SHM Converge Scientific Abstract ePoster Gallery-Rare Pathogens Encountered in Maggot-Infested Foot Wounds

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A 49-year-old man with uncontrolled type 2 diabetes and a recent right trans-metatarsal amputation for necrotizing fasciitis/osteomyelitis returned after running out of wound care supplies. He had a foul-smelling, dehisced surgical wound with maggots embedded in the site. He was hemodynamically stable, with mild leukocytosis (WBC 11.4 × 10^9/L). CT of the right foot could not exclude infection, and ankle-brachial index showed normal perfusion.

Blood cultures grew <strong>Wohlfahrtiimonas chitiniclastica</strong>, <strong>Ignatzschineria</strong> species, and <strong>Citrobacter koseri</strong>. Bone biopsy yielded a polymicrobial infection including <strong>W. chitiniclastica, C. koseri, Proteus vulgaris, Morganella morganii, Klebsiella pneumoniae, Vagococcus fluvialis,</strong> and <strong>Enterococcus faecalis</strong>. He was initially treated with vancomycin, cefepime, and metronidazole, then underwent revision of the trans-metatarsal amputation followed by a Lisfranc amputation with clear viable margins. Due to worsening drainage while in long-term care, he completed six weeks of piperacillin-tazobactam.

The report highlights that <strong>W. chitiniclastica</strong> and <strong>Ignatzschineria</strong> spp. are rare gram-negative bacteria associated with <strong>myiasis</strong> (maggot-infested wounds). The authors note that maggots may act as vectors for these organisms, although maggot secretions can also have antibacterial properties that may suppress common skin flora. Because these pathogens can appear in chronic or neglected wounds, clinicians should consider atypical organisms when infections fail to improve on standard therapy and provide empiric coverage when maggot infestation is present.

Asset Subtitle

Alaq MA Al-Abayechi

Meta Tag

Author List Alaq MA Al-Abayechi, Divya Chandramohan, Hasan Baher, James C. Saca

Category Clinical Vignettes

Concept Myiasis

Concept Diabetic Foot Wound

Concept Wohlfahrtiimonas chitiniclastica

Concept Ignatzschineria

Concept Source Control

Distinguished Non-Finalist

Presenter Organization Department of Medicine, University of Texas Health Science Center, San Antonio, Texas

Presenting Author Alaq MA Al-Abayechi

Track Adult

Keywords

Wohlfahrtiimonas chitiniclastica

Ignatzschineria

myiasis

maggot-infested wound

diabetic foot infection

polymicrobial infection

osteomyelitis

trans-metatarsal amputation

Lisfranc amputation

piperacillin-tazobactam

Myiasis

Diabetic Foot Wound

Wohlfahrtiimonas chitiniclastica

Ignatzschineria

Source Control