Mouth in Foot Disease

Hawaii J Med Public Health. 2015 Sep;74(9 Suppl 2):30-2.

Abstract

Toothpicks are commonly used household items that rarely cause serious injury or infection. Toothpick-related injuries often occur due to ingestion with subsequent trauma/infection at distal sites within the gastrointestinal tract; however, cardiovascular, pleural, and soft tissue infections have been reported. Eikenella corrodens is a gram-negative, facultative anaerobic bacillus found in oral flora associated with bite wound infections. A few case reports describe E. corrodens osteomyelitis from toothpick puncture wounds. We report a case of foot cellulitis and abscess in an elderly diabetic after toothpick puncture injury that was unresponsive to empiric antibiotics. Wound cultures grew E. corrodens and rare Peptostreptococcus species. E. corrodens is resistant to first-generation cephalosporins, macrolides, aminoglycosides, clindamycin, and metronidazole. This case highlights the insidious nature of E. corrodens infections and the need to tailor empiric antibiotics for skin and soft tissue infections based on the mechanism of injury. In addition, this case stresses the importance of protective footwear in diabetics and serves as a cautionary tale regarding the use of seemingly innocuous toothpicks.

Publication types

  • Case Reports

MeSH terms

  • Abscess / etiology
  • Abscess / microbiology
  • Aged
  • Cellulitis / etiology
  • Cellulitis / microbiology
  • Eikenella corrodens / pathogenicity*
  • Female
  • Foot Diseases / etiology*
  • Foot Diseases / microbiology
  • Gram-Negative Bacterial Infections / complications*
  • Gram-Negative Bacterial Infections / etiology
  • Humans
  • Mouth / injuries*
  • Wounds, Penetrating / complications*
  • Wounds, Penetrating / microbiology