Sepsis Due to Ignatzschineria ureiclastica Caused by Maggot-Infested Wounds in a Homeless Man in Germany: a Case Report

Abstract

The gram-negative rod bacteria Ignatzschineria inhabits the digestive tract of larvae and adult forms of flesh flies and mostly causes bloodstream infections in animals, but rarely in humans with chronic wounds. This is the second case report of sepsis due to Ignatzschineria ureiclastica worldwide and the first reported case of Ignatzschineria species in Germany. We present a case report of 57-year-old homeless male with chronic leg and foot ulcers with maggot infestation. Blood cultures revealed gramnegative rod bacteria, which later could be identified by 16S rRNA sequence analysis as Ignatzschineria ureiclastica. Intravenous antibiotic treatment with ampicillin/sulbactam and later oral ciprofloxacin as well as local wound management lead to complete wound healing. Blood cultures of patients with chronic wounds and maggot infestation should be analyzed with 16S rRNA sequence analysis when commercial-automated devices lead to indecisive results. Live and preserved samples of insect infestation should be acquired for further entomological characterization. Susceptibility testing of rare pathogens should be performed and published. Antibiotic treatment of bloodstream infections due to Ignatzschineria species with ampicillin/sulbactam showed good clinical outcome.

The Brief Case: A Maggot Mystery—Ignatzschineria larvae Sepsis Secondary to an Infested Wound

“…Of note, Le Brun et al described a case of Ignatzschineria-associated septicemia arising in a clinical scenario very similar to our case, with the isolate identified only to the genus level, as 16S rRNA sequencing showed homology identical to that of both I. larvae (99%) and I. ureiclastica (99%) (10). There has been one reported case of sepsis due to I. ureiclastica in which a 99.7% 16S rRNA sequence homology was observed to the original I. ureiclastica (FFA3 T ) GenBank isolate reported by Gupta et al (11). To our knowledge, there are no definitive prior case reports of I. larvae infection in humans, although there are several reports in which species-level identification could not be reliably performed.…”

A case of sepsis due to a rare carbapenem-resistant Ignatzschineria species

“…Ignatzschineria bacteremia is often associated with poor living or working conditions, alcoholism, open wounds/ulcers, and peripheral vascular disease [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] . It was reported that this patient had been living in poor conditions in a basement and had also shown behaviors of self-neglect both of which predisposed him to myiasis and therefore Ignatzschineria infection.…”

“…The organism identified in this case was determined to be most genetically similar to I. larvae and I. ureiclastica, both of which are rarer when compared to I. indica . While there have been 11 cases of I. indica reported, there have been only three cases of I. larvae and two cases of I. ureiclastica [1] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [13] , [15] , [16] , [18] , [20] , [21] . In addition, I. indica is the only species to have been reported in North America [7] , [8] , [10] , [11] , [15] , [17] , [20] .…”

“…The case reported by Tanida et al [21] in Germany described a 57-year-old homeless male who presented with pain in both extremities due to infected wounds. The patient had the wounds for months without seeking medical care prior to presentation.…”

“…In a review of the literature, Ignatzschineria species were only isolated in blood, urine, and abscess cultures; however, interestingly, none were isolated in wound cultures [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] . Common complications associated Ignatzschineria bacteremia include: sepsis, need for debridement, amputation of limb with the most commonly affected body area being the lower extremities, and acute kidney injury [7] , [9] , [10] , [11] , [12] , [13] , [15] , [17] , [18] , [20] , [21] . Ignatzschineria bacteremia is rarely associated with osteitis/osteomyelitis in the literature though it has been identified and subsequently required debridement or amputation of the affected limb [7] , [9] , [12] , [17] .…”