Providencia Infections Clinical Presentation

  • Author: Joshua S Hawley, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 11, 2012
 

History

  • P stuartii and P rettgeri
    • Patients who develop Providencia urinary tract infections often have long-standing dependence on an indwelling urinary catheter.
    • Patients who have recently undergone a urinary tract procedure with instrumentation are also at greater risk of infection.
    • Urinary tract infections typically present with dysuria, polyuria, hematuria, and fever/chills
    • Both species (P rettgeri more commonly than P stuartii) have recently been implicated as etiologic agents in traveler's diarrhea, making travel history important in patients with acute-onset diarrhea.
    • Vomiting is common in P rettgeri gastrointestinal infection.
    • Patients with respiratory tract infection are more likely to have been intubated or to have undergone intratracheal suctioning. These conditions promote airway colonization. Presenting symptoms are those typical of pneumonia, including cough and fevers/chills.
    • Patients with burns are at a higher risk of Providencia wound infection.
  • P alcalifaciens, P rustigianii, and P heimbachae
    • Infections with these Providencia species are most likely to elicit gastrointestinal symptoms. In a study that examined P alcalifaciens infection specifically, the most common presenting symptom was diarrhea (86.7%), followed by abdominal pain (77.8%) and fever greater than 37.5°C (24.1%). Diarrhea was described as watery; no bloody diarrhea was reported.[12]
    • P alcalifaciens infection is also associated with overseas travel.
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Physical

  • P stuartii and P rettgeri
    • Providencia urinary tract infections manifest as typical features on physical examination, including fever, dry mucous membranes, suprapubic tenderness, and flank pain in pyelonephritis (Lloyd sign).
    • Providencia bloodstream infection is associated with fever, tachycardia, and hypotension.
    • Vascular collapse is uncommon in Providencia septicemia.
    • The examination findings of Providencia respiratory tract infection are typical of pneumonia, including fever, tachypnea, dyspnea, accessory muscle use, and abnormal breath sounds on auscultation.
  • P alcalifaciens, P rustigianii, and P heimbachae: Physical examination findings include fever, tachycardia, abdominal pain, dry mucous membranes, and typically negative occult blood in stool.[12]
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Causes

  • Urinary tract infection with P stuartii or, less commonly, P rettgeri is associated with long-term indwelling urinary devices and complicated cystitis.
    • Many patients with such infections are residents of long-term care facilities.
    • When one of these organisms causes bloodstream infection, it is most commonly from a urinary tract origin.
    • Finally, some evidence suggests that patients with underlying comorbidities may be at greater risk of obstruction (tumors, ureteric stricture), foreign bodies (ureteral stent, nephrostomy tubes), and functional disturbances (neurogenic bladder, vesicoureteral reflux).
  • Gastroenteritis due to P alcalifaciens, P rettgeri, and P stuartii may develop after travel to developing countries.
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Contributor Information and Disclosures
Author

Joshua S Hawley, MD  Staff, Department of Infectious Disease; Associate Program Director, Resident of Internal Medicine, Department of Medicine, Tripler Army Medical Center

Joshua S Hawley, MD is a member of the following medical societies: American College of Physicians, Armed Forces Infectious Diseases Society, Infectious Diseases Society of America, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Evan G Brown, DO  Resident Physician, Department of Internal Medicine, Tripler Army Medical Center

Evan G Brown, DO is a member of the following medical societies: American College of Physicians and American Osteopathic Association

Disclosure: Nothing to disclose.

Leanne B Gasink, MD, MSc  Assistant Professor, Department of Medicine and Faculty-Fellow, Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania School of Medicine; Associate Hospital Epidemiologist, Hospital of the University of Pennsylvania

Disclosure: Johnson and Johnson Salary Employment

Ebbing Lautenbach, MD, MPH  Director of Infection Control, Presbyterian Medical Center, Assistant Professor, Department of Medicine, Division of Infectious Disease, University of Pennsylvania School of Medicine

Ebbing Lautenbach, MD, MPH is a member of the following medical societies: American College of Epidemiology, American College of Physicians, Infectious Diseases Society of America, Society for Epidemiologic Research, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Kenneth C Earhart, MD  Deputy Head, Disease Surveillance Program, United States Naval Medical Research Unit #3

Kenneth C Earhart, MD is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Charles V Sanders, MD  Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center

Charles V Sanders, MD is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, Alpha Omega Alpha, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, American College of Physician Executives, American College of Physicians, American Federation for Medical Research, American Foundation for AIDS Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges, Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society for Obstetrics and Gynecology, Infectious Diseases Society of America, Louisiana State Medical Society, Orleans Parish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

The views expressed in this abstract/manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.

References

  1. O'Hara CM, Brenner FW, Miller JM. Classification, identification, and clinical significance of Proteus, Providencia, and Morganella. Clin Microbiol Rev. Oct 2000;13(4):534-46. [Medline].

  2. Janda, J. Michael, Abbott, Sharon. Enterobacteria 2nd edition. 2006;ASM Press.

  3. Mohr O'Hara C, Steigerwalt AG, Green D, McDowell M, Hill BC, Brenner DJ, et al. Isolation of Providencia heimbachae from human feces. J Clin Microbiol. Sep 1999;37(9):3048-50. [Medline].

  4. Krake PR, Tandon N. Infective endocarditis due to Providenca stuartii. South Med J. Oct 2004;97(10):1022-3. [Medline].

  5. Koreishi AF, Schechter BA, Karp CL. Ocular infections caused by Providencia rettgeri. Ophthalmology. Aug 2006;113(8):1463-6. [Medline].

  6. Rahav G, Pinco E, Silbaq F, Bercovier H. Molecular epidemiology of catheter-associated bacteriuria in nursing home patients. J Clin Microbiol. Apr 1994;32(4):1031-4. [Medline].

  7. Darouiche RO. Device-associated infections: a macroproblem that starts with microadherence. Clin Infect Dis. Nov 1 2001;33(9):1567-72. [Medline].

  8. Tumbarello M, Citton R, Spanu T, et al. ESBL-producing multidrug-resistant Providencia stuartii infections in a university hospital. J Antimicrob Chemother. Feb 2004;53(2):277-82. [Medline].

  9. Yoh M, Matsuyama J, Ohnishi M, Takagi K, Miyagi H, Mori K, et al. Importance of Providencia species as a major cause of travellers' diarrhoea. J Med Microbiol. Nov 2005;54:1077-82. [Medline].

  10. Arpin C, Thabet L, Yassine H, Messadi A, Boukadida J, Dubois V, et al. Evolution of an Incompatibility Group IncA/C Plasmid Harboring blaCMY-16 and qnrA6 Genes and its transfer through three clones of Providencia stuartii during a 2-year Outbreak in a Tunisian Burn Unit. Antimicrob Agents Chemother. Dec 12 2011;[Medline].

  11. Nicolle LE. Urinary tract pathogens in complicated infection and in elderly individuals. J Infect Dis. Mar 1 2001;183 Suppl 1:S5-8. [Medline].

  12. Murata T, Iida T, Shiomi Y, Tagomori K, Akeda Y, Yanagihara I, et al. A large outbreak of foodborne infection attributed to Providencia alcalifaciens. J Infect Dis. Oct 15 2001;184(8):1050-5. [Medline].

  13. Luzzaro F, Mezzatesta M, Mugnaioli C, Perilli M, Stefani S, Amicosante G, et al. Trends in production of extended-spectrum beta-lactamases among enterobacteria of medical interest: report of the second Italian nationwide survey. J Clin Microbiol. May 2006;44(5):1659-64. [Medline].

  14. Prentice B, Robinson BL. A review of Providencia bacteremia in a general hospital, with a comment on patterns of antimicrobial sensitivity and use. Can Med Assoc J. Sep 22 1979;121(6):745-9. [Medline].

  15. Albert MJ, Faruque AS, Mahalanabis D. Association of Providencia alcalifaciens with diarrhea in children. J Clin Microbiol. May 1998;36(5):1433-5. [Medline].

  16. Hawkey PM. Providencia stuartii: a review of a multiply antibiotic-resistant bacterium. J Antimicrob Chemother. Mar 1984;13(3):209-26. [Medline].

  17. Haynes J, Hawkey PM. Providencia alcalifaciens and travellers' diarrhoea. BMJ. Jul 8 1989;299(6691):94-5. [Medline].

  18. Hickman-Brenner FW, Farmer JJ, Steigerwalt AG, Brenner DJ. Providencia rustigianii: a new species in the family Enterobacteriaceae formerly known as Providencia alcalifaciens biogroup 3. J Clin Microbiol. Jun 1983;17(6):1057-60. [Medline].

  19. Kaslow RA, Lindsey JO, Bisno AL, Price A. Nosocomial infection with highly resistant, Proteus rettgeri. Report of an epidemic. Am J Epidemiol. Sep 1976;104(3):278-86. [Medline].

  20. Krake PR, Tandon N. Infective endocarditis due to Providenca stuartii. South Med J. Oct 2004;97(10):1022-3. [Medline].

  21. Matsuda T, Beppu T, Hirota M, et al. [A long-term surviving case of multiple metastatic liver tumors from rectal cancer treated with microwave coagulation therapy (MCT)]. Gan To Kagaku Ryoho. Oct 1999;26(12):1921-4. [Medline].

  22. Muder RR, Brennen C, Wagener MM, Goetz AM. Bacteremia in a long-term-care facility: a five-year prospective study of 163 consecutive episodes. Clin Infect Dis. Mar 1992;14(3):647-54. [Medline].

  23. Stock I, Wiedemann B. Natural antibiotic susceptibility of Providencia stuartii, P. rettgeri, P. alcalifaciens and P. rustigianii strains. J Med Microbiol. Jul 1998;47(7):629-42. [Medline].

  24. Warren JW. Providencia stuartii: a common cause of antibiotic-resistant bacteriuria in patients with long-term indwelling catheters. Rev Infect Dis. Jan-Feb 1986;8(1):61-7. [Medline].

  25. Wenzel RP, Hunting KJ, Osterman CA, Sande MA. Providencia stuartii, a hospital pathogen: potential factors for its emergence and transmission. Am J Epidemiol. Aug 1976;104(2):170-80. [Medline].

  26. Woods TD, Watanakunakorn C. Bacteremia due to Providencia stuartii: review of 49 episodes. South Med J. Feb 1996;89(2):221-4. [Medline].

 
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