Louise Welsh Fei Fang Nicholas Coriasso Scott Kaatz
Henry Ford Health System
Case Presentation - A 49 year old female was found unresponsive in her home and covered in feces. She presented initially in undifferentiated shock requiring vasopressors and endotracheal intubation. ..
Case Presentation - A 49 year old female was found unresponsive in her home and covered in feces. She presented initially in undifferentiated shock requiring vasopressors and endotracheal intubation. The patient has a history of extensive stage 2-4 decubitus ulcers involving her back, buttocks, and right lower extremity secondary to prolonged inactivity from severe depression. Exam revealed ulcers that were covered in feces, maggots, and animal hair. She was started on broad-spectrum antimicrobial coverage with vancomycin, piperacillin-tazobactam, and fluconazole. Labs were remarkable for WBC 28 K/uL, K+ 6.3 mmol/L, and ammonia 235 umol/L. Blood cultures grewTissierella praeacuta. CT abdomen/pelvis was negative for intra-abdominal abscess. Antibiotics were de-escalated to piperacillin-tazobactam only. Right lower extremity ulcer was debrided for source control. Patient improved clinically with a two-week course of antibiotics, remaining afebrile and hemodynamically stable throughout her hospital stay. Discussion- Tissierella praeacuta is a rod-shaped, non-spore forming, Gram-negative strict anaerobe that has been isolated from soil and human feces, and has 99.9% genomic similarity to the Gram-positive, spore forming Clostridium hastiforme.Tissierella praeacuta is a rare cause of human infection with only two cases reported, but is reportedly susceptible to beta lactams, carbapenems, and metronidazole. Conclusion- Our case raises the issue that T. praeacuta may be a more common source of human infection than previously expected and should be considered when fecal contamination of wounds is present.