Eikenella corrodens Empyema in Children

Abstract

\s=b\Eikenella corrodens is a slow-growing, Gram-negative, facultative, anaerobic organism that is normally found among oropharyngeal flora. Its isolation as a pathogen is increasingly being reported. Although well documented in the literature on adults, few cases of E corrodens infection have been reported in children.We describe two children with E corrodens pneumonia and empyema. In one, infection was mixed, but in the other the organism was isolated in pure culture. Both patients recovered after therapy with a combination of an antibiotic active in vitro against the organism, and surgical drainage. The diagnosis, bacteriology, and evidence for potential pathogenicity of the organism are reviewed; E corrodens should be considered as a potential pathogen, especially in predisposed patients. (Am J Dis Child 1981;135:415-417) Infecti ons due to Eikenella corro¬ dens have rarely been reported in children. In a review of the literature, we found reports of 16 children with serious E corrodens infections. We describe two children with empyema and pneumonia caused by E corro¬ dens. Management was complicated by the very slow growth of the orga¬ nism, which delayed its isolation and final identification. REPORT OF CASESCase l.-An 11-year-old boy had cerebral palsy, spastic quadriparesis, and mental retardation secondary to birth asphyxia.He had been bedridden in a chronic care facility for several years. He was trans¬ ferred to our hospital with a history of abdominal pain and a nonproductive cough of four days' duration. At the time of admission, he was in mild respiratory dis¬ tress. His height and weight were both below the third percentile. His vital signs were as follows: blood pressure, 120/100 mm Hg; pulse rate, 140 beats per minute; respiratory rate, 26/min; and temperature, 37.6°C. Examination of the chest revealed reduced expansion, with dullness to percus¬ sion, bronchial breathing, and markedly decreased air entry in the left lower lobe. Results of an examination of the right side of the chest were normal. Neurologic exam¬ ination revealed spastic quadriparesis, hypertonia with hyperreflexia in all extremi¬ ties, and incoordination of swallowing. He demonstrated severe psychomotor delay.Hemoglobin level on admission was 15 g/dL, and the leukocyte count was 18.4 lOVmL, with 73% polymorphonuclear leukocytes, 5% band forms, 18% lym¬ phocytes, and 4% monocytes. The platelet count was normal and the ESR was 72 mm/hr (Wintrobe). The initial chest roent¬ genogram showed a partially aerated left upper lobe and a markedly increased pleu¬ ral density in the left lower lung field. An ultrasound study confirmed the presence of a large left pleural effusion that extended from the axilla to the level of the diaphragm. A thoracocentesis drained 600 mL of yellowish, purulent fluid that had a pH of 6.71, a glucose level of less than 10 mg/dL, and a protein level of 6.1 g/dL. Gram's stain revealed a large number of neutrophils and Gram-negative bacilli.Ziehl-Neelsen stain, subsequent mycobacterial cultures, and countercu...

Bronchopleural cutaneous fistula due to <i>Eikenella corrodens</i>

“…A Eikenella corrodens tem sido implicada como um potencial patógeno causador de infecções pleuropulmonares [1][2][3] . No entanto, fistulas broncopleurais com formação de abscessos seguidas de empiema e pneumonite necrotizante (PN) resultantes de infecções por E. corrodens 4 já foram também relatadas.…”