Mark Crislip, MD

Disclosures

September 28, 2010

That is an odd bunch of bacteria.

Eikenella is part of the HACEK (Haemophilus species [parainfluenzae, Haemophilus aphrophilus, Haemophilus paraphrophilus], Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) mouth flora that are a rare cause of endocarditis; I have seen 2 of each infection in 25 years of practice. She had none of the clinical manifestations (murmur, emboli) of endocarditis.

Pasteurella typically causes focal infections, usually soft tissue, after a cat or dog bite, and does not cause a prolonged febrile illness.

H influenza, although a disease of children (17 is a bit old, however), does not cause a prolonged illness. Type b, the most common strain in children, has almost been eradicated by the vaccine and she is up to date on vaccinations.

Tularemia is unusual in urban environments and the classic manifestations include an eschar/ulcer at the inoculation site with some combination of eye involvement, pharyngitis, lymphadenitis, pneumonia, and/or sepsis. Rabbits and rodents are the common sources, and she has no exposure to these animals.

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