- Email: [email protected]
Cellulitis and Bacteremia Caused by Bergeyella zoohelcum
CASE REPORT
Cellulitis and Bacteremia Caused by Bergeyella zoohelcum Wei-Ru Lin,1,2 Yao-Shen Chen,2 Yung-Ching Liu2* Bergeyella zoohelcum is a rod-shaped, aerobic, Gram-negative, non-motile and non-saccharolytic bacterium. It is frequently isolated from the upper respiratory tract of dogs, cats and other mammals. Clinically, B. zoohelcum has been known to cause cellulitis, leg abscess, tenosynovitis, septicemia, pneumonia and meningitis, and is associated with animal bites. In addition, food-borne transmission was considered in a recent case report. We report a 73-year-old man with liver cirrhosis who had no history of dog bite but had dog exposure, who developed cellulitis of the left lower leg and B. zoohelcum was isolated from blood culture. This patient, without evidence of polymicrobial infection, was treated with cefazolin and gentamicin with a good outcome. B. zoohelcum is a zoonotic pathogen that may cause bacteremia in patients with underlying disease such as liver cirrhosis; it can be treated with a beta-lactam or quinolone. [J Formos Med Assoc 2007;106(7):573–576] Key Words: Bergeyella zoohelcum, cellulitis, dog bite, liver cirrhosis
was considered.14 Herein, we report a case of cellulitis with B. zoohelcum septicemia and a review of the literature.
Bergeyella (formerly Weeksella) zoohelcum is a rodshaped, aerobic, Gram-negative, non-motile, nonsaccharolytic bacterium that is frequently isolated from the upper respiratory tract of dogs, cats and other mammals.1–4 Transient intraoral colonization of Weeksella species has been isolated in irradiated, dentate, xerostomic individuals.5 Most clinical isolates come from bite wounds and have been known to cause cellulitis, leg abscess, tenosynovitis, septicemia, pneumonia and meningitis.6–11 Källman et al reported the species found in the wounds of tsunami patients.12 Weeksella- and Bergeyella-like bacteria were isolated from a variety of food sources. However, the phenotypic relationships of these isolates could not be regarded as belonging to the known species of W. virosa and B. zoohelcum.13 Beltran et al reported the first case of bacteremia after ingestion of a dish prepared with goat’s blood and food-borne transmission
Case Report A 73-year-old man was sent to the emergency room due to fever, vomiting, malaise and painful swelling of his left lower leg for 3 days. This patient had a history of liver cirrhosis caused by hepatitis C and transitional cell carcinoma of the urinary bladder for which he had undergone transurethral resection of the bladder tumor 3 years ago. He had stasis dermatitis of both lower legs and had received skin graft in the past. He also suffered from recurrent cellulitis of the left lower leg. On examination, he had a tympanic temperature of 40°C, blood pressure of 109/46 mmHg, pulse
©2007 Elsevier & Formosan Medical Association .
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1
Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, and 2Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. Received: June 28, 2006 Revised: December 19, 2006 Accepted: January 2, 2007
*Correspondence to: Dr Yung-Ching Liu, Section of Infectious Diseases, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 813, Taiwan. E-mail: [email protected]
J Formos Med Assoc | 2007 • Vol 106 • No 7
573
W.R. Lin, et al
rate of 96/minute and respiratory rate of 19/ minute. Physical examination revealed erythematous change, swelling, local heat and fissures with serous discharge over his left lower leg, and a soft distended abdomen with shifting dullness. Laboratory investigations revealed leukocyte count of 5680/mm3 with 68% neutrophils and 25% band forms, potassium of 3 mmol/L (normal range, 3.5– 5.0 mmol/L), total bilirubin of 3 mg/dL (normal range, 0.3–1.2 mg/dL), C-reactive protein of 2.7 mg/dL (normal range, < 0.5 mg/dL), and microscopic hematuria. He was treated with crystal penicillin G 3 million units every 6 hours initially, but was subsequently given oxacillin 2 g every 6 hours. However, preliminary blood culture reported isolation of a Gram-negative bacilli, thereafter, antibiotic treatment was changed to cefazolin 1 g every 8 hours and gentamicin 80 mg every 12 hours. Abdominal computed tomography was performed to rule out intra-abdominal lesion as the origin of the soft tissue infection and was unremarkable. The clinical condition was stable and the lesions on the left lower leg improved. Two sets of blood cultures isolated a Gram-negative rod susceptible to penicillin. The isolate was identified as B. zoohelcum, which was susceptible to all antibiotics in the panel tested. With continued use of cefazolin and gentamicin, the patient defervescenced 3 days later and the cellulitis over his left lower leg improved 4 days later. A detailed history disclosed that the patient had slept with his three dogs but he denied sustaining any dog bites. Cefazolin and gentamicin were given for a total of 14 days duration. The patient was well and without any complications related to this episode of B. zoohelcum septicemia at the 1-year follow-up.
Discussion Liver cirrhosis predisposes patients to bacteremia. The incidence of bacteremia in patients with chronic liver disease is five to seven times higher than in other hospitalized patients.15 Soft tissue 574
infections are found in 2–11% of cirrhotic patients. Gram-positive cocci, primarily staphylococci and streptococci, are the most prevalent pathogens.16 However, Gram-negative bacteria should be considered potential etiologic agents in patients with cirrhosis.17 B. zoohelcum, CDC group IIj, formerly belonging to Weeksella, are non-fermentative, Gramnegative bacilli that grow well on blood agar; however, most strains do not grow on MacConkey’s agar.2 Colonies are circular, entire, translucent, smooth, glossy, butyrous and very sticky, making them difficult to remove from solid media. Growth in broth is poor. No hemolysis is seen on blood agar plates, although greening is occasionally observed around colonies.18 The organisms test positive for oxidase, catalase and indole, and are non-pigmented. Weeksella differed from most non-fermentative Gram-negative bacilli in being susceptible to penicillin, and B. zoohelcum differs from W. virosa for the production of urease.2 B. zoohelcum (from the Greek words “animal” + “wound”) has been recovered from the nasal fluid of 30% and from the oral fluid of 90% of dogs,1 and is seen in 38% of the gingival flora of dogs.15 It is also part of the normal flora of cats and other mammals.9 This organism is susceptible to beta-lactams, including penicillin, cefazolin, chloramphenicol, fluoroquinolones, and are variable in susceptibility to clindamycin, tetracycline and trimethoprimsulfamethoxazole.1,19–23 Most clinical isolates have been recovered from the wounds caused by the bites of various animals or by repeated contact with animals. Previously reported cases in the literature have been associated with meningitis, pneumonia, tenosynovitis, cellulitis, wound, and abscesses of the leg, 6,7,9–12 and only four cases of B. zoohelcum bacteremia have been reported before (Table). Noell et al reported an 80-year-old diabetic woman with B. zoolhelcum bacteremia who had bed sores and cat contact history.8 Montejo et al reported a 33-year-old man who developed B. zoolhelcum bacteremia 4 days after sustaining a dog bite over J Formos Med Assoc | 2007 • Vol 106 • No 7
Recovered Recovered Recovered Recovered Recovered Cefotaxime Ciprofloxacin Amoxicillin-clavulanic acid Cefuroxime Cefazolin & gentamicin Diabetes mellitus None None Diabetes mellitus, steroid use Liver cirrhosis, transitional cell carcinoma of urinary bladder Cat contact Goat’s blood ingestion Dog bite Cat contact Dog contact Bed sore infection Diarrhea Wound infection Skin infection Cellulitis 80/F 44/F 33/M 77/F 73/M
Exposure Type of Infection Age (yr)/Sex
his left forearm.24 Kivinen et al reported a 77-year-old woman with impaired health and many mild illnesses with steroidal and diabetic medication and cat contact history who suffered from severe skin infection and B. zoolhelcum bacteremia.25 Beltran et al reported a 44-year-old woman who developed diarrhea and bacteremia after ingestion of a dish prepared with goat’s blood.14 Here, we have reported the fifth case of a man who developed B. zoolhelcum bacteremia after dog contact. In summary, the source for B. zoolhelcum infection is contact or exposure to dogs, cats or contaminated food. Older people with prolonged exposure to dogs or cats may develop invasive diseases with B. zoolhelcum. There is no specific antibiotic treatment recommended for infections caused by B. zoohelcum. However, patients can be treated with agents that have been demonstrated to be effective against strains isolated from animals. Cefotaxime,8 amoxicillinclavulanic acid,24 ampicillin-sulbactam,6 cefuroxime25 and ciprofloxacin14 have been used to treat patients successfully. Use of amoxicillin-clavulanic acid and ampicillin-sulbactam is appropriate for the treatment of bite-related infection and is a reasonable choice for possible co-infection with other pathogens including Pasteurella multocida and anaerobes. However, the use of extended spectrum antimicrobials for the treatment of B. zoohelcum infection in the era of rising antimicrobial resistance deserves careful consideration. Our patient, without evidence of polymicrobial infection, was treated with cefazolin and gentamicin with a good outcome. In conclusion, B. zoohelcum is a zoonotic pathogen that may cause bacteremia in patients with underlying diseases such as diabetes mellitus and liver cirrhosis, and it can be treated with a beta-lactam or quinolone.
8
Noell et al Beltran et al14 Montejo et al24 Kivinen et al25 This case
References Reference
Table. Summary of reported cases of Bergeyella zoohelcum bacteremia
Underlying disease
Treatment
Outcome
Bergeyella zoohelcum bacteremia and cellulitis
J Formos Med Assoc | 2007 • Vol 106 • No 7
1. Bailie WE, Stow EC, Schmitt EC. Aerobic bacterial flora of oral and nasal fluids of canines with references to bacteria associated with bites. J Clin Microbiol 1978;7:223–31. 2. Steinberg JP, Del Rio C. Other Gram-negative and Gramvariable bacilli—Weeksella and Bergeyella. In: Mandell GL,
575
W.R. Lin, et al
3.
4.
5.
6.
7.
8. 9.
10.
11. 12.
13.
14.
576
Bennett JE, Dolin R (eds). Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 6th edition. Philadelphia: Elsevier, 2005:2762. Talan DA, Citron DM, Abrahamian FM, et al. Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group. N Engl J Med 1999;340: 85–92. Botha WC, Jooste PJ, Britz TJ. The taxonomic relationship of certain environmental flavobacteria to the genus Weeksella. J Appl Bacteriol 1989;67:551–9. Leung W, Jin L, Yam W, et al. Oral colonization of aerobic and facultatively anaerobic Gram-negative rods and cocci in irradiated, dentate, xerostomic individuals. Oral Microbiol Immunol 2001;16:1–9. Shukla SK, Paustian DL, Stockwell PJ, et al. Isolation of a fastidious Bergeyella species associated with cellulitis after a cat bite and a phylogenetic comparison with Bergeyella zoohelcum strains. J Clin Microbiol 2004;42:290–3. Grimault E, Glerant JC, Aubry P, et al. Uncommon site of Bergeyella zoohelcum. Apropos of a case. Rev Pneumol Clin 1996;52:387–9. Noell F, Gorce MF, Garde C, et al. Isolation of Weeksella zoohelcum in septicaemia. Lancet 1989;2:332. Isotalo PA, Edgar D, Toye B. Polymicrobial tenosynovitis with Pasteurella multocida and other Gram-negative bacilli after a Siberian tiger bite. J Clin Pathol 2000;53:871–2. Reina J, Borrell N. Leg abscess caused by Weeksella zoohelcum following a dog bite. Clin Infect Dis 1992;14: 1162–3. Bracis R, Seibers K, Julien RM. Meningitis caused by Group IIj following a dog bite. West J Med 1979;131:438–40. Källman O, Lundberg C, Wretlind B, et al. Rare bacteria species found in wounds of tsunami patients. Predominance of Gram-negative rods, increased antibiotic resistance. Lakartidningen 2005;102:3660–5. Botha WC, Jooste PJ, Hugo CJ. The incidence of Weeksellaand Bergeyella-like bacteria in the food environment. J Appl Microbiol 1998;84:349–56. Beltran A, Bdiiwi S, Jani J, et al. A case of Bergeyella zoohelcum bacteremia after ingestion of a dish prepared with goat blood. Clin Infect Dis 2006;15;42:891–2.
15. Thulstrup AM, Sorénsen HT, Schonheyder HC, et al. Population-based study of the risk and short-term prognosis for bacteremia in patients with liver cirrhosis. Clin Infect Dis 2000;31:1357–61. 16. Corredoira JM, Ariza J, Pallares R, et al. Gram-negative bacillary cellulitis in patients with hepatic cirrhosis. Eur J Clin Microbiol Infect Dis 1994;13:19–24. 17. Horowitz Y, Sperber AD, Almog Y. Gram-negative cellulitis complicating cirrhosis. Mayo Clin Proc 2004;79:247–50. 18. Saphir DA, Carter GR. Gingival flora of the dog with special reference to bacteria associated with bites. J Clin Microbiol 1976;3:344–9. 19. Goldstein EJ, Citron DM, Merriam CV. Linezolid activity compared to those of selected macrolides and other agents against aerobic and anaerobic pathogens isolated from soft tissue bite infections in humans. Antimicrob Agents Chemother 1999;43:1469–74. 20. Goldstein EJ, Citron DM, Merriam CV, et al. Activity of gatifloxacin compared to those of five other quinolones versus aerobic and anaerobic isolates from skin and soft tissue samples of human and animal bite wound infections. Antimicrob Agents Chemother 1999b;43:1475–9. 21. Goldstein EJ, Citron DM, Merriam CV, et al. Comparative in vitro activities of ABT-773 against aerobic and anaerobic pathogens isolated from skin and soft-tissue animal and human bite wound infections. Antimicrob Agents Chemother 2000;44:2525–9. 22. Goldstein EJ, Citron DM, Merriam CV, et al. Comparative in vitro activities of GAR-936 against aerobic and anaerobic animal and human bite wound pathogens. Antimicrob Agents Chemother 2000;44:2747–51. 23. Vay CA, Almuzara MN, Rodríguez CH, et al. “In vitro” activity of different antimicrobial agents on Gram-negative nonfermentative bacilli, excluding Pseudomonas aeruginosa and Acinetobacter spp. Rev Argent Microbiol 2005;37:34–45. 24. Montejo M, Aguirrebengoa K, Ugalde J, et al. Bergeyella zoohelcum bacteremia after a dog bite. Clin Infect Dis 2001;33:1608–9. 25. Kivinen PK, Lahtinen MR, Ruotsalainen E, et al. Bergeyella zoohelcum septicaemia of a patient suffering from severe skin infection. Acta Derm Venereol 2003;83:74–5.
J Formos Med Assoc | 2007 • Vol 106 • No 7
Cellulitis and Bacteremia Caused by Bergeyella zoohelcum Wei-Ru Lin,1,2 Yao-Shen Chen,2 Yung-Ching Liu2* Bergeyella zoohelcum is a rod-shaped, aerobic, Gram-negative, non-motile and non-saccharolytic bacterium. It is frequently isolated from the upper respiratory tract of dogs, cats and other mammals. Clinically, B. zoohelcum has been known to cause cellulitis, leg abscess, tenosynovitis, septicemia, pneumonia and meningitis, and is associated with animal bites. In addition, food-borne transmission was considered in a recent case report. We report a 73-year-old man with liver cirrhosis who had no history of dog bite but had dog exposure, who developed cellulitis of the left lower leg and B. zoohelcum was isolated from blood culture. This patient, without evidence of polymicrobial infection, was treated with cefazolin and gentamicin with a good outcome. B. zoohelcum is a zoonotic pathogen that may cause bacteremia in patients with underlying disease such as liver cirrhosis; it can be treated with a beta-lactam or quinolone. [J Formos Med Assoc 2007;106(7):573–576] Key Words: Bergeyella zoohelcum, cellulitis, dog bite, liver cirrhosis
was considered.14 Herein, we report a case of cellulitis with B. zoohelcum septicemia and a review of the literature.
Bergeyella (formerly Weeksella) zoohelcum is a rodshaped, aerobic, Gram-negative, non-motile, nonsaccharolytic bacterium that is frequently isolated from the upper respiratory tract of dogs, cats and other mammals.1–4 Transient intraoral colonization of Weeksella species has been isolated in irradiated, dentate, xerostomic individuals.5 Most clinical isolates come from bite wounds and have been known to cause cellulitis, leg abscess, tenosynovitis, septicemia, pneumonia and meningitis.6–11 Källman et al reported the species found in the wounds of tsunami patients.12 Weeksella- and Bergeyella-like bacteria were isolated from a variety of food sources. However, the phenotypic relationships of these isolates could not be regarded as belonging to the known species of W. virosa and B. zoohelcum.13 Beltran et al reported the first case of bacteremia after ingestion of a dish prepared with goat’s blood and food-borne transmission
Case Report A 73-year-old man was sent to the emergency room due to fever, vomiting, malaise and painful swelling of his left lower leg for 3 days. This patient had a history of liver cirrhosis caused by hepatitis C and transitional cell carcinoma of the urinary bladder for which he had undergone transurethral resection of the bladder tumor 3 years ago. He had stasis dermatitis of both lower legs and had received skin graft in the past. He also suffered from recurrent cellulitis of the left lower leg. On examination, he had a tympanic temperature of 40°C, blood pressure of 109/46 mmHg, pulse
©2007 Elsevier & Formosan Medical Association .
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1
Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, and 2Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. Received: June 28, 2006 Revised: December 19, 2006 Accepted: January 2, 2007
*Correspondence to: Dr Yung-Ching Liu, Section of Infectious Diseases, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 813, Taiwan. E-mail: [email protected]
J Formos Med Assoc | 2007 • Vol 106 • No 7
573
W.R. Lin, et al
rate of 96/minute and respiratory rate of 19/ minute. Physical examination revealed erythematous change, swelling, local heat and fissures with serous discharge over his left lower leg, and a soft distended abdomen with shifting dullness. Laboratory investigations revealed leukocyte count of 5680/mm3 with 68% neutrophils and 25% band forms, potassium of 3 mmol/L (normal range, 3.5– 5.0 mmol/L), total bilirubin of 3 mg/dL (normal range, 0.3–1.2 mg/dL), C-reactive protein of 2.7 mg/dL (normal range, < 0.5 mg/dL), and microscopic hematuria. He was treated with crystal penicillin G 3 million units every 6 hours initially, but was subsequently given oxacillin 2 g every 6 hours. However, preliminary blood culture reported isolation of a Gram-negative bacilli, thereafter, antibiotic treatment was changed to cefazolin 1 g every 8 hours and gentamicin 80 mg every 12 hours. Abdominal computed tomography was performed to rule out intra-abdominal lesion as the origin of the soft tissue infection and was unremarkable. The clinical condition was stable and the lesions on the left lower leg improved. Two sets of blood cultures isolated a Gram-negative rod susceptible to penicillin. The isolate was identified as B. zoohelcum, which was susceptible to all antibiotics in the panel tested. With continued use of cefazolin and gentamicin, the patient defervescenced 3 days later and the cellulitis over his left lower leg improved 4 days later. A detailed history disclosed that the patient had slept with his three dogs but he denied sustaining any dog bites. Cefazolin and gentamicin were given for a total of 14 days duration. The patient was well and without any complications related to this episode of B. zoohelcum septicemia at the 1-year follow-up.
Discussion Liver cirrhosis predisposes patients to bacteremia. The incidence of bacteremia in patients with chronic liver disease is five to seven times higher than in other hospitalized patients.15 Soft tissue 574
infections are found in 2–11% of cirrhotic patients. Gram-positive cocci, primarily staphylococci and streptococci, are the most prevalent pathogens.16 However, Gram-negative bacteria should be considered potential etiologic agents in patients with cirrhosis.17 B. zoohelcum, CDC group IIj, formerly belonging to Weeksella, are non-fermentative, Gramnegative bacilli that grow well on blood agar; however, most strains do not grow on MacConkey’s agar.2 Colonies are circular, entire, translucent, smooth, glossy, butyrous and very sticky, making them difficult to remove from solid media. Growth in broth is poor. No hemolysis is seen on blood agar plates, although greening is occasionally observed around colonies.18 The organisms test positive for oxidase, catalase and indole, and are non-pigmented. Weeksella differed from most non-fermentative Gram-negative bacilli in being susceptible to penicillin, and B. zoohelcum differs from W. virosa for the production of urease.2 B. zoohelcum (from the Greek words “animal” + “wound”) has been recovered from the nasal fluid of 30% and from the oral fluid of 90% of dogs,1 and is seen in 38% of the gingival flora of dogs.15 It is also part of the normal flora of cats and other mammals.9 This organism is susceptible to beta-lactams, including penicillin, cefazolin, chloramphenicol, fluoroquinolones, and are variable in susceptibility to clindamycin, tetracycline and trimethoprimsulfamethoxazole.1,19–23 Most clinical isolates have been recovered from the wounds caused by the bites of various animals or by repeated contact with animals. Previously reported cases in the literature have been associated with meningitis, pneumonia, tenosynovitis, cellulitis, wound, and abscesses of the leg, 6,7,9–12 and only four cases of B. zoohelcum bacteremia have been reported before (Table). Noell et al reported an 80-year-old diabetic woman with B. zoolhelcum bacteremia who had bed sores and cat contact history.8 Montejo et al reported a 33-year-old man who developed B. zoolhelcum bacteremia 4 days after sustaining a dog bite over J Formos Med Assoc | 2007 • Vol 106 • No 7
Recovered Recovered Recovered Recovered Recovered Cefotaxime Ciprofloxacin Amoxicillin-clavulanic acid Cefuroxime Cefazolin & gentamicin Diabetes mellitus None None Diabetes mellitus, steroid use Liver cirrhosis, transitional cell carcinoma of urinary bladder Cat contact Goat’s blood ingestion Dog bite Cat contact Dog contact Bed sore infection Diarrhea Wound infection Skin infection Cellulitis 80/F 44/F 33/M 77/F 73/M
Exposure Type of Infection Age (yr)/Sex
his left forearm.24 Kivinen et al reported a 77-year-old woman with impaired health and many mild illnesses with steroidal and diabetic medication and cat contact history who suffered from severe skin infection and B. zoolhelcum bacteremia.25 Beltran et al reported a 44-year-old woman who developed diarrhea and bacteremia after ingestion of a dish prepared with goat’s blood.14 Here, we have reported the fifth case of a man who developed B. zoolhelcum bacteremia after dog contact. In summary, the source for B. zoolhelcum infection is contact or exposure to dogs, cats or contaminated food. Older people with prolonged exposure to dogs or cats may develop invasive diseases with B. zoolhelcum. There is no specific antibiotic treatment recommended for infections caused by B. zoohelcum. However, patients can be treated with agents that have been demonstrated to be effective against strains isolated from animals. Cefotaxime,8 amoxicillinclavulanic acid,24 ampicillin-sulbactam,6 cefuroxime25 and ciprofloxacin14 have been used to treat patients successfully. Use of amoxicillin-clavulanic acid and ampicillin-sulbactam is appropriate for the treatment of bite-related infection and is a reasonable choice for possible co-infection with other pathogens including Pasteurella multocida and anaerobes. However, the use of extended spectrum antimicrobials for the treatment of B. zoohelcum infection in the era of rising antimicrobial resistance deserves careful consideration. Our patient, without evidence of polymicrobial infection, was treated with cefazolin and gentamicin with a good outcome. In conclusion, B. zoohelcum is a zoonotic pathogen that may cause bacteremia in patients with underlying diseases such as diabetes mellitus and liver cirrhosis, and it can be treated with a beta-lactam or quinolone.
8
Noell et al Beltran et al14 Montejo et al24 Kivinen et al25 This case
References Reference
Table. Summary of reported cases of Bergeyella zoohelcum bacteremia
Underlying disease
Treatment
Outcome
Bergeyella zoohelcum bacteremia and cellulitis
J Formos Med Assoc | 2007 • Vol 106 • No 7
1. Bailie WE, Stow EC, Schmitt EC. Aerobic bacterial flora of oral and nasal fluids of canines with references to bacteria associated with bites. J Clin Microbiol 1978;7:223–31. 2. Steinberg JP, Del Rio C. Other Gram-negative and Gramvariable bacilli—Weeksella and Bergeyella. In: Mandell GL,
575
W.R. Lin, et al
3.
4.
5.
6.
7.
8. 9.
10.
11. 12.
13.
14.
576
Bennett JE, Dolin R (eds). Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 6th edition. Philadelphia: Elsevier, 2005:2762. Talan DA, Citron DM, Abrahamian FM, et al. Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group. N Engl J Med 1999;340: 85–92. Botha WC, Jooste PJ, Britz TJ. The taxonomic relationship of certain environmental flavobacteria to the genus Weeksella. J Appl Bacteriol 1989;67:551–9. Leung W, Jin L, Yam W, et al. Oral colonization of aerobic and facultatively anaerobic Gram-negative rods and cocci in irradiated, dentate, xerostomic individuals. Oral Microbiol Immunol 2001;16:1–9. Shukla SK, Paustian DL, Stockwell PJ, et al. Isolation of a fastidious Bergeyella species associated with cellulitis after a cat bite and a phylogenetic comparison with Bergeyella zoohelcum strains. J Clin Microbiol 2004;42:290–3. Grimault E, Glerant JC, Aubry P, et al. Uncommon site of Bergeyella zoohelcum. Apropos of a case. Rev Pneumol Clin 1996;52:387–9. Noell F, Gorce MF, Garde C, et al. Isolation of Weeksella zoohelcum in septicaemia. Lancet 1989;2:332. Isotalo PA, Edgar D, Toye B. Polymicrobial tenosynovitis with Pasteurella multocida and other Gram-negative bacilli after a Siberian tiger bite. J Clin Pathol 2000;53:871–2. Reina J, Borrell N. Leg abscess caused by Weeksella zoohelcum following a dog bite. Clin Infect Dis 1992;14: 1162–3. Bracis R, Seibers K, Julien RM. Meningitis caused by Group IIj following a dog bite. West J Med 1979;131:438–40. Källman O, Lundberg C, Wretlind B, et al. Rare bacteria species found in wounds of tsunami patients. Predominance of Gram-negative rods, increased antibiotic resistance. Lakartidningen 2005;102:3660–5. Botha WC, Jooste PJ, Hugo CJ. The incidence of Weeksellaand Bergeyella-like bacteria in the food environment. J Appl Microbiol 1998;84:349–56. Beltran A, Bdiiwi S, Jani J, et al. A case of Bergeyella zoohelcum bacteremia after ingestion of a dish prepared with goat blood. Clin Infect Dis 2006;15;42:891–2.
15. Thulstrup AM, Sorénsen HT, Schonheyder HC, et al. Population-based study of the risk and short-term prognosis for bacteremia in patients with liver cirrhosis. Clin Infect Dis 2000;31:1357–61. 16. Corredoira JM, Ariza J, Pallares R, et al. Gram-negative bacillary cellulitis in patients with hepatic cirrhosis. Eur J Clin Microbiol Infect Dis 1994;13:19–24. 17. Horowitz Y, Sperber AD, Almog Y. Gram-negative cellulitis complicating cirrhosis. Mayo Clin Proc 2004;79:247–50. 18. Saphir DA, Carter GR. Gingival flora of the dog with special reference to bacteria associated with bites. J Clin Microbiol 1976;3:344–9. 19. Goldstein EJ, Citron DM, Merriam CV. Linezolid activity compared to those of selected macrolides and other agents against aerobic and anaerobic pathogens isolated from soft tissue bite infections in humans. Antimicrob Agents Chemother 1999;43:1469–74. 20. Goldstein EJ, Citron DM, Merriam CV, et al. Activity of gatifloxacin compared to those of five other quinolones versus aerobic and anaerobic isolates from skin and soft tissue samples of human and animal bite wound infections. Antimicrob Agents Chemother 1999b;43:1475–9. 21. Goldstein EJ, Citron DM, Merriam CV, et al. Comparative in vitro activities of ABT-773 against aerobic and anaerobic pathogens isolated from skin and soft-tissue animal and human bite wound infections. Antimicrob Agents Chemother 2000;44:2525–9. 22. Goldstein EJ, Citron DM, Merriam CV, et al. Comparative in vitro activities of GAR-936 against aerobic and anaerobic animal and human bite wound pathogens. Antimicrob Agents Chemother 2000;44:2747–51. 23. Vay CA, Almuzara MN, Rodríguez CH, et al. “In vitro” activity of different antimicrobial agents on Gram-negative nonfermentative bacilli, excluding Pseudomonas aeruginosa and Acinetobacter spp. Rev Argent Microbiol 2005;37:34–45. 24. Montejo M, Aguirrebengoa K, Ugalde J, et al. Bergeyella zoohelcum bacteremia after a dog bite. Clin Infect Dis 2001;33:1608–9. 25. Kivinen PK, Lahtinen MR, Ruotsalainen E, et al. Bergeyella zoohelcum septicaemia of a patient suffering from severe skin infection. Acta Derm Venereol 2003;83:74–5.
J Formos Med Assoc | 2007 • Vol 106 • No 7