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Journal of Clinical Microbiology, September 1999, p. 3048-3050, Vol. 37, No. 9
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.
Isolation of Providencia heimbachae from
Human Feces
Caroline
Mohr O'Hara,1,*
Arnie G.
Steigerwalt,2
Donna
Green,3
Michael
McDowell,3
Bertha C.
Hill,1
Don J.
Brenner,2 and
J.
Michael
Miller1
Hospital Infections
Program1 and Meningitis and Special
Pathogens Branch, Division of Bacterial and Mycotic
Diseases,2 Centers for Disease Control and
Prevention, Atlanta, Georgia, and State of Washington
Department of Public Health, Seattle, Washington3
Received 1 March 1999/Returned for modification 25 April
1999/Accepted 9 June 1999
 |
ABSTRACT |
Providencia heimbachae was first described in 1986. It
has been isolated from penguin feces and an aborted bovine fetus. To date, there has been no reported isolation of this organism from human
specimens. We now report the isolation of P. heimbachae from the stool of a 23-year-old woman with idiopathic diarrhea. The
identity of the human strain was determined biochemically and by DNA
relatedness to the type strain of P. heimbachae.
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TEXT |
Providencia heimbachae
was first described in 1986 by Müller et al. (7) using
13 strains isolated from the feces of healthy penguins in Germany and
from an aborted bovine fetus in the United States. No human isolates
have been previously reported. We report the first isolation of this
organism from a human, obtained from the stool of a 23-year-old woman
in Washington who was suffering from unexplained diarrhea.
Case report.
A 23-year-old woman presented to the Seattle-King
County, Washington, county health department with complaints of four to five watery stools per day over the previous 60 days. She denied any
abdominal cramping, fever, or malaise. She did not drink well water or
unpasteurized milk and had not been traveling either within the United
States or outside of the country. She had no history of irritable bowel
syndrome, and the diarrhea improved when the patient ate a bland,
starchy diet. There was no blood or mucus present in the stools. Tests
for ova and parasites, occult blood, and fecal leukocytes were all
negative. Her complete blood count and erythrocyte sedimentation rate
were both within normal limits. The only medication that the patient
was receiving was sertraline hydrochloride (Zoloft) (50 mg) one to two
times per day. Approximately 30 days after the patient reported to the
county health department, the symptoms resolved and the patient
reported that she was asymptomatic. There is no evidence that the
patient received antibiotics.
A culture of the stool specimen on only one occasion yielded a
gram-negative rod which grew better when incubated in 5% carbon dioxide. Initial conventional biochemical tests performed at the county
health department were unable to identify the organism. The strain was
tested in the Sherlock System (MIDI, Inc., Newark, Del.) using the CLIN
database, version 3.9. It should be noted that P. heimbachae
is not included in this database. This system identified the organism
as Yersinia pseudotuberculosis at a discrimination level of
0.527, signifying a moderately good identification.
The strain was sent to the Centers for Disease Control and Prevention
for confirmation. Identification was performed by conventional
biochemical methods as previously described (
3-5). While
the
results are not identical to those of the type strain (Table
1),
they were sufficiently similar to
indicate a high probability
that the organism was
P. heimbachae. Important differences include
the fact that the type
strain is positive for phenylalanine deaminase,
gas production from
glucose, and fermentation of maltose and
D-mannitol,
and is
positive for motility only after delayed incubation of
4 days, while
the case isolate is negative in these tests and
is motile only after 6 days. The type strain gives a negative
reaction in Jordan's tartrate
and ONPG
(
o-nitrophenyl-
-
D-galactopyranoside),
while
the case isolate is positive for tartrate and delayed positive
for
ONPG.
Radiolabeled DNA from the clinical isolate was hybridized to unlabeled
DNAs from the
P. heimbachae type strain and another
P. heimbachae strain, using the hydroxyapatite method as previously
described (
2). A species consists of strains whose DNAs are
70% or more related at 60°C and 55% or more related at 75°C and
whose DNAs contain 6% or less divergence in related nucleotide
requences (
1,
2). The high species level of DNA relatedness,
94% and 96%, respectively, with the two other strains of
P. heimbachae at 60°C and 93% and 97%, respectively, at 75°C
with corresponding
divergences of 1.5 and 1.0 confirmed that the
clinical isolate
was
P. heimbachae (Table
2).
When the organism was inoculated into additional commercial
identification systems, it was reported either as unidentified
or as
Providencia species because
P. heimbachae is not
contained
in the databases. The API 20E (bioMérieux Inc.,
Hazelwood, Mo.)
yielded a profile number of 0044210, resulting in no
identification.
Inoculation of a GNI+ card (bioMérieux Inc.)
yielded bionumber
7002103420, resulting in an "unidentified
organism" message. The
MicroScan Rapid Neg ID 3 panel (Dade Behring,
Inc., West Sacramento,
Calif.) identified the organism as
Providencia species at a probability
level of 99.61%.
Susceptibility to antimicrobial agents was determined by broth
microdilution using the standardized methods described by the
National
Committee for Clinical Laboratory Standards (
8). This
organism was susceptible to the penicillins (ampicillin,
piperacillin,
piperacillin-tazobactam, and ticarcillin-clavulanic
acid), cephalosporins
(cefazolin, cefoxitin, cefotetan, cefotaxime,
ceftriaxone, ceftazidime,
cefepime, and cefpodoxime), beta-lactams
(imipenem and aztreonam),
aminoglycosides (gentamicin, tobramycin, and
amikacin), quinolones
(ciprofloxacin), chloramphenicol, and
trimethoprim-sulfamethoxazole.
It was resistant to tetracycline
(MIC =
32).
We do not know if this organism in this setting was clinically
significant. The
Physicians' Desk Reference, in its
clinical
trial data, suggests that 2% of patients taking sertraline
hydrochloride
may experience diarrhea (
6). We do not know if
this had any
significance in this patient. Even if this was the cause
of the
diarrhea, it would not explain the presence of the organism.
Hospital
laboratories would probably not expect to identify this
organism
without using a reference lab. Key biochemical test results
that
might lead to suspicion of this organism include negative
reactions
for indole, citrate, and KCN and its positive fermentation
reactions
for adonitol,
D-arabitol,
D-galactose, and
L-rhamnose (
7).
| |
FOOTNOTES |
*
Corresponding author. Mailing address: Centers for
Disease Control, Mailstop C16, Atlanta, GA 30333. Phone: (404)
639-2316. Fax: (404) 639-3241. E-mail: cmo1{at}cdc.gov.
| |
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Journal of Clinical Microbiology, September 1999, p. 3048-3050, Vol. 37, No. 9
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.
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