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Volume 16, Number 3—March 2010

Dispatch

Paenibacillus larvae Bacteremia in Injection Drug Users

Siegbert RiegComments to Author , Tilman Martin Bauer, Gabriele Peyerl-Hoffmann, Jürgen Held, Wolfgang Ritter, Dirk Wagner, Winfried Vinzenz Kern, and Annerose Serr
Author affiliations: University Hospital, Freiburg, Germany (S. Rieg, T.M. Bauer, G. Peyerl-Hoffman, J. Held, D. Wagner, W.V. Kern, A. Serr); Reference Laboratory of the World Organisation for Animal Health, Freiburg (W. Ritter)

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Table

Patient characteristics, clinical presentation, treatment, and laboratory and microbiologic results of 5 patients with Paenibacillus larvae bacteremia*

Characteristic Patient no.
1 2 3 4 5
Age, y/sex 28/F 32/M 20/M 35/M 27/F
Date evaluated 2003 Jul 2003 Sep 2003 Oct 2004 Feb 2008 May
Clinical samples with identification of P. larvae Culture of ascites (2003 Jul), blood culture (2003 Aug) Blood culture Blood culture Blood culture Blood culture
CRP, mg/L 43 17 11 37 40
Leukocyte count, × 109/L 23.0 13.0 9.3 11.8 19.2
Medical history IVDA, hepatitis C, Child B liver cirrhosis with refractory ascites IVDA, hepatitis C, hepatitis B IVDA, hepatitis C IVDA, hepatitis C, history of hepatitis A IVDA, hepatitis C, alcohol abuse
Clinical signs and symptoms Decompensated liver cirrhosis, ascites, fever (39.2°C) Persistent weakness and malaise, fever (39.2°C) Somnolence, fever (38.2°C) Tachypnoe, right-sided pleuritic chest pain, fever (37.8°C) Severe anemia, spontaneous mucosal bleeding, fever (39.8°C)
Clinical conditions other than bacteremia Bacterial peritonitis, hepatic encephalopathy after TIPS placement Acute hepatitis B diagnosed 1 mo before bacteremia, eosinophilia Methadone/ diazepam overdose Pulmonary embolism, infarction pneumonia, deep vein thrombosis Subsequently diagnosed with ITP, Paracoccus yeei and Micrococcus luteus bacteremia
Treatment (duration) Meropenem (7 d) followed by ampicillin IV (2 d), then meropenem (7 d) followed by penicillin G (14 d) None None Cefuroxim IV (7 d) Imipenem (21 d)

*CRP, C-reactive protein (reference range <5 mg/L); IVDA, intravenous drug abuse; TIPS, transjugular intrahepatic portosystemic shunt; ITP, idiopathic thrombocytopenic purpura; IV, intravenous.
P. larvae identified after culture using 16S rRNA gene sequencing.

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