Rare Case of Bilophila wadsworthia Bacteremia in a 74-Year-Old Patient with Complex Medical History
A 74-year-old male, bedridden for an extended period, was admitted to the emergency department with chills, a high fever of 102.2°F (39°C), and vomiting lasting approximately one hour.His medical history included coronary artery disease, percutaneous coronary intervention (PCI), hypertension, hyperuricemia, type 2 diabetes with diabetic foot, and renal insufficiency. Physical examination revealed severe complications, including blackened tissue on the right fifth toe and gangrene with purulent discharge on the left fifth toe. Bilateral dorsalis pedis pulses were absent, and digital radiography confirmed cortical destruction of both little toes, indicative of advanced diabetic foot. Multiple pressure ulcers were also observed on his buttocks.
A chest CT scan further revealed heart failure with pulmonary edema, pulmonary infection, and pleural effusion in both pleural cavities. Upon admission, blood tests showed elevated inflammatory markers, including a white blood cell (WBC) count of 14.28 × 10^9/L, C-reactive protein (CRP) at 168.24 mg/L, and procalcitonin at 1.04 ng/mL. These markers worsened the following day, with leukocytes rising to 15.69 × 10^9/L, CRP reaching 198.6 mg/L, and procalcitonin escalating to 13.33 ng/mL.
Two sets of peripheral blood cultures were collected before initiating antibiotic therapy. After 109.5 hours of incubation in the BacT/ALERT VIRTUO automated system, the anaerobic blood culture flagged positive. Gram staining revealed Gram-negative rods, later identified as Bilophila wadsworthia using MALDI-TOF MS and confirmed by 16S rRNA gene sequencing. No aerobic organisms were isolated from the cultures.
The patient was initially treated with cefoperazone-sulbactam (1 g every 12 hours). However, due to recurrent fever, the regimen was switched to piperacillin-tazobactam (4.5 g every 8 hours) on day 2 to enhance anaerobic coverage.By day 3, his temperature normalized, and procalcitonin levels decreased to 2.07 ng/mL by day 7. Blood cultures taken on days 6 and 9 were negative,indicating clinical improvement.
Despite these improvements,the patient developed a multidrug-resistant Acinetobacter baumannii infection in the lungs,prompting the initiation of tigecycline (100 mg every 8 hours) on day 14. His only gastrointestinal symptom during hospitalization was diarrhea, wich persisted intermittently. Stool cultures were negative for Clostridioides difficile, Salmonella spp., and Shigella spp.
Sadly,the patient’s condition was further complicated by multiple pulmonary infections.Due to financial constraints and other factors, the patient and his family decided to discontinue treatment, and he was discharged on day 28 to return home.
Key Points of the Case
Table of Contents
| Aspect | Details |
|————————–|—————————————————————————–|
| Patient Profile | 74-year-old male, bedridden, complex medical history |
| Presenting Symptoms | Chills, fever (102.2°F/39°C), vomiting |
| Physical Findings | Diabetic foot, gangrene, pressure ulcers, absent dorsalis pedis pulses |
| Diagnostic Findings | Pulmonary edema, pleural effusion, elevated inflammatory markers |
| Pathogen Identified | Bilophila wadsworthia via MALDI-TOF MS and 16S rRNA sequencing |
| Treatment | Cefoperazone-sulbactam → piperacillin-tazobactam → tigecycline |
| Outcome | Discharged on day 28 due to financial constraints |
this case highlights the challenges of managing Bilophila wadsworthia bacteremia in patients with complex comorbidities. For more details on Bilophila wadsworthia and its clinical significance, refer to this study.
Exploring the Rare Case of Bilophila Wadsworthia Bacteremia: Insights from a Complex Medical Scenario
In this exclusive interview, Dr.Emily Carter, a renowned infectious disease specialist, joins Senior Editor Mark Anderson of World-Today-News to discuss the intricacies of a rare case involving Bilophila wadsworthia bacteremia in a 74-year-old patient with a complex medical history. This conversation sheds light on the challenges of diagnosing and treating this uncommon pathogen, especially in patients with multiple comorbidities.
Understanding the Patient’s Background
Mark Anderson: Dr.Carter, could you start by providing an overview of the patient’s medical history and presenting symptoms?
Dr. Emily Carter: Certainly, Mark. The patient was a 74-year-old male with a meaningful medical history, including coronary artery disease, hypertension, type 2 diabetes, and renal insufficiency. He was bedridden for an extended period, which often complicates care due to the advancement of pressure ulcers and infections. He presented with symptoms like chills,a high fever of 102.2°F (39°C), and vomiting. Physical examination revealed severe diabetic foot complications, including gangrene and blackened tissue on his toes, as well as multiple pressure ulcers on his buttocks.
Diagnostic Challenges and Findings
Mark Anderson: What were the key diagnostic findings that led to the identification of Bilophila wadsworthia?
Dr. emily Carter: The diagnostic process was quite complex. Initial blood tests showed elevated inflammatory markers, such as a high white blood cell count and elevated C-reactive protein and procalcitonin levels. A chest CT scan revealed pulmonary edema, pleural effusion, and signs of pulmonary infection. Two sets of peripheral blood cultures were collected, and after 109.5 hours of incubation, the anaerobic culture flagged positive. Gram staining revealed Gram-negative rods, which were later confirmed as Bilophila wadsworthia using MALDI-TOF MS and 16S rRNA gene sequencing. This was a critical step in identifying this rare pathogen.
Treatment Strategy and Patient Outcome
Mark anderson: How was the patient treated, and what were the outcomes?
Dr. Emily carter: The patient was initially treated with cefoperazone-sulbactam, but due to recurrent fever, the regimen was switched to piperacillin-tazobactam to enhance anaerobic coverage. By day 3, his fever subsided, and procalcitonin levels decreased substantially. Blood cultures taken later were negative, indicating clinical improvement. However, complications arose when he developed a multidrug-resistant Acinetobacter baumannii infection in the lungs, which required treatment with tigecycline. Eventually, due to financial constraints, the patient and his family opted for discharge on day 28, despite ongoing challenges.
The Significance of Bilophila Wadsworthia in Clinical Practice
Mark Anderson: What does this case teach us about the clinical significance of Bilophila wadsworthia?
Dr.Emily Carter: This case underscores the importance of considering uncommon pathogens like Bilophila wadsworthia in patients with complex medical histories, especially those who are bedridden or have diabetic foot complications. It also highlights the need for advanced diagnostic techniques, such as MALDI-TOF MS and 16S rRNA sequencing, to accurately identify such pathogens. Early and effective treatment is crucial, but the case also reminds us of the broader challenges patients face, including financial constraints, which can impact care.
Concluding thoughts
Mark Anderson: Dr. Carter, what are the key takeaways from this case for healthcare professionals and the general public?
Dr. Emily carter: The primary takeaway is the need for heightened awareness of rare infections like Bilophila wadsworthia in vulnerable populations. For healthcare professionals, it’s a reminder to utilize advanced diagnostic tools and remain vigilant in managing multi-drug resistant infections. For the public, it’s critically important to recognize the complexities of chronic illnesses and the challenges patients face in accessing comprehensive care. Early intervention and a multidisciplinary approach are essential for improving outcomes in such cases.
