39579. Beyond the Urinary Tract: Providencia stuartii as a Novel Cause of Cellulitis
Session: Poster Abstract Session: Medical Student Poster Session
Friday, October 4, 2013
Room: Yerba Buena Ballrooms
Background:

Providencia species cause infection in a wide range of animal hosts but are rarer in humans. Though P. stuartii infections are overall uncommon, these organisms typically cause urinary tract infections in nursing home patients who have chronic indwelling urinary catheters. Although there are reports of P. stuartii meningitis and endocarditis, it is a very uncommon cause of Gram-negative rod bacteremia.

Methods:

A 58-year-old Caucasian man presented with six days of right leg redness, swelling, difficulty ambulating and subjective fevers. The patient worked as a pool technician and his duties required that he wade in standing water ranging from commercial pools to horse pastures, often contaminated with animal urine.

Results:

His initial exam was notable for heart rate of 103 beats per minute and circumferential erythema extending from his right ankle to mid-tibia, as well as pitting edema, warmth, and tenderness to palpation. He also had two 1 cm bleeding ulcers between the 1st and 2nd digits of his right foot. His white blood cell count was 10,600 cells/μl.  Urinalysis was normal.  C-reactive protein was 6.9 mg/dl, and erythrocyte sedimentation rate was 72 mm/h. Four out of four blood cultures grew Providencia stuartii. Urine culture remained negative. A 131indium-labeled white blood cell scan was consistent with osteomyelitis.

Conclusion:

Providencia infections have been described in both animals and humans. In humans, Providencia species have been isolated from throat, perineum, axilla, stool, blood, and cerebrospinal fluid but are most commonly found in urine. There is one documented case of P. stuartii cellulitis in a dog from a suspected primary genitourinary source. Our patient had never had an indwelling urinary catheter and his urinalysis and urine culture were unremarkable. To our knowledge, this is the first reported case of P. stuartii causing cellulitis and osteomyelitis in a human host in the absence of a primary genitourinary source. Our patient likely acquired his skin and soft tissue infection directly through exposure to water contaminated by animal urine, with the portal of entry presumed to be his compromised skin. This case suggests that P. stuartii can cause cellulitis and osteomyelitis in humans, beyond simply nosocomial urinary tract infections.

William Auyeung, MD, Natalia Khalaf, MD, Annie Sheckter and Samir Desai, MD, Baylor College of Medicine, Houston, TX

Disclosures:

W. Auyeung, None

N. Khalaf, None

A. Sheckter, None

S. Desai, None

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