History
Providencia stuartii and Providencia rettgeri infections
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.
Providencia alcalifaciens, Providencia rustigianii, and Providencia heimbachae infections
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. [14, 18]
P alcalifaciens infection is also associated with overseas travel.
Physical
Providencia stuartii and Providencia rettgeri infections
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. [19]
Providencia alcalifaciens, Providencia rustigianii, and Providencia heimbachae infections
Physical examination findings include fever, tachycardia, abdominal pain, dry mucous membranes, and typically negative occult blood in stool. [14]
Causes
Providencia urinary tract infection
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).
Providencia gastroenteritis
Gastroenteritis due to P alcalifaciens, P rettgeri, and P stuartii may develop after travel to developing countries.
Complications
P stuartii and P rettgeri infections, particularly when they involve the bloodstream, have been associated with numerous complications, as follows:
-
Sepsis/vascular collapse
-
Renal failure
-
Pneumonia
-
ARDS
Providencia gastrointestinal tract infection may be associated with bloody diarrhea and dehydration.
