cHerbaspirillum spp. are Gram-negative bacteria that inhabit soil and water. Infections caused by these organisms have been reported in immunocompromised hosts. We describe severe community-acquired pneumonia and bacteremia caused by Herbaspirillum aquaticum or H. huttiense in an immunocompetent adult male.
CASE REPORT
In early September 2014, a 46-year-old white male presented to a referring facility with fever, fatigue, and shortness of breath. His illness began 5 days prior to admission to our facility after he was drenched in rain during a fishing trip. He had a fever of 40°C, despite use of antipyretics, with chills, night sweats, anorexia, myalgia, and headache. Three days prior to admission, he had a transient period of dry cough for half a day that resolved spontaneously. The next day he developed sharp right-sided pleuritic chest pain, worsening dyspnea, and severe fatigue. When he presented to the referring facility, clinical findings were remarkable for a respiratory rate (RR) of 28/min with an oxygen saturation (SpO 2 ) level of 77% on room air which improved to 91% on 4 liters/min of oxygen via nasal cannula. His white blood cell (WBC) count was 7.7 ϫ 10 Ϫ3 /l with 55% bands, and bilateral alveolar infiltrates were noted on a chest X-ray. Analysis of his arterial blood gas revealed a pH level of 7.46, partial pressure of CO 2 (pCO 2 ) of 34 mm Hg, pO 2 of 53 mm Hg, SpO 2 of 89% on 4 liters/min of oxygen via nasal cannula, and HCO 3 of 24 meq/liter. Blood cultures were drawn, and he was treated with intravenous vancomycin, ceftriaxone, and azithromycin. His condition worsened and he was transferred to our university teaching hospital.The patient's past medical history was unremarkable, except for childhood asthma, atypical pneumonia as a teenager, and tonsillectomy. He was on no home medications. He lived on a farm in rural Missouri with his wife and had close contact with cattle and turkeys (he had birthed calves 6 months earlier and handled 15,000 baby turkeys 3 weeks prior to the onset of illness). A few weeks prior to admission, the patient returned from work with about 20 loosely attached ticks. He also cleaned a grain bin in his barn (contained mold and possible rat excreta) a week prior to presentation. He smoked cigarettes for 30 years and also consumed alcohol regularly. He denied sick contacts, animal bites or scratches, and recent travel.The results of a physical examination conducted on presentation to our facility were remarkable for temperature (38°C), heart rate (HR) (98 beats/min), blood pressure (BP) (141/88 mm Hg), and RR (30/min with use of accessory muscles). There was bilateral lower chest wall tenderness, coarse inspiratory crepitations were heard in left axilla and left lower chest, and diminished breath sounds were noted in the right axilla and right lower chest.The rest of the exam was unremarkable. Laboratory measurements on admission revealed a WBC count of 9.0 ϫ 10 Ϫ3 /l, granulocytes at 89.6% and no bands on automated differential determinations, hemoglobin at 13.4 g/dl, ...