Non-vertebral Veillonella species septicemia and osteomyelitis in a patient with diabetes: a case report and review of the literature.
BACKGROUND
Veillonella is a nonfermentative, strictly anaerobic, Gram-negative coccus that forms part of the human gastrointestinal tract, mouth and vaginal flora. Like other anaerobic infection, Veillonella species usually are involved in polymicrobial processes, which make it difficult to determine their pathogenic role. Isolation of a clinically significant Veillonella species is rare and V. parvula is the most common one reported to cause infection in humans. The most frequently reported infection caused by V. parvula is osteomyelitis, almost always in association with bacteremia.


METHODS
Here, we describe a rare case of nonvertebral osteomyelitis and septicemia caused by Veillonella species in a 49-year-old Saudi man with diabetes. Initial treatment with ciprofloxacin was associated with treatment failure and poor response. Identification of the organism was essential for the selection of appropriate treatment. There have been only seven previous reports of Veillonella vertebral osteomyelitis and one report of V. parvula foot osteomyelitis with sepsis in the literature. This is the second case of Veillonella nonvertebral osteomyelitis associated with septicemia reported to date.


CONCLUSIONS
Veillonella species should be considered a true pathogen in diabetic patients with osteomyelitis and those with underlying immune suppression, particularly if the organism is isolated from blood. The isolation of those obligate anaerobes from blood may signal the presence of severe underlying disease and the probable need for timely surgical intervention.
King Khalid University Hospital, King Saud University, PO: 2925, Riyadh 11461, Saudi Arabia. ofawzia@ksu.edu.sa.
Fawzia Eida
FE
Al-Otaibi
Maha Mohammed
MM
Al-Mohizea
D048909:Diabetes Complications / Q000175:diagnosis / Q000382:microbiology*; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000175:diagnosis / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology*; D018805:Sepsis / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology*; D014678:Veillonella