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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].

Lymphadenopathy
  • المحتويات Cellulitis and Abscesses 501 Infectious Diseases with Lymphadenopathy 505 Upper Respiratory Tract Infections 513 Bronchitis and Bronchiectasis 523 Acute Pneumonia 529 Cavitary Pulmonary Disease 539 Diffuse Pulmonary Infiltrates and Acute Respiratory[books.google.com]
Intravenous Drugs
  • Drug Abuse and Infection 849 Alcohol Abuse Host Defenses and Infection 853 Fever in Travelers to Tropical Countries 859 Endemic and Travelers Diarrhea in Tropical Countries 875 Eosinophilia in Travelers to Tropical Countries 881 Infections after Animal[books.google.com]
Hyperthermia
  • الصفحة 395 - Dantrolene: a review of its pharmacodynamic and pharmacokinetic properties and therapeutic use in malignant hyperthermia, the neuroleptic malignant syndrome and an update of its use in muscle spasticity. ‏[books.google.com]
Fatigue
  • Infections Associated with Myelopathy Radiculopathy and Neuropathy 715 Focal Central Nervous System Infections 723 Ocular and Periocular Infections 733 Osteomyelitis 741 Infectious and Postinfectious Arthritis 757 Myositis and Fasciitis 767 Chronic Fatigue[books.google.com]
Respiratory Distress
  • Distress Syndrome 557 Pleurisy and Empyema 565 Epidemiology and Control of Infectious Diseases in Health Care Facilities 61 Host Responses to Infection Fever Hyperthermia and Hypothermia 71 The Acute Inflammatory Response 83 The Specific Immune Response[books.google.com]
Hypertension
  • Past medical history was positive for non-ischemic dilated cardiomyopathy, congestive heart failure (NYHA class III), atrial fibrillation, essential hypertension and a recent syncopal episode.[link.springer.com]
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]
Muscle Spasticity
  • الصفحة 395 - Dantrolene: a review of its pharmacodynamic and pharmacokinetic properties and therapeutic use in malignant hyperthermia, the neuroleptic malignant syndrome and an update of its use in muscle spasticity. ‏[books.google.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]
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]
Polyuria
  • 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.[symptoma.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

  • A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia. N Engl J Med 1994; 331:1325-1330. ‏[books.google.com]
  • 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]

Prognosis

  • Prognosis The prognosis depends on the type of infection and the particular host. Data suggest that inappropriate antimicrobials (ones that an organism is resistant to) are associated with a worse outcome. Tucci V, Isenberg HD.[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]
  • Of interest to internists, infectious disease specialists, and residents in training, the book is structured to give the reader essential information about the etiology and pathogenesis of various infectious diseases, and focuses on the clinical issues[books.google.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

  • Infection Control & Hospital Epidemiology ISSN: 0899-823X EISSN: 1559-6834 URL: /core/journals/infection-control-and-hospital-epidemiology[cambridge.org]
  • A detailed presentation on HIV infection includes discussions of epidemiology, pathogenesis, immunology, clinical manifestations and antiviral treatment, as well as management of opportunistic infections.[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]
  • It provides balanced coverage of specific groups of microorganisms and the work-up of clinical specimens by organ system, and also discusses the role of the microbiology laboratory in regard to emerging infections, healthcare epidemiology, and bioterrorism[books.google.es]
  • 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]

Prevention

  • Preventive measures for different types of infections are also addressed.[books.google.com]
  • 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]
  • 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]
  • Make sure labs immediately alert clinical and infection prevention staff when CRE are identified. Prescribe and use antibiotics wisely. Discontinue devices like urinary catheters as soon as no longer necessary.[cdc.gov]

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: 2019-06-28 10:48