vol21no7_pdf-version

LETTERSTable. Documented cases of pathogenic Oligella ureolytica infection*YearPatientage, yPatientsex Location Culture source Concurrent conditions Urinary disorder Reference†2014 30 M India Blood Metastatic lung Urinary incontinence (3)adenocarcinoma2013 Newborn F Turkey Blood None Maternal urine exposure (4)during delivery?2013 89 M United UrineAdenocarcinoma of High post void residual (5)Statesprostate1996 49 F Canada Neck lymph node Non-Hodgkin lymphoma None (6)1993 40 M United BloodAIDS, sacral ulcer,None (7)Statesdiarrhea*Some published cases that were believed to be contamination or for which the organisms did not fit the laboratory profile of O. ureolytica were excluded.†Antimicrobial drug sensitivity has varied among reports; some resistant organisms have been encountered (3–8).test results were negative. The nonspecific electrocardiogramchanges prompted us to request a transesophagealechocardiogram, but the patient refused. For 10 days, thepatient was given vancomycin (1 g/d), aztreonam (2 g/8h), and metronidazole (500 mg/8 h). Cultures of blood thathad been collected 5 and 8 days after the original culturewere sterile. After 16 days, leukocytosis and fever had resolved,and the patient was discharged to a skilled nursingfacility. Although we found no reports in the literature ofendocarditis caused by O. ureolytica, the patient’s refusalof a transesophageal echocardiogram and the presence ofthe uncommon bacterium led us to empirically continueaztreonam for endocarditis after her discharge.The literature reports 5 cases of pathogenic O. ureolyticainfection (Table). This bacterium has also beenisolated from the respiratory tract of patients with cysticfibrosis (9). A 2-year study conducted in 1983 at ahigh-volume hospital in the United States demonstratedO. ureolytica growth in the urine of 72 patients (8). Ofthese patients, 71 had long-term urinary drainage systemsand 14 had symptomatic urinary tract infections. Many ofthese patients were permanently disabled from spinal cordinjuries (8). This study was the only one we found focusedon O. ureolytica infection in the clinical setting. Wefound no cases in which a patient’s death was attributedto O. ureolytica infection, and all reported cases resolvedwith antimicrobial drug treatment (3–8). The low virulenceof this organism may contribute to the paucity ofrecognized cases.Of the reported cases, all occurred as opportunisticinfections in patients with a source of immunosuppressionsuch as malignancy, HIV, or newborn status. The patientwe reported in this article showed no evidence of malignancyand had no major source of immunosuppressionbesides malnutrition, tobacco use, and advanced age. Thepatient’s wound had been contaminated by urine and feces,which was postulated to be the cause of bacteremiain the 1993 case.Limitations in commonly available laboratory proceduresmake the identification of this bacterium difficult. Theincubation period is long (4 days), and not all laboratoriesincubate cultures for that long, as occurred in the 2013 urinarytract infection case (1,3,5). Also, the identification ofless commonly encountered bacteria is not always pursuedto the genus and species level (2). Furthermore, it is believedthat Oligella spp. can be misidentified as phenotypicallysimilar organisms, such as Bordetella bronchisepticaand Achromobacter spp. (4,10).We believe that many cases of O. ureolytica infectionhave gone unrecognized or were incorrectly identified.Some cases may also have been dismissed as contaminationbecause of laboratorians’ and clinicians’ lack of familiaritywith this bacterium. Our review suggests that advancinglaboratory techniques will lead to more recognizedcases and that further studies are necessary to understandthis bacterium’s clinical significance.AcknowledgmentsSpecial thanks to Rani Bright and the Philadelphia College ofOsteopathic Medicine library staff for their time, effort, andguidance in working on this manuscript.References1. Rossau R, Kersters K, Falsen E, Jantzen E, Segers P, Union A,et al. Oligella, a new genus including Oligella urethralis comb.nov. (formerly Moraxella urethralis) and Oligella ureolyticasp. nov. (formerly CDC group IVe): relationship to Taylorellaequigenitalis and related taxa. Int J Syst Evol Microbiol.1987;37:198–210. http://dx.doi.org/10.1099/00207713-37-3-1982. Steinberg JP, Burd EM. Other gram-negative and gram-variablebacilli. In: Bennett J, Dolin R, Blaser M, editors. Mandell, Douglas,and Bennett’s principles and practice of infectious diseases. 8th ed.Philadelphia: Elsevier; 2015. p. 2667–83.3. Baruah FK, Jain M, Lodha M, Grover RK. Blood stream infectionby an emerging pathogen Oligella ureolytica in a cancer patient:case report and review of literature. Indian J Pathol Microbiol.2014;57:141–3. http://dx.doi.org/10.4103/0377-4929.1309284. Demir T, Celenk N. Bloodstream infection with Oligella ureolyticain a newborn infant: a case report and review of literature.J Infect Dev Ctries. 2014;8:793–5. http://dx.doi.org/10.3855/jidc.32605. Dabkowski J, Dodds P, Hughes K, Bush M. A persistent, symptomaticurinary tract infection with multiple “negative” urine cultures.Conn Med. 2013;77:27–9.6. Baqi M, Mazzulli T. Oligella infections: case report and review ofthe literature. Can J Infect Dis. 1996;7:377–9.1272 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 21, No. 7, July 2015