Webster WZ, J Clin Stud Med Case Rep 2020, 7: 105 DOI: 10.24966/CSMC-8801/100105
HSOA Journal of
Clinical Studies and Medical Case Reports Case Report
Myroides odoratum
Osteomyelitis in a Diabetic Patient: Case Report and Review on a Rare Pathogen
William Z Webster* University of South Carolina School of Medicine, Columbia, USA
Abstract Given the multi-drug resistance pattern and general unfamiliarity of the gram-negative bacillus known as Myroides species, this report focuses on a rare presentation with emphasis on drug resistance and pathogenesis. With only 48 reported cases of Myroides infection as of 2017, this case presents the first known report of osteomyelitis from Myroides species. The most common reported infections include urinary tract infection, cellulitis, and blood stream infection, all occurring in immunocompromised hosts except for one case of cellulitis following a pig bite in a pediatric patient. Reported cases are to be discussed with respect to incidence, presentation, and proposed mechanisms of resistance such as chromosome-encoded metallo-beta-lactamases, with similarities and differences highlighted between prior reports and this case of osteomyelitis.
with the relative unfamiliarity of the pathogen. This case describes a diabetic, but otherwise immunocompetent patient with Myroides odoratum osteomyelitis, being the first reported case of Myroides species osteomyelitis to our knowledge. Discussion is focused on the characteristics of the organism and its known pathogenicity, including typical presentation, resistance patterns, and risk factors for inoculation and subsequent infection.
Case Report A 64 year old male with a history of diabetes, hypertension and peripheral vascular disease presented with a one year history of a right great toe wound that had been progressively worsening for one month. Over the past several weeks, the toe wound became red, painful, and swollen and began draining clear fluid. His blood pressure was 100/72 and on exam his right great toe revealed an approximate 6.0 x4.0 cm purulent ulcer along the plantar surface with marked erythematous extension surrounding the entire great toe, most prominent over the hallux. He had a leukocytosis of 20.5, erythrocyte sedimentation rate of 60, and lactic acid was 4.6. X-ray of the right foot revealed osteomyelitis of the hallux of the great toe with associated soft tissue swelling. Blood cultureswere negative for growth. He underwent debridement with intraoperative cultures of the lesion which grew Myroides odoratum with antibiotic susceptibilities depicted in table 1. He underwent right great toe amputation and was started on trimethoprim-sulfamethoxazole in accordance with sensitivity data. He experienced further clinical decline and despite negative blood cultures, developed hemodynamic instability with subsequent multiorgan dysfunction and eventual death.
Introduction Myroides species constitute a rare cause of human infection and are classified as a gram negative, nonmotile obligate aerobic bacilli that is not thought to be a part of the human microbiome. Previously known as Flavobacterium species, these pathogens have been isolated from environmental sources including water and soil and have rarely been found to cause infection in humans, especially immunocompetent hosts. Myroides odoratum and Myroides odoratimimus were the first and now the most common species isolated and are notably found to be multi-drug resistant organisms. This has led to challenging treatment regimens due to the ubiquitous resistance patterns coupled *Corresponding author: William Z Webster, University of South Carolina School of Medicine, Columbia, USA, Tel: +1 4042265352; E-mail: william.webster@ prismahealth.org Citation: Webster WZ (2020) Myroides odoratum Osteomyelitis in a Diabetic Patient: Case Report and Review on a Rare Pathogen. J Clin Stud Med Case Rep 7: 105. Received: May 02, 2020; Accepted: December 24, 2020; Published: December 30, 2020 Copyright: © 2020 Webster WZ. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Drug
MMINT
MMDIL (mcg/mL)
Amikacin
R
>32
Cefepime
S
8
Ceftazidime
R
>16
Ceftriaxone
R
>32
Ciprofloxacin
R
>4
Gentamicin
R
>8
Imipenem
I
8
Levofloxacin
R
>4
Meropenem
S
2
Piperacillin/Tazobactam
I
32
Tobramycin
R
>8
Trimethoprim/Sulfa
S
<=0.5/9.5
Table 1: Antimicrobial Susceptibilities to Myroides odoratum.
Discussion Initially discovered 1923, Flavobacterium species have been isolated from ubiquitous environmental settings including soil, fresh and marine waters, seafood products, meat processing plants, and the gut of adult flesh flies [1]. The Myroides genus diverged from Flavobacterium in 1996 due to genomic and phenotypic differences