Wohlfahrtiimonas chitiniclastica Bacteremia Associated through Myiasis, United Kingdom – Volume 21, Number 6—June 2015 – Emerging Infectious Disease magazine – CDC
Volume 21, Number 6—June 2015
Wohlfahrtiimonas chitiniclastica Bacteremia Associated with Myiasis, United Kingdom
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To the Editor: We make known the identification of Wohlfahrtiimonas chitiniclastica bacteria in a pattern of blood obtained from a indulgent in Surrey, United Kingdom. We highlight the consequence of recognizing unusual bacteria that are associated with the larvae of parasitic flies taken in the character of a potential causative agent of sedate infection in patients with myiasis in the United Kingdom and perhaps worldwide.
The patient, an 82-year-thoughtful woman, was found collapsed in her garden through maggots covering her body and hair. Skin excoriations into the bargain her neck, face, and head showed shallow tissue breakdown in keeping with proteolytic enzyme secretions of maggots. The woman may obtain been lying outside for 72–96 hours. She had a chronicle of recurrent falls, hypertension, chronic kidney malady, ischemic heart disease, hypercholesterolemia, and osteoarthritis.
Blood calculus showed a marked inflammatory response. The quiet had a C-reactive protein raze of 157 mg/L (reference <10 mg/L); leukocyte tell of 15.56 × 109 cells/L (allusion 4.0–11.0 × 109 cells/L); prevailing neutrophilia; and evidence of rhabdomyolysis. She had tenacious acute kidney injury; her creatinine take aim was 131 µmol/L (reference 49–90 µmol/L), and her urea destroy was 23.3 mmol/L (reference 2.5–7.8 mmol/L). Her serum lactate make horizontal was 2.5 mmol/L (intimation 0.6–2.2 mmol/L), suggesting sepsis.
Intravenous antimicrobial deaden with narcotics therapy with cefuroxime (750 mg 3×/d), metronidazole (500 mg 3×/d), and clarithromycin (500 mg 2×/d) was continued on account of 7 days, followed by oral flucloxacillin (500 mg 4×/d). Topical chloramphenicol and fusidic acid were applied to ear canals. Superficial maggots were manually removed; however, larvae continued to emerge from the patient’s inflamed organ of h~ing canals, requiring otoscopic removal and cleaning of her ears. Larvae were identified at the same time that the third instar of Lucilia sericata, the inferior green bottle fly. W. chitiniclastica bacteria, which were isolated from cultures of kindred samples obtained on admission, were identified through using matrix-assisted laser desorption/ionization time-of-hasty departure (MALDI-TOF) mass spectrometry (Bruker Daltonics, Billerica, MA, USA), a tool in opposition to rapid identification of uncommon microorganisms, and confirmed ~ the agency of using 16S rRNA sequencing. Two W. chitiniclastica reference isolates were in the MALDI-TOF database at time of testing; scores matched to our set apart were 2.264 and 2.200, indicating a be married to species level. We could not isolate W. chitiniclastica from mop specimens of superficial lesions or musical perception swab specimens.
Blood culture samples grew a diversity of Proteus mirabilis, Providencia rettgeri, and Staphylococcus aureus. The contented made good clinical recovery and was later discharged to a limited rehabilitation unit.
Previous case reports from Argentina and the southward of France of bacteremia caused by Wohlfahrtiimonas spp. involved homeless persons through histories of alcohol abuse, 1 of whom was infested with insect larvae (1,2). One of these patients died from sepsis. W. chitiniclastica is known to colonize at minutest 2 species of flies but is not reported in Lucilia sp. This bacterium has been single from larvae of the fly Wohlfahrtia magnifica, a momentous parasite of livestock in eastern Europe, the Mediterranean, and Central Asia (3), still this fly is not usually seen in the United Kingdom. W. chitiniclastica has besides been isolated in China from Chrysomya megacephala valuable latrine flies, a screwworm species customary in tropical and subtropical regions that is a facultative effect of myiasis (4,5). A study from South Korea reported a new Wohlfahrtiimonas sp. single from the larval gut of Hermetia illucens, the doleful soldier fly, although this fly is not pathogenic (6).
L. sericata is a blowfly that is universal across much of the world. Although it usually feeds on dead or necrotic tissue, it can invade healthy tissue and is the ground of sheep blowfly strike (i.e., cutaneous myiasis) in other causes healthy livestock. This organism has a role in proper to courts investigations and is used in hale condition care settings for larval debridement of necrotic series from wounds and ulcers (5). The woman in our study had myiasis (i.e., infestation) through some invasion of healthy tissue and structure damage from enzymes secreted by the larvae.
In this condition, use of MALDI-TOF mass spectrometry enabled rapid identification of a rare bacterial sort (7) in a patient with myiasis; slower molecular methods were previously required for like diagnoses. Without local availability of this technology, considerably additional time would have been required on account of the diagnosis. Previous lack of identification of this fashion may be due to the maker shortage of W. chitiniclastica isolates in the MALDI-TOF database.
This predicament demonstrates association of W. chitiniclastica through myiasis, although the pathogenic role in this clinical category is uncertain. It is difficult to charge the clinical symptoms solely to bacteremia caused through this organism because multiple organisms were solitary. The cultures might have been heavily contaminated, goal this would still highlight an guild between L. sericata and W. chitiniclastica. Although we did not standard the extracted fly larvae for W. chitiniclastica, we credit it is likely that the bacteremia originated from the patient’s interior ear infestation. L. sericata may subsist a vector for this microorganism in the United Kingdom, and maybe worldwide, given this fly’s widespread natural locality .
Lisa Campisi, Nitin Mahobia, and James J. Clayton
Author affiliations: Royal Surrey County Hospital, Guildford, United Kingdom
We return ~s to Louise Hill-King for her patronage in the laboratory.
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Suggested summons for this article: Campisi L, Mahobia N, Clayton JJ. Wohlfahrtiimonas chitiniclastica bacteremia associated with myiasis, United Kingdom. Emerg Infect Dis. 2015 Jun [begin cited]. http://dx.doi.org/10.3201/eid2106.140007
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