Effect of scaling and root planing with and without minocycline HCl microspheres on periodontal pathogens and clinical outcomes: A randomized clinical trial

BACKGROUND

This study tests the effects of scaling and root planing (SRP) versus SRP plus minocycline hydrochloride microspheres (SRP+MM) on 11 periodontal pathogens and clinical outcomes in Stage II-IV Grade B periodontitis participants.

METHODS

Seventy participants were randomized to receive SRP (n = 35) or SRP+MM (n = 35). Saliva and clinical outcomes were collected for both groups at baseline before SRP, 1-month reevaluation, and at 3- and 6-month periodontal recall. MM were delivered to pockets ≥5 mm immediately after SRP and immediately after the 3-month periodontal maintenance in the SRP+MM group. A proprietary saliva test* was utilized to quantitate 11 putative periodontal pathogens. Microorganisms and clinical outcomes were compared between groups using generalized linear mixed-effects models with fixed effects and random effects terms. Mean changes from baseline were compared between groups via group-by-visit interaction tests.

RESULTS

Significant reduction in Tannerella forsythia, Treponema denticola, Fusobacterium nucleatum, Prevotella intermedia, Parvimonas micra, and Eikenella corrodens were identified at the 1-month reevaluation after SRP+MM. Six months after SRP with a re-application of MM 3 months after SRP, Fusobacterium nucleatum, Prevotella intermedia, Campylobacter rectus, and Eikenella corrodens were significantly reduced. SRP+MM participants had significant clinical outcome reductions in pockets ≥5 mm at the reevaluation, 3- and 6-month periodontal maintenance, and clinical attachment loss gains at the 6-month periodontal maintenance.

CONCLUSION

MM delivered immediately after SRP and reapplication at 3 months appeared to contribute to improved clinical outcomes and sustained decreased numbers of Fusobacterium nucleatum, Prevotella intermedia, Campylobacter rectus, and Eikenella corrodens at 6 months.

Machine operator's lung outbreak due to Eikenella corrodens

BACKGROUND

Outbreaks of hypersensitivity pneumonitis (HP) are not uncommon in workplaces where metalworking fluids (MWFs) are used. The recirculation of MWFs leads to microbiological contamination, which is responsible for outbreaks. Most outbreak reports come from USA and the UK; however, no similar reports have been published from Central Europe.

AIMS

To describe an outbreak of MWF-associated HP in workers from a compressor assembly manufacturing facility in Slovak Republic and to identify the potential antigens responsible for the outbreak.

METHODS

We investigated the history of worker's symptoms, physical examinations, lung function tests, radiographic scans and lung biopsies. The MWF samples were analysed for different strains of bacteria and fungi. Antigen extracts were produced from the microorganisms isolated from MWFs, and positive precipitin reactions were evaluated.

RESULTS

MWF-associated HP was diagnosed in 21 men and 6 women. All workers had work-related dyspnoea and cough with abnormal pulmonary diffusing capacity. Twenty-four cases had evidence of interstitial lung disease. Four cases were classified as having fibrotic HP. Nineteen microbial isolates (12 bacteria and 7 fungi) were cultured from the MWFs. Twenty-five cases had a positive response to at least one isolate. Eikenella corrodens and Bacillus subtilis were the most frequently reacting antigens (in 15 and 12 workers, respectively).

CONCLUSIONS

Despite decreasing reports of MWF-associated HP outbreaks over the past several decades, we describe one of the largest outbreaks in Europe. While the bacterium E. corrodens was found in the MWF samples, its relationship to the disease should be further investigated.

Salivary Outer Membrane Vesicles and DNA Methylation of Small Extracellular Vesicles as Biomarkers for Periodontal Status: A Pilot Study

Periodontitis is an inflammatory disease, associated with a microbial dysbiosis. Early detection using salivary small extracellular vesicles (sEVs) biomarkers may facilitate timely prevention. sEVs derived from different species (i.e., humans, bacteria) are expected to circulate in saliva. This pilot study recruited 22 participants (seven periodontal healthy, seven gingivitis and eight periodontitis) and salivary sEVs were isolated using the size-exclusion chromatography (SEC) method. The healthy, gingivitis and periodontitis groups were compared in terms of salivary sEVs in the CD9+ sEV subpopulation, Gram-negative bacteria-enriched lipopolysaccharide (LPS+) outer membrane vesicles (OMVs) and global DNA methylation pattern of 5-methylcytosine (5mC), 5-hydroxymethylcytosine (5hmC) and N6-Methyladenosine (m6dA). It was found that LPS+ OMVs, global 5mC methylation and four periodontal pathogens (T. denticola, E. corrodens, P. gingivalis and F. nucleatum) that secreted OMVs were significantly increased in periodontitis sEVs compared to those from healthy groups. These differences were more pronounced in sEVs than the whole saliva and were more superior in distinguishing periodontitis than gingivitis, in comparison to healthy patients. Of note, global 5mC hypermethylation in salivary sEVs can distinguish periodontitis patients from both healthy controls and gingivitis patients with high sensitivity and specificity (AUC = 1). The research findings suggest that assessing global sEV methylation may be a useful biomarker for periodontitis.

[Pulmonary aspergillosis associated with empyema due to Eikenella corrodens]

A 74-year-old female had previously undergone a left upper lobectomy and received radiotherapy for squamous cell carcinoma of the lung in 2002. She was admitted to our hospital because of left pulmonary aspergillosis in 2011. We performed left completion pneumonectomy and decortications. After the operation, Eikenella corrodens was isolated from pleural effusion. She was therefore diagnosed as having simultaneous empyema due to Eikenella corrodens, and continued to have antibiotic treatment. Wound dehiscence caused by malnutrition occurred postoperatively, but was healed by peroral nutritional support. She was discharged 78 days after the operation without recurrence of pulmonary aspergillosis and empyema for 23 months.

Eikenella corrodens

We present a case of facet joint infection (pyogenic facetitis) due to Eikenella corrodens, diagnosed by physical examination, radiography, positive blood cultures, and response to antibiotic therapy. E. corrodens is a very rare cause of spine infection. There are fewer than 20 such cases reported in the literature, only one of which was diagnosed by non-invasive means, and none of which were isolated to the facet joint. We briefly review the microbiology of E. corrodens in addition to the diagnosis and management of spine infection.

[Maternal chorioamnionitis and neonatal conjunctive infection due to an infrequent pathogen]

Chorioamnionitis generates significant neonatal mortality and morbidity. Its incidence in premature birth can reach 30% and up to 30-40% of cases of premature rupture of membranes is due to this entity. We describe a case of chorioamnionitis by a commensal of the oral flora (Eikenella corrodens) in a pregnant woman with premature rupture of membranes and preterm delivery, which caused conjunctivitis in the newborn. On occasion of this case, we review the issue, delving into the diagnosis and clinical significance of this pathogen.

[The effectiveness of glass bead sterilizer in the dental practice]

OBJECTIVES

Although it is not FDA-approved as inter-patients sterilization measure, in Israel, glass bead sterilizer is still a common method for chair-side sterilization of small dental hand instruments, especially endodontic files. Studies from the 1950-1970s achieved sterilization by the bead sterilizer within few seconds. Nevertheless, there are no current evidence-based instructions for using this sterilizer. The study was designed to evaluate the effectiveness of this method in sterilization of endodontic files, according to current microbiologic knowledge.

METHODS

Standard endodontic k-files (#15, 50, 80) were sterilized in a steam autoclave and then soaked in Actinomyces israelii, Eikenella corrodens or Bacillus cereus [0.5 MacFarland] media for 10 sec. After drying, the files were placed in 225 degrees C or 250 degrees C-heated glass bead sterilizers for 0, 15, 30 or 60 sec. After appropriate incubation for 10 d, morphologic and biochemical examinations were performed to reveal bacterial growth.

RESULTS

Files that have been contaminated with A. israelii were sterilized within 30 sec, whereas B. cereus and E. corrodens-contaminated files needed 60 sec for sterilization.

CONCLUSIONS

The use in bead sterilizer has to be limited only for sterilization of intra-appointment purpose. However, it seems that the common method of using bead sterilizer for sterilization time of few seconds is not effective. In order to eliminate spore-forming bacteria, like B. cereus, by bead sterilizer, the sterilization time has to be at least 60 sec. More research is needed, however, for establishing the effectiveness of the bead sterilizer for viral infection control and for other dental instruments.

[Sepsis after pharyngitis]

We report about a 36-year-old patient, who developped 4 days after a pharyngitis a sepsis with high temperature und recurrent vomiting. The chest radiograph showed multiple pulmonary abcesses and in the computed tomography additionally a thrombosis was detected in a communicans vein between the right jugularis anterior and the jugularis interna. This disease is commonly known as Lemierre Syndrom. The most common pathogen is the Fusobacterium necrophorum, but other bacteria of the normal oropharyngeal flora can also be the causative organisms. Given an adequate antibiotic therapy and supportive care, the prognosis is favourable.

Eikinella corrodens wound infection in a diabetic foot: a brief report

Eikinella corrodens normally forms part of the flora of the oral cavity and mucous membranes of the respiratory tract. It is usually associated with dental, head and neck infections (Cohen, Powderly, 2004, Infectious Diseases) and is considered to be an unusual cause of orthopaedic infections. We recently treated a diabetic patient with E. corrodens osteomyelitis of the fifth metatarsophalangeal joint, a phenomenon which has been reported in only three cases previously (Konugres et al., 1987, E. corrodens as a cause of osteomyelitis in the feet of the diabetic patients. Report of three cases). We recommend including E. corrodens in the spectrum of causative pathogens in diabetic foot infections.

Penile ulcer from traumatic orogenital contact

Human bite injuries, although less frequent than animal bites, usually stem from aggressive behavior, sports participation, or sexual activity. Human genital bites and similar traumatic events also occur, but are infrequently reported because of embarrassment. A genital ulceration following mild trauma during oral-genital contact is reported and appropriate diagnostic and therapeutic interventions reviewed. The ulcer was infected, as verified by culture, with an aggressive oral flora organism, Eikenella corrodens. The genital ulceration healed following appropriate antibiotic therapy. Treatment of human bites focuses on obtaining an accurate history and salient physical examination, as well as performing early irrigation and debridement. Prophylactic antibiotic treatment and primary closure of bite wounds remain areas of controversy. Because there is an inherent high risk of infection, genital human bite wounds (and similar traumatic events related to orogenital contact) should be managed with prophylactic antibiotic administration.

Bronchopleural cutaneous fistula due to Eikenella corrodens

OBJECTIVE

The aim of this paper is to review the subject and to report on and discuss a case of bronchopleural cutaneous fistula due to Eikenella corrodens.

DESCRIPTION

A 16-year-old girl was brought to our hospital with fever and blood-tinged sputum 2 weeks prior to her admission. She suffered from neurologic sequelae of herpetic encephalitis and had been bed-ridden since 5 years of age. A longitudinal paraspinal soft mass had been noted in the previous week by her mother. She had been given oral feeding despite frequent choking for the past few years. On palpation, the mass can be squeezed to follow the least resistance of subcutaneous space longitudinally extending to the lower thoracic region. Chest computed tomography scan revealed right lower lobe necrotizing pneumonitis and a pleuro-cutaneous fistula leading to the subcutaneous air locules. A protracted course of antibiotics was prescribed and subcutaneous air trapping decreased in size over 8 weeks.

COMMENTS

Eikenella corrodens has increasingly been implicated as a potential causative pathogen in pleuropulmonary infections. Pleuro-cutaneous fistula and abscess formation complicating empyema and necrotizing pneumonitis due to E. corrodens infection have not been reported. A bulging thoracic subcutaneous lesion waxes and wanes with respiration suggest the possibility of a pleruo-cutaneous fistula. Treatment of Eikenella empyema using antibiotics without surgical decortication requires a prolonged course of antibiotic therapy.

Role of troponin I in active infective endocarditis

Infective endocarditis (IE) remains a disease associated with high morbidity and mortality rates. In this pilot study, the role of troponin I in IE was assessed. Myocardial involvement distal to the site of infection in IE has been previously described. Elevated troponin was demonstrated in 11 of 15 patients diagnosed with the condition. Patients diagnosed with staphylococcal endocarditis were more likely to have elevated troponin (3 of 3 patients). Patients with elevated troponin I were not more likely to need valve replacement. Troponin I levels did not predict perivalvular extension. It is hypothesized that elevated troponin I is a reflection of myocardial involvement.

Inflammatory pseudotumour associated with chronic persistent Eikenella corrodens infection: a case report and brief review

Inflammatory pseudotumour is an uncommon mass forming lesion, representing the histological expression of an infective or reactive/reparative process (pseudotumour) in most cases, and a bona fide neoplasm (for example, inflammatory myofibroblastic tumour) in a minority of cases. This report describes the case of an inflammatory pseudotumour with a pathology that unveiled proliferative CD68 positive and actin negative spindle shaped cells, with a mild mixed inflammatory infiltrate, and a culture that yielded an uncommon fastidious bacillus, Eikenella corrodens. The clinical course was indolent but protracted, with insidious progression to multifocal non-contiguous lesions, involving the lungs, liver, spleen, left kidney, and deep neck tissue, all of which responded to medical treatment with appropriate antibiotics. It is of paramount importance that clinicians search for an infective cause of an inflammatory pseudotumour, to ensure appropriate treatment.

A case of brain abscess by Eikenella corrodens in a HIV-positive patient

We report the case of a 61-year-old homosexual male who came to our observation because of a recent onset occipital and left frontoparietal headache, weakness, anorexia, hyperosmia and hypergeusia and psychomotor slowing, apathy and fatuous behavior. This case, besides the old problem of the differential diagnosis of intracranial mass lesions in HIV-positive patients, induces one to examine more closely the relationship between HIV, brain abscesses and Eikenella corrodens. We suspect that the primary infection was in the oral cavity, since HIV-positive patients have a higher incidence of atypical gingivitis and typical periodontitis due, among others, to Eikenella corrodens.

Unusual cause of infective discitis in an adolescent

The first case of infective discitis caused by Eikenella corrodens in an adolescent is presented. The need for anaerobic cultures when dealing with infective pathology in the spine is stressed. A 14 year old boy presented with acute exacerbation of back pain, which showed characteristics of infective discitis after magnetic resonance imaging. Computed tomography guided biopsy grew E corrodens in anaerobic cultures that was sensitive to ampicillin, co-amoxiclav, cefadroxil, and cefotaxime. This patient responded well to co-amoxiclav and recovered without any surgical intervention.

Aortic stent-graft infection due to a presumed aortoenteric fistula

PURPOSE

To report a case of late stent-graft infection with aortoenteric fistula.

CASE REPORT

A 76-year-old Colombian man received an AneuRx stent-graft for a 5.5-cm infrarenal AAA. The aneurysm sac progressively shrank until 22 months postoperatively, when an increase in diameter was noted on magnetic resonance imaging without evidence of endoleak or air in the sac. Two months prior, the patient had developed fever and an elevated white blood cell count; he underwent a 6-week course of intravenous antibiotics. Shortly thereafter, the fever recurred, along with progressive weight loss, which prompted admission. The computed tomographic scan showed no evidence of endoleak, but gas collection was seen anteriorly in the sac; aspirated material was positive for a variety of organisms. At surgery 23 months after stent-graft implantation, pronounced inflammatory reaction and scarring were seen around the graft in conjunction with evidence of a healed duodenal perforation, suggestive of an aortoenteric fistula. The excised stent-graft was intact; no deterioration was seen. The patient had a protracted recovery but has been afebrile and asymptomatic >1 year after stent-graft explantation

CONCLUSIONS

Close surveillance after endovascular AAA repair is essential to detect late leaks, secondary migration, endotension, structural failure, and infection with or without aortoenteric fistula.

[Acute suppurative thyroiditis in 7 year-old girl with piriform sinus fistula]

A 7 year-old girl was admitted to our hospital with high grade fever and redness, swelling and tenderness in left neck. CT scan revealed cyst formation (4.5x3 cm) in left lobe of thyroid with swelling of surrounding lymphonodes. We diagnosed her as acute suppurative thyroiditis and treated her with intravenous antibiotics infusion and incisional drainage. After the treatment, the clinical course was uneventful. Pharyngograph revealed left piriform sinus fistula.

Eikenella corrodens infections in children and adolescents: case reports and review of the literature

Eikenella corrodens is a slow-growing, gram-negative, nonmotile, facultative rod that can cause infection in humans. Although the clinical characteristics of Eikenella infections in adults are well described, the literature regarding Eikenella infections in children is lacking. Thirteen cases of Eikenella infection in children and adolescents reported from a hospital and an additional 41 cases from the literature were reviewed. Eikenella species can be serious pediatric pathogens, particularly when there is an exposure to human oral secretions. Empirical therapy used to manage most oropharyngeal flora may be ineffective against Eikenella species. The treatment of choice for children and adolescents who are infected with Eikenella species includes a combination of surgical management and antibiotics.

Eikenella corrodens: an unusual cause of severe parapneumonic infection and empyema in immunocompetent patients

Over the past 25 years, Eikenella corrodens has increasingly been recognized for its pathogenic potential. Previously identified as an organism most likely to cause opportunistic infection in the immunocompromised host, Eikenella more recently has been implicated in a number of clinical infections in non-immunocompromised patients. We report a case of community-acquired pneumonia, caused by Eikenella, in a patient with diabetes mellitus and a past history of testicular cancer. A review of the literature was conducted in order to review other cases of pulmonary infection with Eikenella, in immunocompetent adults. The condition was diagnosed in 15 patients, occurring most often in men with a mean age of 50. Patients most often presented with fever, cough and pleuritic chest pain. Complications often involved parapneumonic effusion, empyema, and necrotic parenchymal disease. Mortality rates appear to be low. Eikenella is most often susceptible to ampicillin and has variable susceptibility to aminoglycosides. The addition of clindamycin in non-immunocompromised patients with Eikenella infection, co-infected with other pathogens, also appears to be useful. Surgical intervention plays an important role in the recovery of these patients.

[Lingual abscess]

The unilateral abscess of the anterior portion of the tongue is an extremely rare occurrence. We report a case in which we have used the ultrasonography in the diagnosis, and discuss, as etiologic hypothesis the participation of Blandin-Nühn glands in the genesis of these abscess.

[Repeated hemoptysis for foreign body bronchial aspiration: presentation of a case and review of literature]

The foreign body aspiration is more frequent in children. The most usual etiology is the foreign bodies of vegetable nature, which can not be observed in the chest radiograph. The clinic signs are varied, including shortness of breath, cough and wheezing. Hemoptysis is a rare symptom, whose arising is generally connected with the existence of bronchiectasis. We present the case of a child who showed repeated hemoptysis and focal neumonitis due to Eikenelle corrodens three years after the aspiration of a spike. The diagnosis of the bronchial aspiration obtained after The most unusual in this case is the clinic manifestation of repeated hemoptysis, together with the long connected to the existence of foreign body inside the bronchus.

Infrarenal aortic rupture in association with a contiguous polymicrobial intraabdominal abscess including Eikenella corrodens

Aortic rupture in association with a contiguous intraabdominal abscess is rare. We report an unusual case of aortic rupture in association with a polymicrobial abscess and review the related literature. Cultures grew Eikenella corrodens, a rare intraabdominal pathogen, as well as betahemolytic streptococcus and S. viridans. The patient was successfully managed by aortic ligation followed by an extraanatomic bypass.

Eikenella corrodens vertebral osteomyelitis secondary to direct inoculation: a case report

STUDY DESIGN

A case report.

OBJECTIVE

To present a unique method of inoculation with an unusual bacterial organism, Eikenella corrodens, which led to vertebral osteomyelitis and to heighten awareness of different bacterial organisms that may cause orthopedic infections.

SUMMARY OF BACKGROUND DATA

E. corrodens has been known to cause orthopedic infections for more than 20 years. The usual mechanism is from "Fight bite" injuries to the hand or metacarpal phalangeal joint. Eikenella osteomyelitis of the vertebral body is extremely rare.

METHODS

A 65-year-old man from Indonesia developed slowly progressive vertebral collapse and worsening neck pain. History suggested a previous pharyngeal injury while eating fish. Work up for malignancy was negative, and imaging studies were suggestive of osteomyelitis. An open biopsy and culture as well as fusion were performed for treatment of the osteomyelitis.

RESULTS

After a complete work up was undertaken, cultures grew out E. corrodens as the causative organism of this patient's osteomyelitis. Computed tomography scan and history were consistent with inoculation of the paravertebral space with E. corrodens secondary to a fish bone transgressing the patient's pharynx. The patient was treated with surgery and the appropriate antibiotics and healed without any significant sequela.

CONCLUSION

Vertebral osteomyelitis due to E. corrodens is extremely rare. Direct inoculation as a cause of vertebral osteomyelitis with Eikenella has never been reported. If diagnosed properly with appropriate cultures and antibiotic sensitivities, Eikenella osteomyelitis can be treated successfully according to standard orthopedic practices including debridement, fusion, and appropriate antibiotics. Awareness of unusual bacteria as potential causative organisms of osteomyelitis is imperative for appropriate treatment.

[Eikenella corrodens: five year experience in a general hospital]

BACKGROUND

Eikenella corrodens is a Gram negative bacillus that colonizes oropharyngeal and digestive mucous membranes. It is difficult to isolate in the laboratory. This might be the reason why its implication in different types of infection is not well known. We report a five year experience in a general hospital.

METHODS

Charts of 125 infections have been retrospectively reviewed. No selective medium was employed for the isolation.

RESULTS

Infections were related to oral cavity in 68 patients (54%) and to gastrointestinal tract in 45 (36%); in 12 no clear source could be found. The prevailing infections were: postsurgical 32, apendiceal 22, abscesses 22, and traumatic wounds 12. Seventy two percent of the patients were adults and 93% were hospitalized. Eighteen patients had a neoplasia, 6 were diabetic, and 3 had some kind of immunodeficiency. Etiology was polymicrobial in 91% of the cases, the prevailing association being with Streptococcus spp. (74%). Only 15 patients had a pure culture, 11 of which had received previous antibiotic treatment. The most serious infections were a subdural empyema secondary to sinusitis, a mediastinitis following a mouth floor abscess, and a peritonitis with pleural empyema preceded by an hepatic abscess. The three were polymicrobial. Outcome was always satisfactory with no associated death.

CONCLUSIONS

The origin of these infections is almost always clearly related with its habitat, but their spectrum is wide. Polymicrobial condition of most of them makes diagnosis as well as interpretation of its clinical meaning difficult. Nevertheless, association of E. corrodens with serious or slow healing infections fully justifies the efforts towards its isolation and the choice of antibiotics to which it is susceptible.

Eikenella corrodens liver abscess complicated by endophthalmitis

A 64-year-old man who presented with sudden, unilateral loss of vision was found to have endophthalmitis associated with a pyogenic liver abscess. The patient was successfully managed with subtotal vitrectomy and percutaneous drainage of the liver abscess. Eikenella corrodens was cultured from the blood and the pus drained from the liver abscess. This is the first reported case of Eikenella corrodens liver abscess complicated by endophthalmitis.

Immunoblastic lymphadenopathy presenting as an acute abdomen and mixed bacteremia with Eikenella corrodens and group C streptococci

Eikenella corrodens and group C streptococci have been noted to occur with increased frequency in patients with underlying malignancies and immunosuppressive states. We report a case where these organisms were isolated from a patient with immunoblastic lymphadenopathy and discuss the possible association between these two conditions.

Chronic sinusitis in children

In children, sinusitis is a common, generally uncomplicated, and self limiting disease which drops with age. The diagnosis is difficult because of relatively non specific signs and symptoms that overlap with viral upper respiratory infection and allergy. Plain paranasal sinus radiographs are not adequate, in determining the extent of involvement in recurrent or chronic sinusitis and so CT scan has become the standard. Viral illness appears to be the most common predisposing factor. Immune defects (mainly IG2 and IGA) may exist in a significant percentage of children. The role of allergy seems less important. With advances in the genetic field of cystic fibrosis, genetic factors are advocated in chronic or recurrent sinusitis. The most common bacterial pathogens in pediatric sinusitis patients are SP (Streptococcus Pneumoniae), HI (Hemophilus Influenza) and MC (Moraxella Catarrhalis). Other less frequent bacterial species include group A streptococcus, group C streptococcus, streptococcus viridans, peptostreptococcus, moraxella species and Eikenella corrodens. Respiratory anaerobes are not common. Antibiotics resistant to the action of the beta-lactamase are the cornerstone in medical treatment. In recurrent acute sinusitis prophylactic antimicrobials may be helpful. The indication for surgery remains controversial. To date, we have no prospective studies comparing surgical to medical therapy in order to guide us in deciding surgical indication. It is therefore recommended to follow a conservative track and to limit surgical procedures in children with suppurative complications, nasal obstruction from polyposis or refractory sinusitis aggravating chronic pulmonary disease such as asthma.

Eikenella corrodens-caused botryomycosis-type pneumonia in a barbary ape (Macaca sylvanus)

An 18-year-old female barbary ape in a safari park died from a mixed bacterial infection. Staphylococus aureus was isolated from a purulent necrotic mastitis and from a chronic purulent granulomatous sialoadenitis of the sublingual glands, Eikenella corrodens from a botryomycosis-type pneumonia. As judged by histopathology, mixed infection of S. aureus and E. corrodens was present in the sialoadenitis, and E. corrodens botryomycosis-type bacterial colonies were also present in the pancreatic parenchyma, though here no bacteriological isolation was attempted. A generalized amyloidosis, and especially pancreatic islet amyloidosis, probably indicated an altered immunological competence.

Eikenella corrodens skull infection: a case report with review of the literature

BACKGROUND

Subgaleal abscesses and skull osteomyelitis are very uncommon since the introduction of antibiotics. Eikenella corrodens infection is extremely rare in childhood and has never been reported in calvarial osteomyelitis.

METHODS

We present a previously healthy 9-year-old boy, with a history of frontal contusion without injury, who developed E corrodens osteomyelitis of the skull. The radiographic findings are reviewed, including skull films and computed tomographic scans. The patient underwent surgical debridement of the lesion, as well as systemic medical therapy with amoxicillin. We review the medical and surgical therapy for such lesions. The differential diagnosis of a posttraumatic scalp swelling is also reviewed.

RESULTS

Good resolution after debridement and antibiotic therapy is reported.

CONCLUSIONS

Surgical intervention is emphasized for the removal of bony sequestrum and nonviable bone while maintaining an intact dura.

Case report in two adolescent females with IDDM

OBJECTIVE

To alert physicians caring for patients with diabetes to the microorganism Eikenella corrodens and to discuss the appropriate preventive and therapeutic measures to take against this potentially morbid opportunistic Gram-negative bacilli.

CASES

We present two cases of extra-oral E. corrodens infections in adolescent females with IDDM. The first patient had diabetes of 4 years' duration, which was moderately well controlled. Chronic finger biting resulted in a complex felon that evolved gradually and worsened while the patient received cephalexin orally. Delay in seeking further intervention resulted in necrosis of her distal fingertip and nail bed. The second patient had poorly controlled diabetes for 5 years. She developed an acute thigh abscess at an insulin injection site that resolved after drainage and intravenous antibiotics.

CONCLUSIONS

E. corrodens commonly inhabits the human oral cavity and becomes a pathogen mostly when host defenses are impaired, causing abscesses and infections that are at times fatal. Patients with IDDM are compromised hosts and with daily microtrauma to their skin via glucose monitoring and insulin injections, are prone to develop E. corrodens infections that can be introduced through oral secretions by licking or biting their skin. Educational efforts aimed at preventing exposure of traumatized skin to oral secretions can minimize the risk of E. corrodens infections in compromised hosts. Early intravenous administration of antibiotics, bearing in mind E. corrodens resistance to clindamycin, metronidazole, and other antibiotics, coupled with prompt surgical intervention, is essential in successfully managing E. corrodens infections.

Pleuropulmonary infection with chest wall infiltration by Eikenella corrodens

Eikenella corrodens is a facultative anaerobic bacillus which is part of the normal flora of the oral cavity and has an unusual antibiotic sensitivity for an anaerobe. The case history is presented of a young man with chest wall infiltration by Eikenella corrodens.

Hepatic abscess due to Eikenella corrodens and Streptococcus milleri: implications for antibiotic therapy

We report a case of intrahepatic abscess involving infection with Eikenella corrodens. The organism proved difficult to isolate and would not have been covered by some empirical regimens used in penicillin-allergic patients.

The treatment of Eikenella corrodens soft tissue infection in an injection drug user

Eikenella corrodens is a gram negative rod considered normal mouth flora and is commonly linked to human bite injuries. In rare cases, E. corrodens can cause systemic infections. This article describes the case of a 30-year-old injection drug user who presented with a serious polymicrobial infection of the arm. Usual empiric antibiotic coverage resulted in little improvement, and eventually 300 milliliters of purulent material was drained from his upper arm. Cultures of the drainage grew E. corrodens as well as other oral flora. After surgical drainage, specific antibiotic therapy directed towards E. corrodens was added to his antimicrobial therapy and the patient fully recovered. We conclude that E. corrodens is common in the injection drug user population as part of mixed infections, and that empiric antibiotic coverage for this organism, namely penicillin, may be warranted in certain clinical situations.

Apropos of a case]

A case of single bacteria pleuropulmonary infection was observed in a 21-year-old patient with heterozygous sicle-cell amenia. The role of this bacteria in pleuropulmonary suppuration, the pathophysiology and secondary lesions are discussed together with therapeutic modalities.

1H MRS of human brain abscesses in vivo and in vitro

Five patients, each with a brain abscess, were examined by means of 1H MR spectroscopic imaging in vivo. The aspirated pus was analyzed in vitro by means of 1D and 2D COSY 1H MRS. In addition to resonance lines from compounds (lactate, alanine and lipids) often found in the spectra from intracranial tumors, resonance lines were detected from a number of markers of infectious involvement (acetate, succinate, and various amino acids). These results suggest that 1H MRS in vivo might contribute in establishing noninvasively a differential diagnosis between brain abscess and tumor.

[A case of secondary valve replacement caused by pulmonary bioprosthetic valve endocarditis]

A 42-year-old male with pulmonary bioprosthetic valve endocarditis accompanied by residual minor leakage through a previously closed patch for ventricular septal defect (VSD), underwent reoperation with a Carpentier-Edwards bioprosthetic valve. The patient had a history of pulmonary valve replacement and VSD in 1973. A massive vegetation on the pulmonary valve was demonstrated by echocardiography. Five repeated blood cultures yielded Eikenella corrodens. After medical treatment, reoperation was performed. The patient was free of complications after the procedure. Although bioprosthetic valves have potential problems of dysfunction and calcification in long-term use, these problems develop at a significantly slower rate in right-sided positions compared with left-sided positions and bioprosthetic valve thrombosis in the pulmonary position has apparently not been reported. Mechanical prostheses for pulmonary valve replacement have a poor prognosis, with a high incidence of valve thrombosis despite adequate anticoagulant therapy. For the replacement of prosthetic valves in right-sided positions (tricuspid and pulmonary), bioprosthetic valves are now our first choice.