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*Centre Hospitalier Universitaire de Isolation of VITEK2 (bioMérieux) with ID-GN Grenoble, Grenoble, France; and card failed to identify the strain. Disk †Hôpitaux Drôme Nord, Romans sur Isere, Schineria sp. from diffusion assay showed the strain to France a Man be susceptible to β-lactams, amino- glycosides, fluoroquinolones, tetracy- References To the Editor: Schineria larvae clines, erythromycin, rifampin, and 1. Safdar N, Young DK, Andes D. has been isolated from maggots of the colistin but resistant to nalidixic acid Autochthonous furuncular myiasis in the fly Wohlfahrtia magnifica (1), which and fosfomycin. Local therapy of United States: case report and literature cause myiasis in animals and people debridement, bandaging, and sulfadi- review. Clin Infect Dis. 2003;36:e73–80. in Eurasia and northern Africa. In 2. Otranto D, Stevens JR, Brianti E, azin argentic, along with systemic Dorchies P. Human and livestock migra- industrialized nontropical countries, a antimicrobial therapy ( 400 tions: a history of bot fly biodiversity in range of species in the order Diptera mg/day plus cefotaxime 6 g/day) for 2 the Mediterranean region. Trends cause facultative myiasis in patients weeks, led to clinical improvement Parasitol. 2006;22:209–13. with neglected wounds (2). Since the 3. Stevens JR, Wallman JF. The evolution of and sterilization of the blood cultures. myiasis in humans and other animals in recent description of S. larvae, The local therapy was continued, and the Old and New Worlds (part I): phylo- Schineria sp. isolates and clones have ofloxacin (400 mg/day) was pre- genetic analyses. Trends Parasitol. been detected in diverse environmen- scribed for 15 days while the patient 2006;22:129–36. tal and animal sources, but in all cases 4. Stevens JR, Wallman JF, Otranto D, Wall was in a rehabilitation center. R, Pape T. The evolution of myiasis in a relation with flies could be estab- In October 2005, the patient was humans and other animals in the Old and lished. We describe a case of bac- readmitted with the same symptoms. New Worlds (part II): biological and life- teremia due to Schineria sp. in a P. mirabilis, group A and group G history studies. Trends Parasitol. human patient with myiasis. 2006;22:181–8. streptococci, Morganella sp., 5. Seppanen M, Virolainen-Julkunen A, In July 2005, a 39-year-old Bacteroides fragilis, and Candida Kakko I, Vilkamaa P, Meri S. Myiasis homeless man with medical history of albicans were cultured from maggot- during adventure sports race. Emerg polyneuropathy related to alcohol invaded wounds. Aerobic blood cul- Infect Dis. 2004;10:137–9. abuse was examined at Montpellier 6. Fogelman JP, Day DJ, Cohen RJ. Myiasis ture, after 1 day of incubation, was in a traveler: a moving story. Ann Intern Hospital, Montpellier, France, and positive for strain ADV4155.05, Med. 2003;138:521–2. found to be in poor general health and which displayed the same phenotype 7. Toth E, Kovacs G, Schumann P, Kovacs to have an abnormal electrocardio- as strain ADV1107.05 except for AL, Steiner U, Halbritter A, et al. gram, mild fever (38°C), metabolic Schineria larvae gen. nov., sp. nov., iso- resistance. Clinical lated from the 1st and 2nd larval stages of disorders, increased C-reactive pro- improvement was observed after 2 Wohlfahrtia magnifica (Diptera: tein (254 mg/L) and fibrinogen (18.23 weeks of the same local and systemic Sarcophagidae). Int J Syst Evol µ mol/L), and a normal leukocyte treatments as initially prescribed. The Microbiol. 2001;51:401–7. count (7.8 × 109/L). Removal of his 8. Toth EM, Hell E, Kovacs G, Borsodi AK, patient was transferred to an addiction Marialigeti K. isolated from the shoes and socks, which he had worn care center and received oral antimi- different developmental stages and larval continuously for 2 months, showed crobial therapy ( 500 organs of the obligate parasitic fly, advanced maceration of his feet mg/day plus amoxicillin/clavulanic Wohlfahrtia magnifica (Diptera: (trench foot) with wounds invaded by Sarcophagidae). Microb Ecol. 2006;51: acid 3 g/day) for 20 days. 13–21. maggots. The following organisms The 16S rDNA amplification and 9. Juteau P, Tremblay D, Villemur R, were found in wound samples: sequencing were performed with uni- Bisaillon JG, Beaudet R. Analysis of the mirabilis, Providentia stuartii, versal primers 27f and 1492r as bacterial community inhabiting an aero- group G Streptococcus, Streptococcus bic thermophilic sequencing batch reactor described (3). The 1,414-bp sequences (AT-SBR) treating swine waste. Appl sp., and Enterococcus sp. Aerobic of the 2 isolates were identical and Microbiol Biotechnol. 2004;66:115–22. blood culture, after 2 days of incuba- showed similarity level of 99.6% with 10. Weisburg WG, Barns SM, Pelletier DA, tion, was positive for a gram-negative the sequence of Schineria sp. Lane DJ. 16S ribosomal DNA amplifica- rod, strain ADV1107. 05. Subculture tion for phylogenetic study. J Bacteriol. 010793816 isolated from human 1991;173:697–703. on MacConkey medium showed posi- (M. Vaneechoutte, pers. comm.) but tive reactions for oxidase, , only 98.3% with S. larvae L1/68T 16S Address for correspondence: Max Maurin, and gamma-glutamyltransferase. rDNA. This finding differed from the Laboratoire de Bactériologie, Centre Hospitalier Positive malate reaction with API biochemical identification and under- Universitaire de Grenoble, Université Joseph 20NE system (bioMérieux, Marcy lined the usefulness of sequencing to Fourier, BP 217, 38043 Grenoble, CEDEX 9, l’Etoile, France) identified the strain precisely identify gram-negative France; email: [email protected] as Oligella urethralis, whereas bacilli that assimilate only a few

Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 13, No. 4, April 2007 659 LETTERS sugars. Phylogenetic analysis linked could be correlated with fly larvae sive potential. Invasiveness may be the 2 strains to the genus Schineria in proliferation. Because of the lifestyle enhanced by the maggots’ acting as a the class Gamma of Schineria sp., thinking that the vector as they move through the (Figure). However, whether the iso- strains in our patient originated from necrotic tissues toward the blood- lates are species S. larvae remains in his wounds’ maggots is reasonable. stream. Invasiveness also may be a doubt. Enterobacterial repetitive inter- Unfortunately, the maggots were specific characteristic of the bacteri- genic consensus–PCR and repetitive thrown away and could be neither um; phylogenetic methods placed the extragenic palindromic–PCR finger- analyzed nor identified. Schineria sp. genus Schineria in a subgroup that prints (6) showed that the 2 strains could not be cultivated from the included human pathogens Cardio- were unrelated, thereby demonstrat- patient’s wounds, perhaps because of bacterium, Francisella, Coxiella, and ing that the second episode of bac- its close association to larvae or to the Legionella. Indeed, all the phyloge- teremia was a reinfection with a new abundant associated flora. Despite the netic methods tested excluded strain and not a relapse. presence of virulent bacteria in the Schineria spp. of the family Xantho- The 16S rDNA of our isolates is wounds, Schineria sp. was the sole monadaceae (Figure), which conflicts most related to an uncultured bacteri- bacterium recovered from blood dur- with current classification (8). um found in swine waste (7), but its ing the 2 independent episodes of No report has described bac- presence in such an environment bacteremia, which suggests its inva- teremia following myiasis with facul- tative parasites, but investigations of bacteria in reported myiasis cases have been conducted on cutaneous lesions and never on blood (9). Because of this association between maggots and risk for bacteremia, blood cultures should be performed for patients with myiasis and poor hygiene. Moreover, germ-free maggots bred for biosurgery use (10) should be checked, by molec- ular methods, for the absence of Schineria sp.

Laurent Roudiere,* Hélène Jean-Pierre,† Christelle Comte,† Isabelle Zorgniotti,* Hélène Marchandin,† and Estelle Jumas-Bilak* *University Montpellier 1, Montpellier, France; and †Centre Hospitalier Universitaire de Montpellier, Montpellier, France

Figure. Maximum likelihood (ML) 16S rRNA gene phylogenetic tree showing the place- References ment of the genus Schineria (boldface) and the isolate ADV1107.05 (underlined) in the phylum Proteobacteria. To reconstruct this tree, we used the strain ADV1107.05 sequence 1. Toth E, Kovacs G, Schumann P, Kovacs (DQ906159, 1441 bp) and 49 sequences selected from the GenBank database: 38 among AL, Steiner U, Halbritter A, et al. the 15 orders of the Gamma Proteobacteria, 6 for the Beta Proteobacteria, 2 for the Alpha Schineria larvae gen. nov., sp. nov., iso- Proteobacteria, 1 for Delta Proteobacteria, 1 for Epsilon Proteobacteria and Clostridium lated from the 1st and 2nd larval stages of haemolyticum (used as the outgroup organism). Accession nos. are in brackets. Alignment Wohlfahrtia magnifica (Diptera: was performed with ClustalW 1.83 (4). ML phylogenetic analysis was performed by using Sarcophagidae). Int J Syst Evol PHYML v2.4.4 (5) with the general time-reversible plus gamma distribution plus invariable Microbiol. 2001;51:401–7. site (GTR + Γ + I) model found to be most appropriate according to Akaike information cri- 2. Delhaes L, Bourel B, Scala L, Muanza B, teria. Bootstrap values given at the nodes are estimated with 100 replicates. The scale bar Dutoit E, Wattel F, et al. Case report: indicates 0.3 substitutions per nucleotide position. Strain ADV4155.05 sequence recovery of Calliphora vicina first-instar (DQ906158, 1414 bp) is not reported because it was identical to ADV1107.05. Trees were larvae from a human traumatic wound also obtained by distance methods (JC69, F84, and GTR models, and neighbor-joining), associated with a progressive necrotizing by parsimony, and by Bayesian inference. In all instances the genus Schineria branched bacterial infection. Am J Trop Med Hyg. out of the cluster. 2001;64:159–61.

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3. Teyssier C, Marchandin H, Jean-Pierre H, Salmonella Bacteria at the Centers for Disease Diego I, Darbas H, Jeannot JL, et al. Control and Prevention (CDC), and Molecular and phenotypic features for Kingabwa identification of the opportunistic the isolates were susceptible to each pathogens Ochrobactrum spp. J Med Infections and of 15 antimicrobial agents tested. Microbiol. 2005;54:945–53. Lizard Contact, The 6 patients in the 2005 out- 4. Thompson JD, Higgins DG, Gibson TJ. break did not know each other and CLUSTAL W: improving the sensitivity United States, of progressive multiple sequence align- resided in 5 states: Maine (2 patients), ment through sequence weighting, posi- 2005 Arizona, California, Idaho, and Ohio. tion-specific gap penalties and weight Illness onset dates were in June, July, matrix choice. Nucleic Acids Res. To the Editor: Nontyphoidal August, October (2 patients), and 1994;22:4673–80. Salmonella infections cause an esti- November 2005. Of the 6 patients, 4 5. Guindon S, Gascuel O. A simple, fast, and mated 1.4 million illnesses and 400 accurate algorithm to estimate large phy- (67%) were <1 year old (range <1–53 deaths in the United States annually logenies by maximum likelihood. Syst years), 4 were male, 2 were hospital- Biol. 2003;52:696–704. (1). Among the >2,500 Salmonella ized, and none died. 6. Versalovic J, Koeuth T, Lupski JR. serotypes, Interviews with patients or their Distribution of repetitive DNA sequences serotype Kingabwa rarely causes in eubacteria and application to finger- parents or guardians conducted during human illness. This serotype was first printing of bacterial genomes. Nucleic routine public health surveillance col- Acids Res. 1991;19:6823–31. reported in a patient in the Belgian lected information on specific food 7. Juteau P, Tremblay D, Villemur R, Congo in 1953 (2). From 1995 items, water sources, restaurant ven- Bisaillon JG, Beaudet R. Analysis of the through 2004, only 30 human illness- bacterial community inhabiting an aero- ues, travel history, and animal contact. es caused by S. Kingabwa were bic thermophilic sequencing batch reactor No common food or environmental (AT-SBR) treating swine waste. Appl reported to the National Salmonella source was identified. However, 4 Microbiol Biotechnol. 2004;66:115–22. Surveillance System (3). No common (67%) of the 6 patients had known 8. Saddler GS, Bradbury JF. Family I. source for S. Kingabwa human ill- Xanthomonadaceae fam. nov. In: Brenner exposure to lizards: 3 water dragons nesses has been previously identified. DJ, Krieg NR, Staley JT, Garrity GM, edi- (Physignathus cocincinus, Figure) and tors. Bergey’s manual of systematic bac- We recently investigated an outbreak 1 bearded dragon (Pogona sp.). Of teriology. 2nd ed. Vol. 2. New York: of S. Kingabwa infections associated these 4 patients, 3 had >1 lizard in Springer; 2005. p. 63. with 2 lizard species: the water drag- 9. Mallon PW, Evans M, Hall M, Bailey R. their own household as pets; the other on and the bearded dragon. Something moving in my head. Lancet. patient was exposed to a lizard when 1999;354:1260. Eighteen isolates of S. Kingabwa visiting a family member. The 2 10. Nuesch R, Rahm G, Rudin W, Steffen I, (antigenic formula: I 43:y:1,5) were patients who did not recall lizard Frei R, Rufli T, et al. Clustering of blood- received by PulseNet, the National stream infections during maggot debride- exposure might represent patients with Molecular Subtyping Network for ment therapy using contaminated larvae background cases unrelated to lizards. of Protophormia terraenovae. Infection. Foodborne Disease Surveillance, Single cultures of the 2 lizards avail- 2002;30:306–9. from 2001 through 2005. When able for testing in February 2006 did digested with restriction enzyme XbaI not yield S. Kingabwa, which could Address for correspondence: Estelle Jumas- and subtyped by pulsed-field gel elec- Bilak, University Montpellier 1, Laboratoire de mean that they did not carry this rare trophoreisis (PFGE), 13 isolates pro- Salmonella serotype. However, this Bactériologie, EA 3755, Faculté de Pharmacie, duced a single, indistinguishable pat- 15 avenue Charles Flahault, BP14491, 34093 does not exclude lizards as the source tern (KINX01.0001). Of these, 1 (8%) of these illnesses because lizards inter- Montpellier, CEDEX 5 France; email: was isolated in 2001, 4 (31%) were [email protected] mittently shed salmonellae (4). isolated in 2002, 2 (15%) were isolat- The lizards had been purchased ed in 2004, and 6 (46%) were isolated from local pet shops and a traveling in 2005. We defined a case as illness reptile show. Shipments of reptiles during 2005 caused by S. Kingabwa were mixed together at points of sale, that matched pattern KINX01.0001 and numerous distributors and by PFGE. Of the 9 S. Kingabwa iso- importers were used, so determining lates received by PulseNet in 2005, 6 the origin of individual reptiles was matched KINX01.0001. Antimicro- not feasible. However, water dragons bial drug susceptibility of 3 isolates and bearded dragons are imported was determined by the National into the United States from Asia and Antimicrobial Resistance Monitoring Australia and are rarely bred domesti- System (NARMS) for Enteric cally.

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