SHM Converge Scientific Abstract ePoster Gallery-From the Guts of Grubs: A Case of Ignatzschineria Bacteremia

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A 60-year-old woman with chronic lower-extremity wounds presented to the emergency department after a right foot/ankle injury of unknown cause sustained about a week earlier. Because of housing and financial instability, she had been sleeping outdoors and covering the wound with newspapers and fabric. She noticed maggots and insects in the wound, along with increasing pain, but denied fever, chills, or drainage.<br /><br />On exam, she was afebrile and had superficial wounds with mild edema, erythema, and warmth over the right ankle, dorsum of the foot, and interdigital spaces. There was a heavy maggot burden beneath the newspaper, but no deep tissue involvement or crepitus. Distal pulses were intact, though sensation was decreased in both lower extremities. CT imaging showed soft tissue edema without gas, erosion, or fluid collection. She underwent irrigation and bedside debridement by plastic surgery and was started on broad-spectrum antibiotics.<br /><br />Blood cultures from admission grew two unusual organisms: Erysipelothrix rhusiopathiae and Ignatzschineria ureiclastica. She did not recall animal exposure or bites. She completed 14 days of amoxicillin-clavulanate without complications.<br /><br />This case highlights that wounds exposed to the environment, especially those with maggot infestation, can be a source of bacteremia from emerging pathogens such as Ignatzschineria. The report emphasizes the risk to vulnerable populations, including people experiencing homelessness, and notes increasing recognition of Ignatzschineria infections in the United States. It also underscores the need for greater investigation into sources of contamination and the clinical significance of these rare organisms.

Asset Subtitle

Sneha Daya

Meta Tag

Author List Mark Abbruzzese, Rita Poon, Sneha Daya

Category Clinical Vignettes

Concept Myiasis

Concept Wound Infection

Concept Bacteremia

Concept Ignatzschineria ureiclastica

Concept Erysipelothrix rhusiopathiae

Distinguished Finalist

Presenter Organization Medstar Georgetown University Hospital

Presenting Author Sneha Daya

Track Adult

Keywords

maggot infestation

chronic lower-extremity wounds

homelessness

bacteremia

Ignatzschineria ureiclastica

Erysipelothrix rhusiopathiae

soft tissue infection

wound debridement

amoxicillin-clavulanate

emerging pathogens

Myiasis

Wound Infection

Bacteremia

Ignatzschineria ureiclastica

Erysipelothrix rhusiopathiae