Post-traumatic infection of the lower limb caused by rare Enterobacteriaceae and Mucorales in a young healthy male

• Published in: International journal of infectious diseases Vol. 13; no. 2; pp. e57 - e60
• Main Authors: Corti, Giampaolo, Mondanelli, Nicola, Losco, Michele, Bartolini, Laura, Fontanelli, Alessandra, Paradisi, Franco
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01.03.2009
• Subjects: Absidia; Absidia - classification; Absidia - isolation & purification; Adult; Amputation - adverse effects; Anti-Bacterial Agents - therapeutic use; Antifungal Agents - therapeutic use; Enterobacter - classification; Enterobacter - isolation & purification; Enterobacter amnigenus; Enterobacteriaceae; Enterobacteriaceae - classification; Enterobacteriaceae - isolation & purification; Enterobacteriaceae Infections - drug therapy; Enterobacteriaceae Infections - microbiology; Enterobacteriaceae Infections - surgery; Humans; Infectious Disease; Leclercia adecarboxylata; Lower Extremity - injuries; Male; Mucorales; Mucorales - classification; Mucorales - isolation & purification; Mucormycosis - drug therapy; Mucormycosis - microbiology; Mucormycosis - surgery; Post-traumatic infection; Pulmonary/Respiratory; Wound Infection - drug therapy; Wound Infection - microbiology; Wound Infection - surgery; Absidia; Post-traumatic infection; Mucorales; Leclercia adecarboxylata; Enterobacter amnigenus; Enterobacteriaceae
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2008.06.029

Summary Enterobacter amnigenus and Leclercia adecarboxylata are Gram-negative aerobic bacilli of the family Enterobacteriaceae that have been isolated from water and, rarely, from various clinical specimens. Absidia is a filamentous fungus of the class Zygomycetes that is ubiquitous in nature and can cause infection, primarily in immunocompromised hosts. Here, we describe an infection of the left lower limb caused by E. amnigenus and L. adecarboxylata with subsequent isolation of Absidia spp. in a patient with multiple traumatic injuries after a major motor vehicle accident. The severity of the clinical picture made amputation necessary, despite aggressive anti-infective therapy with both antibacterial and antifungal agents. Prompt diagnosis and management are mandatory in order to minimize morbidity and even mortality, and reduce the social and economic cost.