SEPTICAEMIA BY ESCHERICHIA HERMANNII A
PERPLEXING DIAGNOSTIC PROBLEM FOR A
PHYSICIAN
JAYA PRAKASH SHETTY, BHASKAR SHETTY, CHANDRIKA RAO, JH MAKANNAVAR
Vimal Kumar Karnaker, Rekha Rai, Shruthi P and Krishna Prasad M.S are from Department of Microbiology at K.S. Hegde Medical Academy, NITTE University, Mangalore.
Correspondence: Dr. Vimal Kumar Karnaker, Dept. of Microbiology, K.S. Hegde Medical Academy, NITTE University, Nithyanandanagar, Mangalore – 575018, E-mail:vimalkarnaker@yahoo.co.in, Phone :+91-824-2204490/91/92, Fax : +91-824-2204162.
Abstract
Escherichia hermannii was isolated from the blood, stool and wound culture of a 40 year old male patient who was treated with chemotherapy for a retroperitoneal sarcoma. The biotyping and antibiogram pattern confirmed that all the organisms from the three sites were an identical strain. The same organism was also isolated from repeated blood cultures of this patients and this suggested that Escherichia hermannii could be a significant pathogenic organism in an immunocompromised patient.
Introduction
Over the last decade, 3 new species belonging to the genus Escherichia have been isolated from human sources viz, E. vulneris, E. fergusonii and E. hermannii by Brenner et al in 1982 1 and Farmer et al in 1985 2, although their diarrhoegenic potential has been suggested their role in extraintestinal infections has as yet not been reported. This report describes a case of septicemia caused by E. hermannii.
Case Report
A 40 year old man with retroperitoneal sarcoma on chemotherapy since one year was hospitalized due to spiking fevers and chills of one month duration. On physical examination he was pale, irritable and febrile (40.5ºC) with a large ulcer measuring 4 by 6 cm on the lower back in the sacral region, which was surrounded by a swollen annular area and was fluctuant and tender. Firm spleen was palpable 4 cm below the left costal margin.
Laboratory data included a WBC count of 9000 cells/cu.mm with 95% Polymorphonuclear cells, 3% lymphocytes, 2% Eosinophils, a hemoglobin level of 6.7g/dl; a platelet count of 207,000/cu.mm; and an ESR (Wintrobe) of 86mm/hr.
E. hermannii grew from two of the three blood describes a case of septicemia caused by E. hermannii. cultures and also from ulcer swab cultures and stool culture. The organism was identified by standard biochemical reactions (Bergey’s Manual) as enclosed in the Table attached.
The organism displayed the same sensitivity and resistance (sensitive to Gentamicin, Ceftriaxone, Ciprofloxacin, and Netilmicin and resistant to Ampicillin). A sub culture of the isolate was sent to the microbiology laboratory at Christian Medical College, Vellore for confirmation of our bacterial isolate, which was confirmed by Christian Medical College, Vellore as E. hermannii. Gentamicin and Ceftriaxone were administered intravenously and two days later the patient became afebrile.
| Sacral Ulcer( 4x6cm). |
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Discussion:
E. hermannii was first reported in 1982. Wounds account for almost 50% of human isolates of E. hermannii, followed by sputum isolates (25%) and stool isolates (20%) as reported by Brenner et al in 1982 1. The pathogenic potential of E. hermannii has not yet been reported from blood culture. However, in previous studies E. hermannii has been found to be associated with diarrhea in humans and its enteropathogenicity attributable to enterotoxin(s) demonstrated by animal experiments using the rat ileal loops 1, 3.
In our case report, we recovered E. hermannii from bedsore, stool and blood and all were uniformly resistant to Ampicillin and sensitive to Gentamicin, Ceftriaxone, Ciprofloxacin and Netilmicin. The organism has been recognized as a colonizer of human wounds as reported by Pien F.D et al in 1985 4 but its invasive capabilities have not so far been placed on record.
Since E. hermannii was recovered from the three sites described here, undoubtedly the organism from the intestinal source after colonizing the sore in the sacral region caused septicemia by virtue of its invasive potential. Thus it can be concluded that this species is invasive in immunocompromised subjects.
Reference
- Abijith Chaudhury, G. Nath, Anjali Tikoo and S.C Sanyal. 1999 Jun Enteropathogenicity and antimicrobial susceptibility of new Escherichia Spp: J. Diarrhoeal Dis Res; 17(2), 85-87.
- Brenner DJ, Davis BR, Steigerwalt A.G, Riddle CF, McWhorter AC, Allen SD et al. 1982 Nov Atypical biogroups of Escherichia coli found in clinical specimens and description of E. hermannii sp. J. Clin Microbiol , 15, 703-13.
- Farmer JJ, III, Davis BR, Hickman-Brenner F. W, McWhorter A, Huntley-Carter G P, Asbury M A et al. 1985 Biochemical identification of new species and biogroups of Enterobacteriaceae isolated from clinical specimens. J. Clin Microbiol, 21, 46-76.
- Pien FD, Shrum S, Swenson JM, Hill B C, Thornsberry C, Farmer J J. 1985 Aug. Colonization of human wounds by Eschericia vulneris and Escherichia hermannii 3rd. J. clin Microbiol, 22 (2), 283-5.
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