Fatal spontaneous Aeromonas hydrophila myonecrosis and sepsis without antecedent trauma. Issue 3 (September 2014)

• Record Type: Journal Article
• Authors: Behera, Bijayini; Mohapatra, Tushar Kumar; Narasaraju, K.; Pradhan, Nihar Ranjan; Murali Mohan Reddy, K.; Nimmala, Pavani
• Is Part Of: JMM case reports. Volume 1:Issue 3(2014)
• Publication Date: 2014-09
• Subjects: Aeromonas hydrophila -- fatal -- myonecrosis -- sepsis -- trauma; Medical microbiology -- Periodicals; 616.9041
• DOI: 10.1099/jmmcr.0.002519
• Languages: English
• ISSNs: 2053-3721

Abstract

Abstract : Introduction: Aeromonas hydrophila is implicated in a wide spectrum of skin and soft‐tissue infections, ranging from cellulitis to life‐threatening necrotizing fasciitis and myonecrosis. Most reported cases of fulminant A. hydrophila necrotizing soft‐tissue infections occur following a history of trauma sustained in an aquatic environment. However, fatal Aeromonas myonecrosis and gas gangrene without antecedent trauma, underlying liver disease, malignancy or immunosuppression has rarely been reported in the literature. Case presentation: A 50‐year‐old woman who underwent elective percutaneous transluminal coronary angioplasty became acutely ill with septic shock and adult respiratory distress syndrome, on post‐operative day 3. She developed severe oedema, blistering and gangrenous patches in the right lower limb. She died on post‐operative day 3 despite intensive care. A. hydrophila was cultured from the blister fluid, two blood cultures and tissue. An inspection of the hospital water supply was negative for A. hydrophila, and hence the origin of the A. hydrophila could not be ascertained. Conclusion: Post‐operative Aeromonas infection is rare but very serious, and requires particularly vigilant monitoring. The mortality of Aeromonas necrotizing soft‐tissue infections where the microorganism is simultaneously isolated from blood culture is documented to be extremely high. In all cases of rapidly progressive necrotizing infections, A. hydrophila should be kept in mind and a fluoroquinolone/aminoglycoside should be added to the surgical and medical management. The microbiology laboratory should be alert in dealing with Gram‐negative, β‐haemolytic isolates so that an oxidase or deoxyribonuclease screen is performed to differentiate A. hydrophila from microbiologically similar organisms.