This 34 year old patient is a Type 1 diabetic status post kidney pancreas transplant on life-long immunosuppressive medications who now has a neuropathic foot ulcer. That’s dog hair all over the dressing, which the patient argued was nothing to worry about because the dog hair was not actually INSIDE the wound.
Here is the wound which probes to bone. I got the patient to agree to a Total Contact Cast since it’s clearly necessary to protect this wound
Here are the results of the DNA assay by MicrogenDx.
I am still figuring out how to best use DNA assays, but this one is interesting. I got my microbiology degree from Google in about 15 minutes so I am sure some of you know more about these bacteria than I do, but here’s what I found:
- Porphyromonas cangingivalis is a bacteria found in the periodontal pockets of dogs
- Haemophilus parainfluenzae can be part of the normal flora of the mouth but brain abscess, liver abscess, osteomyelitis, pneumonia, peritonitis, septic arthritis, and bacteremia have been reported to be caused by it.
- H. kunzii is primarily recovered from infected wounds, particularly diabetic foot ulcers with cellulitis
- Anaerococcus lactolyticus is a human pathogen found in chronic wounds that is involved in polymicrobial infections.
- Peptoniphilus harei is part of the normal vaginal and gut microbiota but can be part of polymicrobial infections of diabetic skin and soft tissue, bone, joint and surgical site infections.
- Anaerococcus hydrogenalis is isolated from human feces and vaginal discharge.
On second thought, maybe it’s the dog that needs to worry.