Title: Oligella ureolytica bacteremia: report of a case in an immunocompetent adult.
Author: Alhmoud T, Department of Internal Medicine, University of New Mexico, Albuquerque, NM.
Background: Oligella ureolytica is an uncommon gram-negative rod that has rarely been isolated from urine in patients with indwelling urinary catheters. Bacteremia with this organism is exceedingly rare, to the best of my knowledge there is only three reported cases; all have been in patients who were immunocompromised or had a central venous catheter.
Case report: A 61-year-old homeless man presented to the hospital with confusion and signs of alcohol withdrawal. While in the emergency department he had a tonic-clonic seizure and developed atrial fibrillation. He was treated with metoprolol and converted to sinus rhythm, but remained confused and hypoxic. Vital signs were temperature 35.7 C, heart rate 110 beats/min, blood pressure 124/80 mmHg, respiratory rate 18 breaths/min, and oxygen saturation 94% on supplemental oxygen. Physical examination was remarkable for confusion, tremulousness, poor dentition, diffuse expiratory wheezing, and bilateral rhonchi. Leukocyte count was 10,400 cells/mL (67% neutrophils). Urinalysis revealed 8 leukocytes and 56 erythrocytes per high-powered field, negative nitrite and leukocyte esterase. Serum lactate was normal. Chest roentgenogram showed hyperinflation and mild increase in interstitial markings. Computerized tomography of the brain revealed no abnormality. One of two blood cultures grew gram-negative rods which were identified as oligella urealytica. Urine culture was no growth. The patient was treated with ciprofloxacin and became alert and oriented. He reported a few day history of rhinorrhea and productive cough. Repeat blood cultures were negative. After 4 days the patient left the hospital against advice, and was given a prescription for 10 days of oral ciprofloxacin. He was lost to follow-up until two months later when he was readmitted with alcohol withdrawal and had no signs of infection.
Conclusions: This is the fourth reported case of bacteremia witholigella urealytica. Previously reported cases have occurred in an adult man with human immunodeficiency virus, an 18-month-old child, and an adult female with a central venous catheter. This case illustrates that oligella urealytica may be a rare cause of gram-negative bacteremia in immunocompetent adults. It also illustrates the importance of considering an infectious etiology in patients with confusion and alcohol withdrawal.