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Journal of Clinical Microbiology, November 1999, p. 3733-3734, Vol. 37, No. 11
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.
Case of Peritonitis Caused by Ewingella
americana in a Patient Undergoing Continuous Ambulatory
Peritoneal Dialysis
Chryssa
Kati,1,*
Evangelia
Bibashi,1
Elisabeth
Kokolina,2 and
Danai
Sofianou1
Departments of Medical
Microbiology1 and
Nephrology,2 Hippokration General
Hospital, Thessaloniki, Greece
Received 11 May 1999/Returned for modification 14 May 1999/Accepted 22 July 1999
 |
ABSTRACT |
Reports of serious infections caused by Ewingella
americana have been rare. A case of E. americana
peritonitis in a patient receiving continuous ambulatory peritoneal
dialysis is described. This is the first report of E. americana causing such an infection.
| |
TEXT |
Ewingella, previously
known as enteric group 40, is a new genus in the family of
Enterobacteriaceae and was first described by Grimont and
coworkers in 1983 (5). This genus includes only one species,
Ewingella americana. This microorganism is rarely found in
human clinical samples. The most common source of human isolates has
been blood, but it has also been isolated from sputum, urine, wounds,
and stool (1, 4, 5).
In most instances, the pathogenic significance of this organism,
although suggestive, has not been established. Recently, scattered
reports of infections due to E. americana have appeared in
the literature, documenting the pathogenic potential of this organism
in humans (2, 6, 9, 10).
We report the first case of peritonitis caused by E. americana in a patient with end-stage renal disease undergoing
continuous ambulatory peritoneal dialysis since 1994. The primary cause
of renal failure was polycystic kidney disease.
Case report.
A 70-year-old woman was admitted to the hospital
with diffuse abdominal pain and fever of 37.4°C. Physical examination
revealed tenderness and positive rebound. Upon admission, laboratory
findings were as follows: hematocrit, 27%, leukocyte count,
11,900/mm3 (with left shift); creatinine level in blood,
7.1 mg/dl; urea level in blood, 210 mg/dl; and glucose level in blood,
110 mg/dl.
The peritoneal dialysate was turbid, and microscopic examination showed
400 cells/mm3, with a predominance of neutrophils. The
diagnosis of peritonitis was established, and the patient was treated
empirically with amikacin and vancomycin intravenously. Samples of
dialysate were obtained and inoculated onto 5% sheep blood agar,
McConkey agar, and thioglycolate broth (Becton Dickinson
Microbiology Systems, Cockeysville, Md.) that were incubated,
aerobically and anaerobically, at 37°C. Blood cultures were not
performed. After 48 h of incubation, a short, gram-negative,
lactose-fermenting rod that was oxidase negative and catalase positive
grew. The isolate was identified by the Vitek and API 32 GN
identification systems (bioMérieux Vitek Inc. Hazelwood, Mo.) as
E. americana. The biochemical properties of the strain are
compared to properties of published strains in Table
1 (3).
Antimicrobial susceptibility testing of
E. americana was
carried out by the E-test method (AB Biodisk, Solna, Sweden). The
isolate was found to be susceptible to ampicillin,
amoxicillin-clavulanate,
ceftazidime, ceftriaxone, cefotaxime,
cefepime, ofloxacin, gentamicin,
carbenicillin, and amikacin and
was moderately susceptible to
cefuroxime but resistant to
cephalothin, penicillin G, and vancomycin
(Table
2). After bacteriologic results were
obtained, vancomycin
therapy was stopped and the patient was treated
with amikacin
until complete recovery.
E. americana is an infrequent opportunistic pathogen.
Although most isolates in the series of Farmer et al. have been
recovered
from blood, the pathogenic significance of
E. americana remains
unclear (
4).
In 1983, Pien et al. reported a case of bacteremia caused by
E. americana in combination with an unusual
Pseudomonas
sp. in
a patient after coronary bypass surgery (
10). Since
then, five
more cases of bacteremia due to
E. americana have
occurred. All
infected patients had undergone a surgery (
2,
9). Recently,
Heinzmann and Michel described a case of
conjunctivitis due to
E. americana in a previously healthy
woman (
6). In addition,
E. americana has been
associated with an outbreak of pseudobacteremia,
due to
cross-contamination of blood culture bottles with nonsterile
blood
collection tubes (
7,
8).
The present work is the first report in the English literature of a
case of peritonitis caused by
E. americana in a patient
undergoing continuous ambulatory peritoneal dialysis. The source
of
infection was not defined. However, an environmental source
such as
domestic water is one possibility.
E. americana is an
organism without nutritional needs that can survive in water and
citrate solution and preferentially grows at 4°C (
8).
In conclusion,
E. americana is a rare cause of human
infection. Further information is needed to define its ecology and
possible
role in human
disease.
| |
ACKNOWLEDGMENTS |
We gratefully acknowledge Patrice Grimont (Institut Pasteur, Paris,
France) for verifying the identification of the species.
| |
FOOTNOTES |
*
Corresponding author. Mailing address: Department of
Microbiology, Hippokration General Hospital, 49, Konstantinoupoleos
str., GR 54642 Thessaloniki, Greece. Phone: 30-31-892051. Fax:
30-31-855955. E-mail: conman{at}spark.net.gr.
| |
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Journal of Clinical Microbiology, November 1999, p. 3733-3734, Vol. 37, No. 11
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.
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