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Eikenella corrodens: a clinical problem
Infection with Eikenella corrodens occurs m ore frequently than previously thought. Because the anaerobe exists in areas associated w ith th e oral cavity and because the organism can be easily missed in standard laboratory procedures, the dentist should follow patients closely after treatm en t so that therapy can be initiated if infection does develop.
Eikenella corrodens:
a clin ical p ro b le m
E ik e n e lla c o r r o d e n s , a g r a m - n e g a t iv e f a c u lt a t iv e
A rm an d B. G la s s m a n , MD J a m e s S. S im p so n , MD, Augusta, Ga
a n a e ro b e ,
has
been
d e s c r ib e d
n o n e n c a p s u la te d ,
s lig h t ly
ro u n d e d
te n d s
end s;
p h e n o m e n a
it
on
aga r
to
n o n s p o r in g ,
p ro d u c e
p la te s .
It
e x is ts
w ith
“ p itt in g ” as
a
m e m b r a n e s o f t h e g e n it a l t r a c t in w o m e n ,
negative, facultative anaerobe. Its pathogenicity has been disputed because it is frequently mixed with other organisms when cultured from clinical materials. Three cases involving E c o rro d e n s are presented; tw o of the infections follow ed dental m anipulations and the other occurred with laryn geal carcinoma. The possible discrepancy be tween in vitro disk sensitivities and patient re sponse is explored. Practitioners should be alert to the role of this organism especially in mixed cul ture clinical infections. We believe that the patho genicity, problems with treatment, and the clinical significance of these infections have been under estimated.
B ecause
o f
c a v ity
and
p r is in g
to
d itio n s , re p o rt is m
th e
t h is
lo w e r c lo s e
u p p e r
p r o v id e s
tra c t,
and
it s
in fe c t io n
som e
c lin ic a l
r e c e n t p a t ie n ts
th re e
cases
p o in t
h a z a rd s , a n d
o r
r e c o g n itio n seen
o u t
w as
H B 1 in
is o la t e d fro m
as
1958, m a d e
w e re
s tr a in s
o b ta in e d
a
f a c u lt a t iv e w as
m e d iu m
b y
ic a l
s u r
t h is
and
th e
Ja ckso n
c h a r a c t e r is t ic s
to
B a c te r o id e s c o r fir s t
e a r ly
and o f
d e s c r ib e d
d e s c r ip tio n ,
a n a e r o b ic
o r g a n is m s .
o r
fro m
s tu d y o f H is
c u l
in fe c t io n s
o f
h a s b e e n d e s c r ib e d
b y
g ro w
th e
p e r s is t e n c e ,
p e r ia n a l a b s c e s s e s .
p r im a r ily
a n a e ro b e
sh o w n
d e s c r ib e s
a c o m p r e h e n s iv e
o f
T h is o rg a n
o r g a n is m .
w as
t h e o r a l r e g io n . T h e o r g a n is m
e rs 4 a n d
th e
and
a g r a m - n e g a t iv e
p u lm o n a r y
o f
n u m b e r
It
1 9 4 8 .2 I n
E ik e n , 3 in
as
o ra l
n o t
r e s u lt . o f
p o t e n t ia l
o f t h is
b a c illu s .
a
tu re s
is
tra c t.1
th e
a t o u r in s titu t io n ;
th e
v ir u le n c e
H e n r ik s e n
g a n is m
it
can
d e s c r ip tio n
E c o r ro d e n s h a s b e e n c a lle d
it
w ith
im a g in e t h a t u n d e r p r o p e r c lin ic a l c o n
th re e
b y
m o u th ,
g a s t r o in t e s t in a l
a s s o c ia t io n
r e s p ir a t o r y
s ig n if ic a n t
ro d e n s
tra c t,
co m
m u co u s
p o s s ib ly
r e s p ir a t o r y
ro d
a
o f
and
u p p e r
a
m ensal
E ikenella c o rro d e ns (also known as HB1) is a gram-
th e
as
p le o m o r p h ic
H ill on
and
c o -w o rk
h e m in - e n r ic h e d
c o - w o r k e r s . 5 B io c h e m th e
o r g a n is m
in c lu d e
a
JADA, Vol. 91, December 1975 ■ 1237
p o s itiv e
o x id a s e
s m o o th
c o lo n ie s
“ p itt in g , ” 57 to fo r
a
m o st
th e
o r g a n is m
it s
Ja ckso n
in
and
a
th e fa m ily
th e
ly s in e
p lu s
fa c u lt a t iv e
new
in
p lu s
te s t,
h e m o ly tic ty p e , a n d in
p u re
s e n s itiv it ie s .
E ik e n
p e n ic illin
because
o f th e
c o n te n t
o f
in
fo u r
e q u a lly
e n c o u n te re d
th re e
cases
w e
have
ro d e n s .
s e v e ra l o f
a
A
3 3 - y e a r - o ld
c o n g e n it a l c a r d ia c
co m m o n
a t r io v e n t r ic u la r
in v e r s u s , w a s
m adge o f
M e m o r ia l
s e iz u r e
H o s p it a l
a c t iv ity ,
a d m is s io n ,
f ille d ”
and
“ th o ro u g h
had
been
a
g iv e n
to
p e n ic illin
th e
because
m a la is e ,
b e fo re
canal
she
(c o r
d e n ta l
b ilo -
p a r tia l
E u gene o f th e
and had
w ith
c o n s is tin g
s te n o s is , a n d
a d m it t e d
m o n th
w o m a n
a n o m a lie s ,
c u la r e ) , v a lv u la r p u lm o n a r y s it u s
w h it e
a
T a lonset
fe v e r. had
O n e
“ to o th
c le a n in g . ”
p r o p h y la c t ic a lly
to
(0 .5
g m ,
A
to
im b a la n c e ,
c o m p le te
■
C ase
She
fo r an
no.
2:
A
d e f ic ie n c y
re p o rte d
t ie n t d e p a r tm e n t c o m p la in in g w as
e x a m in e d ,
and
h is
d a ys,
and
t in u e d th e
a
r e g im e n
b r a in
lo b e ,
w h ic h
fe v e r.
abscess w as
o f
d r a in e d
S u b se q u e n t th e
le ft
o f 40
m l
e v a l
p a r ie ta l o f fo u l
b la c k
b r a in
to
m an
w ith
d e h y d ro g e n a s e th e
d e n ta l o u tp a
o f a to o th a c h e . r ig h t
a fte r th e
to o th
e x tr a c tio n ,
he
e r y th r o m y c in
e x tr a c tio n .
H e
t h ir d
w a s
F iv e
h o s p ita liz e d
f o r th re e w as
c o n
d a y s a fte r
w ith
a
sub
m a n d ib u la r a n d
s u b lin g u a l a b s c e s s
th a t r e q u ir e d
s u r g ic a l in c is io n
and
a s p ir a te g r e w
d r a in a g e . T h e
E c o rro d e n s a n d a b a c t e r o id e s , n o t t y p e d . E a c h
and
g ra d e
12
o f sep
p e rfo rm e d
p r o p h y la c t ic a lly o f
m a la is e
an
w as
pa
d ie d
m o la r w a s e x tr a c te d . E r y t h r o m y c in (2 5 0 m g , f o u r t im e s a d a y ) w a s g iv e n
in
lo w
T h e
and
m a n d ib u la r
e r y th r o m y c in .
and
d a y ).
p e r s is t e n t
p h o s p h a te
had
r e v e a le d
m g /k g /d a y k a n a m y c in
h o s p it a l,
7 8 - y e a r - o ld
g lu c o s e - 6
and
u a t io n
o f
a d a y ),
1, 2 ).
o r g a n is m
b e fo re
th e and
p e n ic illin
o f t im e
a
a u to p s y
d e n ta l m a n ip u la
p e r io d
50
th e ra p y
d is k
doses
u n its
and
t w ic e
to
p e n ic illin , d ir e c t
m a s s iv e
d o s e s ),
re s p o n d
e le c tr o ly te
to
m illio n
t io n . A f t e r th e d e n ta l v is it , s h e n o te d th e o n s e t o f
u n k n o w n
L a n c e fie ld
b y
( C h lo r o m y c e t in , d iv id e d
a f t e r h e r a d m is s io n
k n o w n
C ase no. I:
(2 0
days
(G o P D )
•
o f
a lp h a
re
E c o r
in v o lv in g
g iv e n
f a ile d
( F ig o f G e o r g ia ,
w as
t ie n t
abscess.
s e n s itiv e
k a n a m y c in
in t r a v e n o u s ly
in t r a m u s c u la r ly
M e d ic a l C o lle g e
C u lt u r e
o f u n c e r t a in
w a s
and
S he
c h lo r a m p h e n ic o l
s is ,
c e n t ly
s u b c u lt u r e
p la c e d
R e p o rt o f cases th e
s tre p to c o c c u s
1972
c y to s in e
m a te r ia l.
p e p to s tre p to c o c c u s ,
E c o rro d e n s . E a c h o f th e s e o r g a n is m s
c h lo r a m p h e n ic o l,
o f
b ro w n
r e v e a le d
o rg a n
D N A .
A t
g r e e n is h
abscess
t h is
th a t
o f b r u c e lla c e a e
s m e llin g , th e
c y t o s in e
a n a e r o b e . 4 ,5 o f
genus,
and
p r o d u c in g
d e c a r b o x y la s e
q u a n in e
G o o d m a n “
q u a n in e
o f ro u g h
ro u g h
c la s s ific a tio n
and
in
p e rc e n t
p re s e n c e
o n ly
o f D N A
re c e n t
b y
m o le s
%
s tr a in s ,
m ost
is m
e lla ,
w ith
p o s itiv e
5 8 m o le s
T h e
te s t, th e
d r a in a g e
r e q u ir e d . d ays
H e
v it r o
d ir e c t
p ro c e d u re s began
la te r a n d
to
s lo w ly
d is k T w o
w ith
s h o w
s e n s itiv it ie s m o re
ir r ig a t io n s
im p r o v e m e n t s
re c o v e re d ;
m a s s iv e
F ig 1 ■ B r a in a u t o p s y s p e c im e n f r o m
to
in c is io n w e re e ig h t doses
p a tie n t in
c a s e n o . 1. A b s c e s s o f le ft p a r ie ta l lo b e is e v id e n t. C u lt u r e w a s p o s itiv e f o r E corrodens, p e p to s tr e p t o c o c c u s , a n d a lp h a h e m o ly tic s t r e p to c o c c u s .
1238 ■ JADA, Vol. 91, December 1975
o f p e n ic illin
F ig 2
■ C a s e n o . 1, a u t o p s y re s u lts .
is t e r e d
1. Abscess of the left parietal lobe of the brain, severe, with infarct of the surrounding tissue. (History of dental work nine weeks before death and diagnosis of brain abscess ten days before death.) Eikenella corrodens, peptostreptococcus, alpha streptococcus grown from cultures taken at autopsy. Infarct of the cortex of the left frontal lobe of the brain, slight. 2. Congenital malformations of the heart and great
■
(1 0 m illio n
in tr a v e n o u s ly
C ase no. 3 :
m it te d
to
co u g h
and
A
th e
vessels: Persistent atrioventricularis communis, severe. Stenosis of the pulmonary valve, moderate. Bicuspid pulmonary valves, moderate. Right aortic arch, severe. Persistent patent ductus arteriosus, moderate. Total anomalous venous pulmonary return. Persistent left superior vena cava. Rudimentary coronary sinus. Anomalous coronary arteries: two orifices of the left coronary artery, the largest branch irrigating left and
w h it e
m an
o f 2 ,4 0 0 r a d s
ra d s
th e
la r y n x .
F iv e
had
s u rg e ry .
th e ra p y to
w e re
s e r v ic e
h e m o p t y s is .
re fu s e d
a d a y)
5 1 - y e a r - o ld
s u rg e ry
la r y n g e a l c a r c in o m a had
u n its
w as
ad
c o m p la in in g
o f
m o n th s
to
O n
and
c o rro d e n s , E co ccu s
o f
s e n s itiv e
th e h is
la r g e
w as
b y
fie ld
and
second
g iv e n
b u t
o r ig in a l a ls o
f iv e
right side of the heart. Short right coronary artery.
c o a g u la s e s it iv e
to
Situs inversus of abdominal organs, complete. Left thoracotomy wound of the anterior chest wall. (His tory of left Blalock-Taussig anastomosis for the relief of pulmonary stenosis 25 years before death.) Bilateral thoracotomy wound of the anterior chest wall, severe. (History of open heart surgery and Brock pro
la te r
th e
m g,
E
la t e r .
n e ck w as
n e g a tiv e .
T h is
a m p ic illin p a tie n t
fo u r
and
w as
a ll
fo rm e d
and
w e re
H e
w as
a
d a y)
t im e s
b e lo w
secon d
c o rro d e n s a lo n g
s tre p to c o c c u s ,
E
s tre p to
ty p e ;
T h is
5 ,4 0 0
r e v e a le d
c e p h a lo th in .
abscess
days
r e v e a le d
h e m o ly tic
and
(5 0 0
a n o th e r
s it e
C u lt u r e s
L a n c e fie ld
a m p ic illin
he
r a d io
h o s p it a l d a y ,
c o li, a n d a lp h a h e m o l y t i c
c e p h a lo t h in
o r a lly ,
a te
d r a in e d .
u n c e r t a in
to
b e fo re ,
b e e n d ia g n o s e d , a n d
T re a tm e n t
a n a b s c e s s o n th e a n t e r io r a s p e c t o f h is d is c o v e r e d
a d m in
( T a b le ) .
th e
a s p ir
w ith
a lp h a
s ta p h y lo c o c c u s
is o la t io n
a ls o
c e p h a lo t h in . d is c h a r g e d ;
w a s
S even
th e
sen days
a re a
w as
s t ill d r a in in g .
Is o la tio n and s e n s itiv ity te s tin g p ro c e d u re s
cedure for relief of stenosis of the pulmonary valve 13 years before death.) Left Blalock-Taussig anastomosis. Fibrosis and fibrous adhesions of the pericardium of the heart to the anterior chest wall, epicardium, and both
A s p ir a te s
fro m
abscesses
w e re
c u ltu r e d
a t 37
C
a e r o b ic a lly a n d a n a e r o b ic a lly o n s h e e p r e d b lo o d c e ll
lungs, severe. Hypertrophy and dilatation of the common atrium and common ventricle of the heart, moderate. Chronic passive congestion of the liver and spleen, moderate. 3. Atelectasis and emphysema of both lungs, slight. 4. Hemorrhagic infarction of the descending colon,
agar
scesses 37 C w e re
and
w e re
in s p e c t e d
an d
48
h o u rs
48
h o u rs .
W h e n
agar
c u ltu r e d
and
and
s u b c u lt u r e s
agar u n d e r C O
g ro w th th e
v is u a l
b ro th ,
in c u b a t e d
b ro th .
on
a
a e r o b ic
a fte r
g ro w th
w e re
c u ltu r e s
c u ltu r e
a p p e a re d s t a in
m ade
a n a e r o b ic a lly
on
and
ab
a g a r at
in c u b a t io n
a n a e r o b ic
G ra m ’s
B r a in
c h o c o la t e
d io x id e . T h e
fo r
24
in e d
th io g ly c o la te
u n d e r c a rb o n
th io g ly c o la te
severe.
in a ls o
o f
a fte r in
th e
w as
e xa m
sheep
b lo o d
on
c h o c o la t e
2.
T ab le ■ Factors related to three cases involving E corrodens. A n t ib io t ic tr e a tm e n t b e fo r e d ia g n o s is
C ase
S o u rc e o f is o la t io n
A c c o m p a n y in g o r g a n is m s
C ase 1
B r a in a b s c e s s
P e p to s t r e p t o c o c c u s O ra l p e n ic illin A lp h a s t r e p to c o c c u s
C ase 2
S u b lin g u a l & s u b m a n d ib u la r abscesses
B a c te r o id e s
C ase 3
A bscess on a n t e r io r a s p e c t o f neck
E coli, a lp h a s t r e p to c o c c u s , s t a p h y lo c o c c u s c o a g u la s e n e g a tiv e
A n t ib io t ic t r e a tm e n t a f te r d ia g n o s is
C o e x is tin g e n t r ie s
C lin ic a l c o u rs e
2 0 m illio n u n its IV p e n ic illin , IV c h lo r a m p h e n ic o l, IM k a n a m y c in
C o r b ilo c u la r e
P a tie n t d ie d
E r y th r o m y c in o r a lly , 2 5 0 m g , f o u r t im e s a day
1 0 m illio n u n its IV p e n ic illin
G 6P D d e f ic ie n c y
H o s p it a liz a t io n . S lo w im p r o v e m e n t. R e c o v e re d .
None
C e p h a lo th in ( K e fle x ) 2 5 0 -5 0 0 m g , f o u r tim e s a d a y
L a ry n g e a l c a r c in o m a , r a d ia tio n th e r a p y
A b s c e s s r e fo rm e d . S lo w r e c o v e r y a fte r in c is io n & d r a in a g e & a n t ib io t ic s
Glassman—Simpson: EIKENELLA CORRODENS ■ 1239
A ll colonies on sheep blood agar and chocolate agar were examined by G ram ’s stain. Small, d ry, colorless colonies that eroded into the agar after 48 hours’ incubation were shown to con tain small pleom orphic gram-negative bacilli. The organism was catalase negative, oxidase positive, indole negative, and nitrate positive and produced both smooth “ nonpitting” and rough “ p ittin g ” colonies on subculture to sheep blood agar incubated at 37 C aerobically fo r 48 to 72 hours. Because o f the colonial, cellular m orphology and the biochemical reactions o f this organism, a tentative identification o f E cor rodens was made, and subcultures were sent to the state health department fo r confirm ation. O u r in v itro susceptibility studies were set up d ire ctly from pure subcultures using M uellerH in to n agar w ith sheep blood. The K irby-B auer method was not used because o f the fastidious nature o f E corrodens. The in h ib ito ry zone measurement standards from the K irby-B auer method were, however, used to determine sen s itiv ity , resistance, or intermediacy. C orrelation w ith m inim al in h ib ito ry concentrations was not perform ed.
Discussion E corrodens is o f significance in dental practice because o f the ubiquitous commensal nature of the organism, the potential clinical virulence, the false security o f in v itro sensitivities, and possible d iffic u lty in isolating the organism be cause o f slow grow th or special media require ments. In the three patients discussed here, each o f the isolates appeared to be sensitive by in vitro disk sensitivity methods to generally used anti biotics. There is a problem o f whether direct disk sensitivities are tru ly transferable to the in vivo situation because o f the fastidious nature o f the organism. E corrodens in these patients was isolated by a variety o f techniques including hemin-enriched medium (sheep red blood cell agar) aerobically in tw o instances, blood agar, chocolate agar, and under C O 2, once each, and in thioglycolate an aerobically in one instance. Cultures were sent to the state health department on each occasion fo r confirm atory identification. The technique fo r isolation fro m clinical specimens has been described earlier. Slow facultative anaerobe grow th characteristics are sought. The organism 1240 ■ JADA, V o l. 91, D ecem ber 1975
can be missed in standard clinical laboratory practice. This is a reflection o f its slow growth rate, production o f small colonies, sometimes small numbers o f colonies, and the frequency in which it occurs mixed w ith other aerobic and anaerobic organisms. D entists, physicians, and laboratory workers should be aware o f the or ganism so that special attention is used to seek and isolate it. A review o f recent literature and the exper iences reported here indicate that E corrodens occurs in clinically apparent infections w ith much greater frequency than previously real ized. One should be particularly aware of the possibility o f infection in patients who have un dergone dental extractions or manipulations, persons w ith subcutaneous abscesses in the head and neck, and in instances o f a debilitated or altered host.7,8 The cases reported here illus trate the potential o f E corrodens systemic and severe local infections after dental manipulation. Since in each patient E corrodens occurred in the presence o f other potential pathogens, syner gism w ith other organisms should be considered. Pathogenicity o f this organism now seems to be established. I t has been documented repeat edly to occur in significant and lethal infections. Infections occur both w ith the Eikenella alone and mixed w ith other organisms.9,10 The pos sible synergism o f E corrodens and alpha strep tococcus, resulting in a higher grade o f virulence, has been raised by others.9 These tw o organ isms were found together in tw o o f our three cases. A lthough the Eikenella isolates in each o f our cases exhibited in v itro sensitivity to penicillin, am picillin, erythrom ycin, kanam ycin, chloram phenicol, or a com bination o f these, one patient died despite prophylactic penicillin and postm anipulative large doses o f intravenous peni c illin and chloramphenicol and intram uscular kanamycin. A severe sublingual abscess that re quired repeated surgical incision and drainage developed in another patient. E rythrom ycin had been administered prophylactically fo r three days and was given fo r tw o days after dental treatment; the patient also received subsequent intravenous penicillin w hile hospitalized.11
Summary E corrodens occurs as a significant clinical infec tion more frequently than suspected o r cultured at the present time. I t is essential that the den tist or physician w ork closely w ith the laboratory
c lin ic ia n
in
o rd e r
to
use
p ro p e r
t e c h n iq u e s
fo r
1. H e n rik s e n ,
S .D .
C o r r o d in g
b a c t e r ia
t r a c t : 2. B a c te r o id e s c o r r o d e n s . A c t a it s
is o la tio n .
d is k
In c o n s is te n c ie s
s e n s itiv it y
n o te d .
and
c lin ic a l
b e tw e e n d ru g
in
re s p o n s e
v it r o a re
B e c a u s e o f c lin ic a l r e s p o n s e , th e c lin ic ia n
fro m
P a th o l
th e
r e s p ir a t o r y
M ic r o b io l S c a n d
7 5 :9 1 , 1969. 2. H e n rik s e n , G r a m - n e g a tiv e
S .D .
S t u d ie s
a n a e r o b ic
in
ro d s
g r a m - n e g a tiv e
w ith
s p r e a d in g
a n a e ro b e s , c o lo n ie s .
II.
A c ta
P a th o l M ic r o b io l S c a n d 2 5 :3 6 8 , 1948. m u s t c a r e f u lly to
r e c o g n iz e
c o m b in a tio n
f o llo w
th e
a n t ib io t ic th e ra p y
p a t ie n t ’ s d a ily
tre a tm e n t
p ro g re s s
f a ilu r e
o r a p p r o p r ia te
3 . E lk e n , M . S tu d ie s o n a n a n a e r o b ic , ro d s h a p e d , g r a m n e g a
so
th a t
t iv e m ic r o o r g a n is m : B a c te r o id e s c o r r o d e n s N. s p . A c t a P a th o l
in c is io n
and
M ic r o b io l S c a n d 4 3 :4 0 4 , 1958. 4. H ill, L .R .; S n e ll, J .J .; a n d
d r a in a g e
p ro c e d u re s
m a y
be
in it ia t e d .
L a P a g e , S .P . I d e n t if ic a t io n
and
c h a r a c t e r iz a t io n o f B a c te r o id e s c o r r o d e n s . J M e d M ic r o b io l 3 :4 8 3 A u g 1970. 5. J a c k s o n , F .L ., a n d o th e r s . T a x o n o m ic s t a tu s o f f a c u lt a t iv e a n d s t r ic t ly a n a e r o b ic " c o r r o d in g
S u p p o r te d
in
p a rt by th e
M e d ic a l
R e s e a rc h
F o u n d a t io n
of
b a c i ll i” t h a t h a v e b e e n c la s
s if ie d a s B a c te r o id e s c o r r o d e n s . J M e d M ic r o b io l 4 :1 7 1 M a y 197 1. 6. J a c k s o n , F .L ., a n d G o o d m a n , Y .E . T r a n s f e r o f t h e f a c u lt a
G e o r g ia .
tiv e ly a n a e r o b ic o r g a n is m B a c te r o id e s c o r r o d e n s E ik e n to a n e w T h e c o o p e r a tio n o f t h e p e r s o n n e l f r o m th e v a r io u s c lin ic a l d e
g e n u s E ik e n e lla . In t J S y s t B a c te r io l 2 2 :7 3 , 197 2.
p a r t m e n ts in t h e S c h o o l o f M e d ic in e a n d D e n tis tr y a t th e M e d
7. Z in n e r , S . H .: D a ly , A .K .: a n d M c C o r m a c k , W .M . Is o la t io n o f
ic a l C o lle g e o f G e o r g ia is a c k n o w le d g e d . T h e a u to p s y o n th e
E ik e n e lla c o r r o d e n s in a g e n e ra l h o s p ita l. A p p l M ic r o b io l 2 5 :7 0 5 M a y 1973.
p a t ie n t in c a s e n o . 1 w a s p e r f o r m e d b y D r. B e r t h a M o r a le s o f t h e
8. K h a ir a t,
d e p a r t m e n t o f p a t h o lo g y .
O.
B a c te r o id e s
c o rro d e n s
is o la te d f r o m
b a c te r -
ia e m ia s . J P a th B a c t 9 4 :2 9 J u ly 1967. P re s e n te d in p a r t a t t h e 4 5 th
m e e tin g o f t h e A s s o c ia t io n
of
9. B r o o k s , G .F ., a n d o th e r s . E ik e n e lla c o r r o d e n s : a n e w p a t h o g e n . C lin R e s 2 1 :841, 1973.
C lin ic a l S c ie n t is t s , M a r c h 8 -1 0 , 1974, a t L a J o lla , C a lif.
10. D o r ff, G .J .; L e o n , J .J .; a n d R y te l, M .W . I n f e c t io n s w ith a D r. G la s s m a n is d i r e c t o r o f c lin ic a l la b o r a to r ie s , p r o f e s s o r o f
n e w ly r e c o g n iz e d h u m a n p a t h o g e n . C lin R e s 2 1 :8 4 2 , 197 3. 11.
S im p s o n , J .S ., a n d G la s s m a n , A .B . E ik e n e lla c o r r o d e n s :
p a t h o lo g y a n d m e d ic a l te c h n o lo g y , a n d a s s o c ia te p r o f e s s o r o f c e ll a n d m o le c u la r b io lo g y a t th e S c h o o l o f M e d ic in e , M e d ic a l
d is c r e p a n c y b e tw e e n c lin ic a l d r u g re s p o n s e a n d in - v itr o s e n s i
C o lle g e o f G e o r g ia , A u g u s ta , 3 0 9 0 2 . D r. S im p s o n , f o r m e r ly
tiv it y . A m J P a th o l 7 4 :1 0 8 a , 1 97 4.
a
s e n io r m e d ic a l s t u d e n t a t th e M e d ic a l C o lle g e o f G e o r g ia , is an in te r n
In t h e d e p a r t m e n t o f s u r g e r y a t th e
U n iv e r s ity o f K e n
t u c k y . A d d re s s r e q u e s ts f o r r e p r in t s t o D r. G la s s m a n .
Foley’s Footnotes ----------------I h o p e I h a v e b e e n u s in g g o o d ju d g m e n t in a s s u m in g t h a t m y r e a d e r s e n jo y s t o r ie s a b o u t v is its t o t h e d e n tis t, f o r I h a v e in c lu d e d m a n y s u c h a c c o u n ts in th e s e “ F o o tn o t e s . ” O n e o f m y f a v o r it e s w a s to ld b y J o h n S t. L o e S tr a c h e y , f o r m a n y y e a r s e d ito r o f T h e S p e c ta to r , in h is “ s u b je c t iv e a u t o b io g r a p h y ” The A d v e n tu r e o f L iv in g (1 9 2 2 ). T h e v is ito r w a s M ile , d e P e y ro n n e t, t h ir d o f th e f o u r r e m a r k a b le d a u g h te r s o f M m e . P e y ro n n e t, a ll o f t h e m a ttr a c t iv e w o m e n a n d b r illia n t c o n v e r s a tio n a lis ts .
I t h in k h e r r e p a rte e , o r r a th e r je u d e m o t, a t th e d e n t is t ’s, w h ic h w e n t t h e r o u n d o f L o n d o n , t h e b e s t e x a m p le I c a n ta k e b y w a y o f illu s t r a tio n [ o f h e r w i t ] . M o s t p e o p le a re d r e a r y a n d d e p re s s e d in a d e n t is t ’s c h a ir . N o t s o M ile , d e P. E ve n h e r e s h e k e p t n o t o n ly h e r g o o d - t e m p e r , b u t a ls o h e r b r illia n t im a g in a t io n a n d , a b o v e a ll, h e r v e r b a l f e lic it y . T h e s c e n e p a s s e s in a D e n ta l A t e lie r in P a ris . M ile , d e P. m u s t b e im a g in e d s e a te d in t h e f a t e f u l c h a ir, d r e a d in g th e p a in , b u t h o p in g f o r th e r e lie f o f an e x t r a c tio n . T h e d e n tis t, in s te a d o f d o in g h is w o r k d e ftly , b u n g le d it, o r e ls e it w a s th e f a u lt o f th e p a t ie n t ’s ja w . A t a n y ra te , th e t o o th b r o k e o f f in th e f o r c e p s , a n d t h e d e n tis t h a d t o c o n fe s s t o t h e p a t ie n t t h a t a ll t h e p a in h e h a d g iv e n h e r w a s u s e le s s . H e h a d le ft in th e r o o t ! “ A h , m a d e m o is e lle ,” h e e x c la im e d , “ q u e lle t r a g e d ie ! ” B u t th e p a tie n t, th o u g h s u f fe r in g a c u te a g o n y , w a s w o r t h y o f th e o c c a s io n . S h e d id n o t p a u s e f o r a n in s ta n t in h e r c o m m e n t — “ U n e T r a g e d ie d e R a c in e ! " [T h e F r e n c h w o r d r a c in e m e a n s “ r o o t . ” ] C o u ld a n y t h in g
h a v e b e e n h a p p ie r , n e a te r, m o re g o o d - t e m p e r e d , m o r e e x a c tly a p p r o p r ia te ? I
s o m e tim e s fe e l I w o u ld r a th e r h a v e s a id t h a t th a n h a v e w r itt e n R a c in e ’s M ith rid a te s .
Gardner P. H. Foley
Glassman—Simpson: EIKENELLA CORRODENS ■ 1241
Eikenella corrodens:
a clin ical p ro b le m
E ik e n e lla c o r r o d e n s , a g r a m - n e g a t iv e f a c u lt a t iv e
A rm an d B. G la s s m a n , MD J a m e s S. S im p so n , MD, Augusta, Ga
a n a e ro b e ,
has
been
d e s c r ib e d
n o n e n c a p s u la te d ,
s lig h t ly
ro u n d e d
te n d s
end s;
p h e n o m e n a
it
on
aga r
to
n o n s p o r in g ,
p ro d u c e
p la te s .
It
e x is ts
w ith
“ p itt in g ” as
a
m e m b r a n e s o f t h e g e n it a l t r a c t in w o m e n ,
negative, facultative anaerobe. Its pathogenicity has been disputed because it is frequently mixed with other organisms when cultured from clinical materials. Three cases involving E c o rro d e n s are presented; tw o of the infections follow ed dental m anipulations and the other occurred with laryn geal carcinoma. The possible discrepancy be tween in vitro disk sensitivities and patient re sponse is explored. Practitioners should be alert to the role of this organism especially in mixed cul ture clinical infections. We believe that the patho genicity, problems with treatment, and the clinical significance of these infections have been under estimated.
B ecause
o f
c a v ity
and
p r is in g
to
d itio n s , re p o rt is m
th e
t h is
lo w e r c lo s e
u p p e r
p r o v id e s
tra c t,
and
it s
in fe c t io n
som e
c lin ic a l
r e c e n t p a t ie n ts
th re e
cases
p o in t
h a z a rd s , a n d
o r
r e c o g n itio n seen
o u t
w as
H B 1 in
is o la t e d fro m
as
1958, m a d e
w e re
s tr a in s
o b ta in e d
a
f a c u lt a t iv e w as
m e d iu m
b y
ic a l
s u r
t h is
and
th e
Ja ckso n
c h a r a c t e r is t ic s
to
B a c te r o id e s c o r fir s t
e a r ly
and o f
d e s c r ib e d
d e s c r ip tio n ,
a n a e r o b ic
o r g a n is m s .
o r
fro m
s tu d y o f H is
c u l
in fe c t io n s
o f
h a s b e e n d e s c r ib e d
b y
g ro w
th e
p e r s is t e n c e ,
p e r ia n a l a b s c e s s e s .
p r im a r ily
a n a e ro b e
sh o w n
d e s c r ib e s
a c o m p r e h e n s iv e
o f
T h is o rg a n
o r g a n is m .
w as
t h e o r a l r e g io n . T h e o r g a n is m
e rs 4 a n d
th e
and
a g r a m - n e g a t iv e
p u lm o n a r y
o f
n u m b e r
It
1 9 4 8 .2 I n
E ik e n , 3 in
as
o ra l
n o t
r e s u lt . o f
p o t e n t ia l
o f t h is
b a c illu s .
a
tu re s
is
tra c t.1
th e
a t o u r in s titu t io n ;
th e
v ir u le n c e
H e n r ik s e n
g a n is m
it
can
d e s c r ip tio n
E c o r ro d e n s h a s b e e n c a lle d
it
w ith
im a g in e t h a t u n d e r p r o p e r c lin ic a l c o n
th re e
b y
m o u th ,
g a s t r o in t e s t in a l
a s s o c ia t io n
r e s p ir a t o r y
s ig n if ic a n t
ro d e n s
tra c t,
co m
m u co u s
p o s s ib ly
r e s p ir a t o r y
ro d
a
o f
and
u p p e r
a
m ensal
E ikenella c o rro d e ns (also known as HB1) is a gram-
th e
as
p le o m o r p h ic
H ill on
and
c o -w o rk
h e m in - e n r ic h e d
c o - w o r k e r s . 5 B io c h e m th e
o r g a n is m
in c lu d e
a
JADA, Vol. 91, December 1975 ■ 1237
p o s itiv e
o x id a s e
s m o o th
c o lo n ie s
“ p itt in g , ” 57 to fo r
a
m o st
th e
o r g a n is m
it s
Ja ckso n
in
and
a
th e fa m ily
th e
ly s in e
p lu s
fa c u lt a t iv e
new
in
p lu s
te s t,
h e m o ly tic ty p e , a n d in
p u re
s e n s itiv it ie s .
E ik e n
p e n ic illin
because
o f th e
c o n te n t
o f
in
fo u r
e q u a lly
e n c o u n te re d
th re e
cases
w e
have
ro d e n s .
s e v e ra l o f
a
A
3 3 - y e a r - o ld
c o n g e n it a l c a r d ia c
co m m o n
a t r io v e n t r ic u la r
in v e r s u s , w a s
m adge o f
M e m o r ia l
s e iz u r e
H o s p it a l
a c t iv ity ,
a d m is s io n ,
f ille d ”
and
“ th o ro u g h
had
been
a
g iv e n
to
p e n ic illin
th e
because
m a la is e ,
b e fo re
canal
she
(c o r
d e n ta l
b ilo -
p a r tia l
E u gene o f th e
and had
w ith
c o n s is tin g
s te n o s is , a n d
a d m it t e d
m o n th
w o m a n
a n o m a lie s ,
c u la r e ) , v a lv u la r p u lm o n a r y s it u s
w h it e
a
T a lonset
fe v e r. had
O n e
“ to o th
c le a n in g . ”
p r o p h y la c t ic a lly
to
(0 .5
g m ,
A
to
im b a la n c e ,
c o m p le te
■
C ase
She
fo r an
no.
2:
A
d e f ic ie n c y
re p o rte d
t ie n t d e p a r tm e n t c o m p la in in g w as
e x a m in e d ,
and
h is
d a ys,
and
t in u e d th e
a
r e g im e n
b r a in
lo b e ,
w h ic h
fe v e r.
abscess w as
o f
d r a in e d
S u b se q u e n t th e
le ft
o f 40
m l
e v a l
p a r ie ta l o f fo u l
b la c k
b r a in
to
m an
w ith
d e h y d ro g e n a s e th e
d e n ta l o u tp a
o f a to o th a c h e . r ig h t
a fte r th e
to o th
e x tr a c tio n ,
he
e r y th r o m y c in
e x tr a c tio n .
H e
t h ir d
w a s
F iv e
h o s p ita liz e d
f o r th re e w as
c o n
d a y s a fte r
w ith
a
sub
m a n d ib u la r a n d
s u b lin g u a l a b s c e s s
th a t r e q u ir e d
s u r g ic a l in c is io n
and
a s p ir a te g r e w
d r a in a g e . T h e
E c o rro d e n s a n d a b a c t e r o id e s , n o t t y p e d . E a c h
and
g ra d e
12
o f sep
p e rfo rm e d
p r o p h y la c t ic a lly o f
m a la is e
an
w as
pa
d ie d
m o la r w a s e x tr a c te d . E r y t h r o m y c in (2 5 0 m g , f o u r t im e s a d a y ) w a s g iv e n
in
lo w
T h e
and
m a n d ib u la r
e r y th r o m y c in .
and
d a y ).
p e r s is t e n t
p h o s p h a te
had
r e v e a le d
m g /k g /d a y k a n a m y c in
h o s p it a l,
7 8 - y e a r - o ld
g lu c o s e - 6
and
u a t io n
o f
a d a y ),
1, 2 ).
o r g a n is m
b e fo re
th e and
p e n ic illin
o f t im e
a
a u to p s y
d e n ta l m a n ip u la
p e r io d
50
th e ra p y
d is k
doses
u n its
and
t w ic e
to
p e n ic illin , d ir e c t
m a s s iv e
d o s e s ),
re s p o n d
e le c tr o ly te
to
m illio n
t io n . A f t e r th e d e n ta l v is it , s h e n o te d th e o n s e t o f
u n k n o w n
L a n c e fie ld
b y
( C h lo r o m y c e t in , d iv id e d
a f t e r h e r a d m is s io n
k n o w n
C ase no. I:
(2 0
days
(G o P D )
•
o f
a lp h a
re
E c o r
in v o lv in g
g iv e n
f a ile d
( F ig o f G e o r g ia ,
w as
t ie n t
abscess.
s e n s itiv e
k a n a m y c in
in t r a v e n o u s ly
in t r a m u s c u la r ly
M e d ic a l C o lle g e
C u lt u r e
o f u n c e r t a in
w a s
and
S he
c h lo r a m p h e n ic o l
s is ,
c e n t ly
s u b c u lt u r e
p la c e d
R e p o rt o f cases th e
s tre p to c o c c u s
1972
c y to s in e
m a te r ia l.
p e p to s tre p to c o c c u s ,
E c o rro d e n s . E a c h o f th e s e o r g a n is m s
c h lo r a m p h e n ic o l,
o f
b ro w n
r e v e a le d
o rg a n
D N A .
A t
g r e e n is h
abscess
t h is
th a t
o f b r u c e lla c e a e
s m e llin g , th e
c y t o s in e
a n a e r o b e . 4 ,5 o f
genus,
and
p r o d u c in g
d e c a r b o x y la s e
q u a n in e
G o o d m a n “
q u a n in e
o f ro u g h
ro u g h
c la s s ific a tio n
and
in
p e rc e n t
p re s e n c e
o n ly
o f D N A
re c e n t
b y
m o le s
%
s tr a in s ,
m ost
is m
e lla ,
w ith
p o s itiv e
5 8 m o le s
T h e
te s t, th e
d r a in a g e
r e q u ir e d . d ays
H e
v it r o
d ir e c t
p ro c e d u re s began
la te r a n d
to
s lo w ly
d is k T w o
w ith
s h o w
s e n s itiv it ie s m o re
ir r ig a t io n s
im p r o v e m e n t s
re c o v e re d ;
m a s s iv e
F ig 1 ■ B r a in a u t o p s y s p e c im e n f r o m
to
in c is io n w e re e ig h t doses
p a tie n t in
c a s e n o . 1. A b s c e s s o f le ft p a r ie ta l lo b e is e v id e n t. C u lt u r e w a s p o s itiv e f o r E corrodens, p e p to s tr e p t o c o c c u s , a n d a lp h a h e m o ly tic s t r e p to c o c c u s .
1238 ■ JADA, Vol. 91, December 1975
o f p e n ic illin
F ig 2
■ C a s e n o . 1, a u t o p s y re s u lts .
is t e r e d
1. Abscess of the left parietal lobe of the brain, severe, with infarct of the surrounding tissue. (History of dental work nine weeks before death and diagnosis of brain abscess ten days before death.) Eikenella corrodens, peptostreptococcus, alpha streptococcus grown from cultures taken at autopsy. Infarct of the cortex of the left frontal lobe of the brain, slight. 2. Congenital malformations of the heart and great
■
(1 0 m illio n
in tr a v e n o u s ly
C ase no. 3 :
m it te d
to
co u g h
and
A
th e
vessels: Persistent atrioventricularis communis, severe. Stenosis of the pulmonary valve, moderate. Bicuspid pulmonary valves, moderate. Right aortic arch, severe. Persistent patent ductus arteriosus, moderate. Total anomalous venous pulmonary return. Persistent left superior vena cava. Rudimentary coronary sinus. Anomalous coronary arteries: two orifices of the left coronary artery, the largest branch irrigating left and
w h it e
m an
o f 2 ,4 0 0 r a d s
ra d s
th e
la r y n x .
F iv e
had
s u rg e ry .
th e ra p y to
w e re
s e r v ic e
h e m o p t y s is .
re fu s e d
a d a y)
5 1 - y e a r - o ld
s u rg e ry
la r y n g e a l c a r c in o m a had
u n its
w as
ad
c o m p la in in g
o f
m o n th s
to
O n
and
c o rro d e n s , E co ccu s
o f
s e n s itiv e
th e h is
la r g e
w as
b y
fie ld
and
second
g iv e n
b u t
o r ig in a l a ls o
f iv e
right side of the heart. Short right coronary artery.
c o a g u la s e s it iv e
to
Situs inversus of abdominal organs, complete. Left thoracotomy wound of the anterior chest wall. (His tory of left Blalock-Taussig anastomosis for the relief of pulmonary stenosis 25 years before death.) Bilateral thoracotomy wound of the anterior chest wall, severe. (History of open heart surgery and Brock pro
la te r
th e
m g,
E
la t e r .
n e ck w as
n e g a tiv e .
T h is
a m p ic illin p a tie n t
fo u r
and
w as
a ll
fo rm e d
and
w e re
H e
w as
a
d a y)
t im e s
b e lo w
secon d
c o rro d e n s a lo n g
s tre p to c o c c u s ,
E
s tre p to
ty p e ;
T h is
5 ,4 0 0
r e v e a le d
c e p h a lo th in .
abscess
days
r e v e a le d
h e m o ly tic
and
(5 0 0
a n o th e r
s it e
C u lt u r e s
L a n c e fie ld
a m p ic illin
he
r a d io
h o s p it a l d a y ,
c o li, a n d a lp h a h e m o l y t i c
c e p h a lo t h in
o r a lly ,
a te
d r a in e d .
u n c e r t a in
to
b e fo re ,
b e e n d ia g n o s e d , a n d
T re a tm e n t
a n a b s c e s s o n th e a n t e r io r a s p e c t o f h is d is c o v e r e d
a d m in
( T a b le ) .
th e
a s p ir
w ith
a lp h a
s ta p h y lo c o c c u s
is o la t io n
a ls o
c e p h a lo t h in . d is c h a r g e d ;
w a s
S even
th e
sen days
a re a
w as
s t ill d r a in in g .
Is o la tio n and s e n s itiv ity te s tin g p ro c e d u re s
cedure for relief of stenosis of the pulmonary valve 13 years before death.) Left Blalock-Taussig anastomosis. Fibrosis and fibrous adhesions of the pericardium of the heart to the anterior chest wall, epicardium, and both
A s p ir a te s
fro m
abscesses
w e re
c u ltu r e d
a t 37
C
a e r o b ic a lly a n d a n a e r o b ic a lly o n s h e e p r e d b lo o d c e ll
lungs, severe. Hypertrophy and dilatation of the common atrium and common ventricle of the heart, moderate. Chronic passive congestion of the liver and spleen, moderate. 3. Atelectasis and emphysema of both lungs, slight. 4. Hemorrhagic infarction of the descending colon,
agar
scesses 37 C w e re
and
w e re
in s p e c t e d
an d
48
h o u rs
48
h o u rs .
W h e n
agar
c u ltu r e d
and
and
s u b c u lt u r e s
agar u n d e r C O
g ro w th th e
v is u a l
b ro th ,
in c u b a t e d
b ro th .
on
a
a e r o b ic
a fte r
g ro w th
w e re
c u ltu r e s
c u ltu r e
a p p e a re d s t a in
m ade
a n a e r o b ic a lly
on
and
ab
a g a r at
in c u b a t io n
a n a e r o b ic
G ra m ’s
B r a in
c h o c o la t e
d io x id e . T h e
fo r
24
in e d
th io g ly c o la te
u n d e r c a rb o n
th io g ly c o la te
severe.
in a ls o
o f
a fte r in
th e
w as
e xa m
sheep
b lo o d
on
c h o c o la t e
2.
T ab le ■ Factors related to three cases involving E corrodens. A n t ib io t ic tr e a tm e n t b e fo r e d ia g n o s is
C ase
S o u rc e o f is o la t io n
A c c o m p a n y in g o r g a n is m s
C ase 1
B r a in a b s c e s s
P e p to s t r e p t o c o c c u s O ra l p e n ic illin A lp h a s t r e p to c o c c u s
C ase 2
S u b lin g u a l & s u b m a n d ib u la r abscesses
B a c te r o id e s
C ase 3
A bscess on a n t e r io r a s p e c t o f neck
E coli, a lp h a s t r e p to c o c c u s , s t a p h y lo c o c c u s c o a g u la s e n e g a tiv e
A n t ib io t ic t r e a tm e n t a f te r d ia g n o s is
C o e x is tin g e n t r ie s
C lin ic a l c o u rs e
2 0 m illio n u n its IV p e n ic illin , IV c h lo r a m p h e n ic o l, IM k a n a m y c in
C o r b ilo c u la r e
P a tie n t d ie d
E r y th r o m y c in o r a lly , 2 5 0 m g , f o u r t im e s a day
1 0 m illio n u n its IV p e n ic illin
G 6P D d e f ic ie n c y
H o s p it a liz a t io n . S lo w im p r o v e m e n t. R e c o v e re d .
None
C e p h a lo th in ( K e fle x ) 2 5 0 -5 0 0 m g , f o u r tim e s a d a y
L a ry n g e a l c a r c in o m a , r a d ia tio n th e r a p y
A b s c e s s r e fo rm e d . S lo w r e c o v e r y a fte r in c is io n & d r a in a g e & a n t ib io t ic s
Glassman—Simpson: EIKENELLA CORRODENS ■ 1239
A ll colonies on sheep blood agar and chocolate agar were examined by G ram ’s stain. Small, d ry, colorless colonies that eroded into the agar after 48 hours’ incubation were shown to con tain small pleom orphic gram-negative bacilli. The organism was catalase negative, oxidase positive, indole negative, and nitrate positive and produced both smooth “ nonpitting” and rough “ p ittin g ” colonies on subculture to sheep blood agar incubated at 37 C aerobically fo r 48 to 72 hours. Because o f the colonial, cellular m orphology and the biochemical reactions o f this organism, a tentative identification o f E cor rodens was made, and subcultures were sent to the state health department fo r confirm ation. O u r in v itro susceptibility studies were set up d ire ctly from pure subcultures using M uellerH in to n agar w ith sheep blood. The K irby-B auer method was not used because o f the fastidious nature o f E corrodens. The in h ib ito ry zone measurement standards from the K irby-B auer method were, however, used to determine sen s itiv ity , resistance, or intermediacy. C orrelation w ith m inim al in h ib ito ry concentrations was not perform ed.
Discussion E corrodens is o f significance in dental practice because o f the ubiquitous commensal nature of the organism, the potential clinical virulence, the false security o f in v itro sensitivities, and possible d iffic u lty in isolating the organism be cause o f slow grow th or special media require ments. In the three patients discussed here, each o f the isolates appeared to be sensitive by in vitro disk sensitivity methods to generally used anti biotics. There is a problem o f whether direct disk sensitivities are tru ly transferable to the in vivo situation because o f the fastidious nature o f the organism. E corrodens in these patients was isolated by a variety o f techniques including hemin-enriched medium (sheep red blood cell agar) aerobically in tw o instances, blood agar, chocolate agar, and under C O 2, once each, and in thioglycolate an aerobically in one instance. Cultures were sent to the state health department on each occasion fo r confirm atory identification. The technique fo r isolation fro m clinical specimens has been described earlier. Slow facultative anaerobe grow th characteristics are sought. The organism 1240 ■ JADA, V o l. 91, D ecem ber 1975
can be missed in standard clinical laboratory practice. This is a reflection o f its slow growth rate, production o f small colonies, sometimes small numbers o f colonies, and the frequency in which it occurs mixed w ith other aerobic and anaerobic organisms. D entists, physicians, and laboratory workers should be aware o f the or ganism so that special attention is used to seek and isolate it. A review o f recent literature and the exper iences reported here indicate that E corrodens occurs in clinically apparent infections w ith much greater frequency than previously real ized. One should be particularly aware of the possibility o f infection in patients who have un dergone dental extractions or manipulations, persons w ith subcutaneous abscesses in the head and neck, and in instances o f a debilitated or altered host.7,8 The cases reported here illus trate the potential o f E corrodens systemic and severe local infections after dental manipulation. Since in each patient E corrodens occurred in the presence o f other potential pathogens, syner gism w ith other organisms should be considered. Pathogenicity o f this organism now seems to be established. I t has been documented repeat edly to occur in significant and lethal infections. Infections occur both w ith the Eikenella alone and mixed w ith other organisms.9,10 The pos sible synergism o f E corrodens and alpha strep tococcus, resulting in a higher grade o f virulence, has been raised by others.9 These tw o organ isms were found together in tw o o f our three cases. A lthough the Eikenella isolates in each o f our cases exhibited in v itro sensitivity to penicillin, am picillin, erythrom ycin, kanam ycin, chloram phenicol, or a com bination o f these, one patient died despite prophylactic penicillin and postm anipulative large doses o f intravenous peni c illin and chloramphenicol and intram uscular kanamycin. A severe sublingual abscess that re quired repeated surgical incision and drainage developed in another patient. E rythrom ycin had been administered prophylactically fo r three days and was given fo r tw o days after dental treatment; the patient also received subsequent intravenous penicillin w hile hospitalized.11
Summary E corrodens occurs as a significant clinical infec tion more frequently than suspected o r cultured at the present time. I t is essential that the den tist or physician w ork closely w ith the laboratory
c lin ic ia n
in
o rd e r
to
use
p ro p e r
t e c h n iq u e s
fo r
1. H e n rik s e n ,
S .D .
C o r r o d in g
b a c t e r ia
t r a c t : 2. B a c te r o id e s c o r r o d e n s . A c t a it s
is o la tio n .
d is k
In c o n s is te n c ie s
s e n s itiv it y
n o te d .
and
c lin ic a l
b e tw e e n d ru g
in
re s p o n s e
v it r o a re
B e c a u s e o f c lin ic a l r e s p o n s e , th e c lin ic ia n
fro m
P a th o l
th e
r e s p ir a t o r y
M ic r o b io l S c a n d
7 5 :9 1 , 1969. 2. H e n rik s e n , G r a m - n e g a tiv e
S .D .
S t u d ie s
a n a e r o b ic
in
ro d s
g r a m - n e g a tiv e
w ith
s p r e a d in g
a n a e ro b e s , c o lo n ie s .
II.
A c ta
P a th o l M ic r o b io l S c a n d 2 5 :3 6 8 , 1948. m u s t c a r e f u lly to
r e c o g n iz e
c o m b in a tio n
f o llo w
th e
a n t ib io t ic th e ra p y
p a t ie n t ’ s d a ily
tre a tm e n t
p ro g re s s
f a ilu r e
o r a p p r o p r ia te
3 . E lk e n , M . S tu d ie s o n a n a n a e r o b ic , ro d s h a p e d , g r a m n e g a
so
th a t
t iv e m ic r o o r g a n is m : B a c te r o id e s c o r r o d e n s N. s p . A c t a P a th o l
in c is io n
and
M ic r o b io l S c a n d 4 3 :4 0 4 , 1958. 4. H ill, L .R .; S n e ll, J .J .; a n d
d r a in a g e
p ro c e d u re s
m a y
be
in it ia t e d .
L a P a g e , S .P . I d e n t if ic a t io n
and
c h a r a c t e r iz a t io n o f B a c te r o id e s c o r r o d e n s . J M e d M ic r o b io l 3 :4 8 3 A u g 1970. 5. J a c k s o n , F .L ., a n d o th e r s . T a x o n o m ic s t a tu s o f f a c u lt a t iv e a n d s t r ic t ly a n a e r o b ic " c o r r o d in g
S u p p o r te d
in
p a rt by th e
M e d ic a l
R e s e a rc h
F o u n d a t io n
of
b a c i ll i” t h a t h a v e b e e n c la s
s if ie d a s B a c te r o id e s c o r r o d e n s . J M e d M ic r o b io l 4 :1 7 1 M a y 197 1. 6. J a c k s o n , F .L ., a n d G o o d m a n , Y .E . T r a n s f e r o f t h e f a c u lt a
G e o r g ia .
tiv e ly a n a e r o b ic o r g a n is m B a c te r o id e s c o r r o d e n s E ik e n to a n e w T h e c o o p e r a tio n o f t h e p e r s o n n e l f r o m th e v a r io u s c lin ic a l d e
g e n u s E ik e n e lla . In t J S y s t B a c te r io l 2 2 :7 3 , 197 2.
p a r t m e n ts in t h e S c h o o l o f M e d ic in e a n d D e n tis tr y a t th e M e d
7. Z in n e r , S . H .: D a ly , A .K .: a n d M c C o r m a c k , W .M . Is o la t io n o f
ic a l C o lle g e o f G e o r g ia is a c k n o w le d g e d . T h e a u to p s y o n th e
E ik e n e lla c o r r o d e n s in a g e n e ra l h o s p ita l. A p p l M ic r o b io l 2 5 :7 0 5 M a y 1973.
p a t ie n t in c a s e n o . 1 w a s p e r f o r m e d b y D r. B e r t h a M o r a le s o f t h e
8. K h a ir a t,
d e p a r t m e n t o f p a t h o lo g y .
O.
B a c te r o id e s
c o rro d e n s
is o la te d f r o m
b a c te r -
ia e m ia s . J P a th B a c t 9 4 :2 9 J u ly 1967. P re s e n te d in p a r t a t t h e 4 5 th
m e e tin g o f t h e A s s o c ia t io n
of
9. B r o o k s , G .F ., a n d o th e r s . E ik e n e lla c o r r o d e n s : a n e w p a t h o g e n . C lin R e s 2 1 :841, 1973.
C lin ic a l S c ie n t is t s , M a r c h 8 -1 0 , 1974, a t L a J o lla , C a lif.
10. D o r ff, G .J .; L e o n , J .J .; a n d R y te l, M .W . I n f e c t io n s w ith a D r. G la s s m a n is d i r e c t o r o f c lin ic a l la b o r a to r ie s , p r o f e s s o r o f
n e w ly r e c o g n iz e d h u m a n p a t h o g e n . C lin R e s 2 1 :8 4 2 , 197 3. 11.
S im p s o n , J .S ., a n d G la s s m a n , A .B . E ik e n e lla c o r r o d e n s :
p a t h o lo g y a n d m e d ic a l te c h n o lo g y , a n d a s s o c ia te p r o f e s s o r o f c e ll a n d m o le c u la r b io lo g y a t th e S c h o o l o f M e d ic in e , M e d ic a l
d is c r e p a n c y b e tw e e n c lin ic a l d r u g re s p o n s e a n d in - v itr o s e n s i
C o lle g e o f G e o r g ia , A u g u s ta , 3 0 9 0 2 . D r. S im p s o n , f o r m e r ly
tiv it y . A m J P a th o l 7 4 :1 0 8 a , 1 97 4.
a
s e n io r m e d ic a l s t u d e n t a t th e M e d ic a l C o lle g e o f G e o r g ia , is an in te r n
In t h e d e p a r t m e n t o f s u r g e r y a t th e
U n iv e r s ity o f K e n
t u c k y . A d d re s s r e q u e s ts f o r r e p r in t s t o D r. G la s s m a n .
Foley’s Footnotes ----------------I h o p e I h a v e b e e n u s in g g o o d ju d g m e n t in a s s u m in g t h a t m y r e a d e r s e n jo y s t o r ie s a b o u t v is its t o t h e d e n tis t, f o r I h a v e in c lu d e d m a n y s u c h a c c o u n ts in th e s e “ F o o tn o t e s . ” O n e o f m y f a v o r it e s w a s to ld b y J o h n S t. L o e S tr a c h e y , f o r m a n y y e a r s e d ito r o f T h e S p e c ta to r , in h is “ s u b je c t iv e a u t o b io g r a p h y ” The A d v e n tu r e o f L iv in g (1 9 2 2 ). T h e v is ito r w a s M ile , d e P e y ro n n e t, t h ir d o f th e f o u r r e m a r k a b le d a u g h te r s o f M m e . P e y ro n n e t, a ll o f t h e m a ttr a c t iv e w o m e n a n d b r illia n t c o n v e r s a tio n a lis ts .
I t h in k h e r r e p a rte e , o r r a th e r je u d e m o t, a t th e d e n t is t ’s, w h ic h w e n t t h e r o u n d o f L o n d o n , t h e b e s t e x a m p le I c a n ta k e b y w a y o f illu s t r a tio n [ o f h e r w i t ] . M o s t p e o p le a re d r e a r y a n d d e p re s s e d in a d e n t is t ’s c h a ir . N o t s o M ile , d e P. E ve n h e r e s h e k e p t n o t o n ly h e r g o o d - t e m p e r , b u t a ls o h e r b r illia n t im a g in a t io n a n d , a b o v e a ll, h e r v e r b a l f e lic it y . T h e s c e n e p a s s e s in a D e n ta l A t e lie r in P a ris . M ile , d e P. m u s t b e im a g in e d s e a te d in t h e f a t e f u l c h a ir, d r e a d in g th e p a in , b u t h o p in g f o r th e r e lie f o f an e x t r a c tio n . T h e d e n tis t, in s te a d o f d o in g h is w o r k d e ftly , b u n g le d it, o r e ls e it w a s th e f a u lt o f th e p a t ie n t ’s ja w . A t a n y ra te , th e t o o th b r o k e o f f in th e f o r c e p s , a n d t h e d e n tis t h a d t o c o n fe s s t o t h e p a t ie n t t h a t a ll t h e p a in h e h a d g iv e n h e r w a s u s e le s s . H e h a d le ft in th e r o o t ! “ A h , m a d e m o is e lle ,” h e e x c la im e d , “ q u e lle t r a g e d ie ! ” B u t th e p a tie n t, th o u g h s u f fe r in g a c u te a g o n y , w a s w o r t h y o f th e o c c a s io n . S h e d id n o t p a u s e f o r a n in s ta n t in h e r c o m m e n t — “ U n e T r a g e d ie d e R a c in e ! " [T h e F r e n c h w o r d r a c in e m e a n s “ r o o t . ” ] C o u ld a n y t h in g
h a v e b e e n h a p p ie r , n e a te r, m o re g o o d - t e m p e r e d , m o r e e x a c tly a p p r o p r ia te ? I
s o m e tim e s fe e l I w o u ld r a th e r h a v e s a id t h a t th a n h a v e w r itt e n R a c in e ’s M ith rid a te s .
Gardner P. H. Foley
Glassman—Simpson: EIKENELLA CORRODENS ■ 1241