Volume 16, Number 3—March 2010
Dispatch
Paenibacillus larvae Bacteremia in Injection Drug Users
Siegbert Rieg
, Tilman Martin Bauer, Gabriele Peyerl-Hoffmann, Jürgen Held, Wolfgang Ritter, Dirk Wagner, Winfried Vinzenz Kern, and Annerose Serr
, Tilman Martin Bauer, Gabriele Peyerl-Hoffmann, Jürgen Held, Wolfgang Ritter, Dirk Wagner, Winfried Vinzenz Kern, and Annerose SerrTable
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.
