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Providencia Infection

Oth Gram Negatv Bacteria

Providencia infection is most commonly encountered as a catheter-associated urinary tract infection in elderly patients residing in nursing homes. Typical symptoms of dysuria, polyuria, and fever are noticed. Having in mind the resistance to many antimicrobial agents by Providencia spp. which may lead to rapid clinical deterioration due to improper therapy, an early diagnosis is vital. Urinalysis and urine cultures are crucial for identifying the causative bacteria.


Presentation

Initially described as a subgroup of Proteus spp., Providencia spp. are ubiquitously present (water, soil, and various animals are known reservoirs) opportunistic gram-negative bacilli belonging to the large group of Enterobacteriaceae and six types have been described in the literature (P. rettgeri, P. stuartii, P. alcalifaciens, P. rustigianii, and P. heimbachae) [1] [2]. P. rettgeri and P. stuartii are the two most important species that are considered primarily as causative agents of catheter-associated urinary tract infections (CA-UTI) in humans [1] [2] [3] [4] [5]. By possessing urease, an enzyme that breaks down urea into carbon dioxide and ammonia, Providencia promotes acidification of urine, bacteremia, and the formation of urolithiasis, which may be particularly troubling in cases with long-standing indwelling urinary catheters where biofilms could be formed [1] [6] [7]. In fact, the majority of patients are elderly individuals residing in nursing homes [4] [5] [7] [8]. The clinical presentation of UTI is marked dysuria, polyuria, and sometimes fever or chills, but a very wide spectrum of symptoms can be observed, ranging from minimal findings to severe and life-threatening urosepsis [7]. In addition to UTIs, frequently being polymicrobial in nature, the bacteria were identified in cases of meningitis, endocarditis, gastrointestinal disorders manifesting with diarrhea, abdominal pain, and vomiting, as well as ocular ailments and endocarditis [8] [9] [10].

Heart Murmur
  • No local ulcers or new heart murmurs were noticed. Poor dentition, together with the presence of disheveling appearance was appreciated.[link.springer.com]
Skin Lesion
  • NIH: National Institute of Allergy and Infectious Diseases Actinomycosis Bacterial vaginosis -- aftercare Blood culture Gram stain Gram stain of skin lesion Necrotizing soft tissue infection Q fever Serology for tularemia Shigellosis Stool Gram stain[icdlist.com]
Excitement
  • Douglas Jones Lippincott Williams & Wilkins , 2006 - 2808 Seiten 2 Rezensionen Click here to view a narrated demo to see all the features of this exciting new Solution![books.google.com]
  • For each plate, fluorescence emission was measured at 590 nm, upon excitation at 560 nm.[journals.plos.org]
Radiculopathy
  • Infections 649 Genital Herpes Syphilis and Genital Ulcer Disease 657 Urethritis Epidydimitis Orchitis Prostatitis 669 Vulvovaginitis Cervicitis and Pelvic Inflammatory Disease 681 Meningitis 689 Encephalitis 703 Infections Associated with Myelopathy Radiculopathy[books.google.com]

Workup

Because of the rare occurrence of this medical entity in clinical practice (isolated studies report an incidence rate of 3.4 infections per 100,000 people per year), the diagnosis may be difficult to attain [8] [10]. For this reason, a meticulous workup must be performed, as mortality rates of Providencia infections are shown to be high without the proper therapy (the main reason being a broad range of antimicrobial resistance) [1] [2]. The physician must assess the presence of risk factors for a UTI (eg. older age, indwelling catheters) when evaluating patients with suggestive signs, whereas residence in nursing homes can further raise suspicion to a less typical causative agent. When a presumptive diagnosis is made, urinalysis (typically showing pyuria) and urine cultures (the gold standard for confirming UTI) must be drawn as soon as possible, in order to determine the etiologic pathogen and the profile of antimicrobial resistance [7]. Detection of more than one microbe on urine cultures in addition to Providencia is not uncommon [1] [2] [6].

Normocytic Normochromic Anemia
  • Admission laboratory findings revealed mild leukocytosis together with mild normocytic normochromic anemia (Table 1 ).[link.springer.com]

Treatment

  • Antibiotics are the usual treatment. When you take antibiotics, follow the directions carefully. Each time you take antibiotics, you increase the chances that bacteria in your body will learn to resist them causing antibiotic resistance.[icdlist.com]
  • Darouiche RO: Treatment of Infections Associated with Surgical Implants. N Engl J Med. 2004, 350: 1422-1429. 10.1056/NEJMra035415. CrossRef PubMed Google Scholar 7.[link.springer.com]
  • In details, the treatment groups were received to Mr. Trivedi’s biofield treatment in sealed pack under laboratory condition. Mr.[trivedieffect.com]
  • ESBL Genes that encode for ESBLs are primarily found on plasmids in some strains of E. coli, K. pneumoniae , and occasionally in Proteus species ESBLs may be inhibited by beta-lactamase inhibitors (e.g. tazobactam) in vitro, there is concern of higher treatment[m.antimicrobialstewardship.com]
  • Consultations Consider consultation with an infectious diseases specialist to help determine the treatment plan. Consider consultation with a urologist if a suspected structural genitourinary pathology is the underlying etiology of the infection.[emedicine.medscape.com]

Etiology

  • In this study, the etiology of the outbreak was investigated. No other recognized enteropathogens were detected in patient fecal samples, but P. alcalifaciens was detected in 7 of 18 samples.[ncbi.nlm.nih.gov]
  • When a presumptive diagnosis is made, urinalysis (typically showing pyuria) and urine cultures (the gold standard for confirming UTI) must be drawn as soon as possible, in order to determine the etiologic pathogen and the profile of antimicrobial resistance[symptoma.com]
  • Consider consultation with a urologist if a suspected structural genitourinary pathology is the underlying etiology of the infection. Diet No special diet is required in patients with Providencia infections.[emedicine.medscape.com]
  • Although we could not find any published cases of P. stuartii conjunctivitis, we did find two mentions of P. stuartii keratitis; in both cases, they were listed as one line in a chart of etiologic agents without further comment [ 4 , 5 ].[joii-journal.springeropen.com]
  • Presenting signs, etiology, bacteriology and localisation. Acta Paediatr Scand . 1983 Nov. 72(6):879-83. [Medline] . Casanova-Roman M, Sanchez-Porto A, Casanova-Bellido M.[emedicine.medscape.com]

Epidemiology

  • , American College of Physicians , Infectious Diseases Society of America , Society for Epidemiologic Research , and Society for Healthcare Epidemiology of America Disclosure: Nothing to disclose.[emedicine.medscape.com]
  • Infection Control & Hospital Epidemiology ISSN: 0899-823X EISSN: 1559-6834 URL: /core/journals/infection-control-and-hospital-epidemiology[cambridge.org]
  • Tropical Countries 859 Endemic and Travelers Diarrhea in Tropical Countries 875 Eosinophilia in Travelers to Tropical Countries 881 Infections after Animal Bites and Scratches 885 EctoparasiteRelated Diseases 891 Human Immunodeficiency Virus and AIDS 903 Epidemiology[books.google.com]
  • Epidemiologic factors included the intensive concomitant use of antibiotics and indwelling urinary catheters; while the use of gloves by personnel showed to be an effective control measure [ 11 , 12 ].[link.springer.com]
  • The metallo-beta-lactamase, New Delhi metallo-beta-lactamase 1 (blaNDM-1), constitutes a case study in the epidemiology of metallo-beta-lactamase transmission.[uniprot.org]
Sex distribution
Age distribution

Pathophysiology

  • PAK Major progress has been made in the pathophysiologic elucidation and management of nephrolithiasis during the past two decades.[books.google.com]
  • Specific organism characteristics, defects in host defenses, and pathophysiologic details concerning particular UTIs now will be discussed.[www1.cgmh.org.tw]
  • Diagnosis requires a high index of suspicion and imaging tests. [3] Pathophysiology M morganii has been associated with urinary tract infections, sepsis , pneumonia , wound infections , musculoskeletal infections, CNS infections, pericarditis, chorioamnionitis[emedicine.medscape.com]
  • Here, we report on planktonic cell growth and biofilm formation by P . stuartii , in conditions that mimic its most common pathophysiological habitat in humans, i . e . the urinary tract.[journals.plos.org]

Prevention

  • It is now possible to detect the cause of stone disease in more than 95% of patients, to prevent recurrent formation of stones in the majority of patients, and to remove most existing stones less invasively.[books.google.com]
  • Endemic and Travelers Diarrhea in Tropical Countries 875 Eosinophilia in Travelers to Tropical Countries 881 Infections after Animal Bites and Scratches 885 EctoparasiteRelated Diseases 891 Human Immunodeficiency Virus and AIDS 903 Epidemiology and Prevention[books.google.com]
  • Prevention of symptomatic CA-UTI is best achieved by early recognition and replacement of obstructed catheters as well as prevention of catheter trauma.[omicsonline.org]
  • It is no surprise that millions of dollars go toward colon cancer research every year in an effort to better understand the disease, prevent it and treat those who suffer from it.[belmarrahealth.com]
  • Conclusion Prevention is the main step against CAUTI.[intechopen.com]

References

Article

  1. Wie S-H. Clinical significance of Providencia bacteremia or bacteriuria. Korean J Intern Med. 2015;30(2):167-169.
  2. Choi HK, Kim YK, Kim HY, Park JE, Uh Y. Clinical and microbiological features of Providencia bacteremia: experience at a tertiary care hospital. Korean J Intern Med. 2015;30(2):219-225.
  3. O'Hara CM, Brenner FW, Miller JM. Classification, identification, and clinical significance of Proteus, Providencia, and Morganella. Clin Microbiol Rev. 2000;13:534–546.
  4. Crane ES, Shum M, Chu DS. Case report: Providencia stuartii conjunctivitis. J Ophthalmic Inflamm Infect. 2016;6:29.
  5. Rahav G, Pinco E, Silbaq F, Bercovier H. Molecular epidemiology of catheter-associated bacteriuria in nursing home patients. J Clin Microbiol. 1994 Apr;32(4):1031-1034.
  6. Armbruster CE, Smith SN, Yep A, Mobley HL. Increased incidence of urolithiasis and bacteremia during Proteus mirabilis and Providencia stuartii coinfection due to synergistic induction of urease activity. J Infect Dis. 2014;209:1524–1532.
  7. Nicolle L, AMMI Canada Guidelines Committee. Complicated urinary tract infection in adults. Can J Infect Dis Med Microbiol. 2005;16(6):349-360.
  8. Laupland, KB, Parkins MD, Ross T, Pitout JD. Population-based laboratory surveillance for tribe Proteeae isolates in a large Canadian health region. Clin Microbiol Infect. 2007;13:683-688.
  9. Yoh M, Matsuyama J, Ohnishi M, et al. Importance of Providencia species as a major cause of travellers' diarrhoea. J Med Microbiol. 2005;54(Pt 11):1077-1082.
  10. Sipahi OR, Bardak-Ozcem S, Ozgiray E, et al. Meningitis Due to Providencia stuartii. J Clin Microbiol. 2010;48(12):4667-4668.

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Last updated: 2018-06-22 02:06