As the patient’s 1st metatarsal bone and proximal phalanx was fragile and crumbled, showing signs of osteomyelitis, we removed parts of it with a rongeur until healthy bone was exposed. We performed massive saline irrigation and radical debridement of necrotic soft tissues. In the operating room, we made a linear incision from the dorsum to the plantar of the foot, and a large amount of thick pus with foul odor was drained. Fluctuations were observed in the plantar and dorsum of the entire right foot. Blood culture was performed directly, and we performed emergency incision, drainage, and ostectomy because of risk of sepsis. On the 6th day of admission, the patient had chills and a fever up to 40☌. Despite wound dressing and antibiotics, the wound worsened. Simple radiological findings at admission showed an osteomyelitis pattern with cortical irregularity on the right 1st metatarsal head and proximal phalanx ( Fig. We started an empirical intravenous antibiotic regimen of 500 mg flomoxef every 12 hours, along with wound culture and diabetic control by insulin injection. Initial laboratory data was consistent with an elevated white blood cell count of 17.79×10 3/μL (normal range: 4.5–11.0×10 3/µL) and C-reactive protein of 83.84 mg/L (normal range: ≤10.0 mg/L). He was admitted through our outpatient clinic under the assumption that intravenous (IV) antibiotic use was necessary. Induration extended to 2/3 of his dorsum and plantar of the foot. Physical examination revealed a Wagner grade 4 draining ulcer with tenderness and pus-like discharge through the ulcer on the 1st metatarsal head area of his right foot ( Fig. He already had his right 3rd, 4th, and 5th toes amputated because of diabetic gangrene.
His medical history included hypertension, diabetes mellitus, and a smoking history of 50 pack-years. The patient did not know when or why he had developed the wound. There was no sign or history of trauma or bug bite on the right foot. The patient gave his written consent to the use of his photos.Ī 76-year-old man presented to our outpatient clinic with swelling, pain, and a foul odor in his right foot that had worsened for three weeks. chitiniclastica infection without myiasis in a male patient. Herein, we present an extremely rare case of W. chitiniclastica is usually accompanied by myiasis. Because the transmission of the bacteria is conducted by fly larvae through open wounds or mucosal surfaces of the host, infection with W. chitiniclastica is suggested to be pathogenic in humans and can cause severe diseases like septicemia and osteomyelitis, as in the case we report here. It shows strong chitinase activity and is thought to play a role in the metamorphosis of the fly, suggesting a symbiotic relationship between the host and bacterium. chitiniclastica is an aerobic, non-motile, gram-negative rod that grows best in the temperature range between 28☌ and 37☌. These flies are one of the most important causes of myiasis in mammals. It is also transmitted by other fly species such as Chrysomya megacephala, Lucilia sericata, and Musca domestica (also known as the housefly), with larvae being deposited in the open wound of the host. This bacterium was isolated from the larvae of the parasitic fly, Wohlfahrtia magnifica.
Wohlfahrtiimonas chitiniclastica was first described by Toth et al. Key Words: Wohlfahrtiimonas chitiniclastica Myiasis Infection Hence, early intravenous antibiotic treatment and adequate surgical management are required for efficient management and also to prevent progression to severe disease. chitiniclastica infection responds well to antibiotics and general treatment of open wounds in diabetic feet. chitiniclastica without myiasis are often missed therefore, careful attention is needed. chitiniclastica in tissue culture from a severely ill, infected patient without myiasis. Herein, we report the identification of W. chitiniclastica is pathogenic to humans and can cause severe diseases like septicemia and osteomyelitis.
#Gram negative rods in wound culture skin#
These bacteria are transmitted through fly larvae in open wounds of skin and/or mucosal surfaces on the host. chitiniclastica infections have been reported worldwide. Wohlfahrtiimonas chitiniclastica are aerobic, non-motile, gram-negative rods, first described by Toth et al.
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