otolaryngologic clinical settings. Careful microbiological culturing and susceptibility testing reveal the causative organism and guide the antibiotic therapy.

Infections with Eikenella corrodens in a general hospital: a report of 33 cases

Of 33 cases of Eikenella corrodens infection occurring in a general hospital during an 18-month period, 18 were related to human bites or fist-fight injuries, and nine of these 18 cases were complicated by septic arthritis and/or osteomyelitis. Because E. corrodens grows slowly, requires an atmosphere containing 5%-10% CO2, and may be overgrown by other organisms, it may be missed on routine culture. The high rate of recovery of the organism in this study was attributable to the use of a selective medium. Because infections due to E. corrodens commonly mimic or occur in association with anaerobic infections, they are sometimes treated inappropriately. E. corrodens should be considered a possible pathogen in infections associated with oral contamination. Empiric antibiotic treatment of these infections with clindamycin or metronidazole alone is inappropriate since E. corrodens is generally resistant to these agents.

Biological effects of White-type polysaccharides of gram-negative bacteria

The White-type polysaccharide (WPS), often called Freeman polysaccharide, was obtained by hydrolyzing gram-negative bacteria in 0.2 N acetic acid at 100 degrees C for 2 h. The crude product contained partially degraded O-antigens as well as other components that were active as immune adjuvants, enhancers of macrophage cytotoxicity of tumor target cells, and inducers of osteoclastic bone resorption. The same WPS preparation augmented the tumor cytotoxicity of normal mouse spleen cells and slightly retarded the take of L1210 leukemia in mice. The WPS preparations generated colony-stimulating factor in mice but were not active in lymphoproliferative (mitogenicity) tests. Chemical analyses of the WPS preparations did not detect the presence of components characteristic of the lipid moiety of endotoxins. The WPS samples were also negative in biological assays of endotoxicity such as local Shwartzman and toxicity tests. These findings indicate that gram-negative bacteria contain nonendotoxin components that are potent modifiers of some biological responses.

Enhancement of experimental actinomycosis in mice by Eikenella corrodens

The infectivity of Actinomyces israelii in a susceptible-weanling-mouse was increased by the presence of Eikenella corrodens in the inoculum. A minimal infecting dose of 1.7 X 10(7) CFU of A. israelii was required to establish chronic lesions after an intraperitoneal injection. When E. corrodens (3.8 X 10(7) CFU) was included in the inoculum, chronic lesions were established with a dose of 8.5 X 10(4) CFU of A. israelii. E. corrodens alone did not produce persistent lesions. Viable E. corrodens could be recovered from chronic mixed actinomycotic lesions in numbers that often equaled or exceeded the populations of A. israelii in the lesions. The duration of acute actinomycotic infections caused by A. viscosus was temporarily extended by the presence of E. corrodens. The cellular inflammatory response and overall morphology of mixed experimental lesions containing A. israelii and E. corrodens did not appear to be significantly different from those of pure-culture lesions containing A. israelii alone. E. corrodens cells could not be readily discerned in stained histological sections of mixed experimental lesions.

Septic pulmonary emboli secondary to internal jugular vein phlebitis (postanginal sepsis) caused by Eikenella corrodens

Postanginal sepsis is the term used to describe the life-threatening infection caused by suppurative phlebitis of the internal jugular vein secondary to infection of the parapharyngeal spaces. This begins with a history of pharyngitis followed by infection of the parapharyngeal spaces, septic pulmonary embolism, and septicemia caused by hematogenous dissemination of the infection. The oral anaerobes are the most common pathogens associated with this syndrome. Recently, we managed 2 patients who had septic pulmonary embolism from postanginal sepsis syndrome caused by Eikenella corrodens. Previously, E. corrodens has not been described in association with this syndrome. The clinical presentation, anatomic, bacteriologic, and management aspects of postanginal sepsis syndrome are reviewed based on our experience with these 2 cases. In patients with clinical evidence of septic pulmonary embolism, particularly in the nonintravenous drug abusers, postanginal sepsis and septic jugular phlebitis have to be considered as a source of septic pulmonary embolism.

Pathogenicity of Eikenella corrodens in humans

Eikenella corrodens is resident flora of the normal adult human oral cavity. Four cases of verified infection and previous case reports of infections caused by this organism were reviewed and analyzed. Rarely has this bacillus been found as the sole isolate to initiate infection in the host with normal immune status. In the immunocompromised host, this organism was observed as the sole isolate in cases of persistent empyemas and/or overwhelming pneumonias with bacteremias. The potential of the organism singly to perpetuate an established infection appears real. In the immunocompromised patients such potentials are accentuated and can result in fulminant pulmonary infections and death. The finding of E corrodens in an infection site of a compromised patient should indicate specific therapy.