Mark Crislip, MD, Infectious Diseases, 01:48PM Sep 25, 2013
Patient is an middle aged female with steroid dependent lupus lung disease. She has been on prednisone for several years with no infectious complications until this admission when she developed the abrupt onset of a red, hot, swollen, tender leg. All of a sudden, whomp, the whole lower leg was involved and she is admitted to the hospital, delirious with infection.
Besides the steroids and chronic edema, there is no unusual exposures to suggest some odd organism as the cause of the cellulitis, so I would have bet on S. pyogenes and I would have lost the bet.
All the blood cultures grew Acinetobacter baumannii. The heck.
It is distinctly rare for gram negative rods to cause a non-necrotizing soft tissue infection, but one or another does rear its ugly head every year or so, almost always in people with immunologic or bio-mechanical risks. in this case I would blame the steroids.
Of course, any bug can cause any disease. Acinetobacter’s claim to fame is soft tissue infections after war related trauma, but there are a number of reports of it causing soft tissue infections in civilians:
“Acinetobacter baumannii is rarely encountered as a pathogen causing community-acquired skin and soft tissue infection. A 79-year-old man had a fever for 3 days accompanied by pain and swelling over the left leg around an old scar caused by a dog bite 10 years ago. Two sets of blood cultures and a wound culture all yielded A. baumannii. The patient’s condition deteriorated initially but recovered completely after 3 weeks of meropenem treatment. This case suggests that A. baumannii should be included among pathogens with the potential to cause complicated skin infection in the community.”
I hate that last line and it, as well as similar sentences, should be banned from the literature. Some one gets some weird bug causing an infection, writes a paper , and then suggests it should be considered in cases in the future. No, it shouldn’t. Every bug is a potential pathogen, in medicine you treat the probable pathogens. And I bet the authors are going to bore their residents forever with each case of cellulitis. “It’s usually Group A streptococcus, but I had this case of Acinetobacter once blah blah blah blah.” I know how Peppermint Patty feels.
When I find Acinetobacter I wonder about an environmental/water source, but history yielded little. She does live in a trailer park but does not use the holding tank for the water, getting it from a hose that is piped into the unit. Is that the source? Don’t know and cannot get a culture. Besides the well known propensity to attract tornadoes (not) I can find no reported medical issues with mobile home/trailer parks on either the Googles or PubMed.
Antibiotics remain the wonder drug that works wonders (not ASA) and she improved rapidly with therapy.
J Formos Med Assoc. 2003 Sep;102(9):650–2. Community-acquired bacteremic cellulitis caused by Acinetobacter baumannii. http://www.ncbi.nlm.nih.gov/pubmed/14625612