Acute cholecystitis with sepsis due to Edwardsiella tarda: a case report

Abstract

Background Edwardsiella tarda (E. tarda) is a Gram-negative facultative anaerobe belonging to Enterobacteriales and is commonly isolated from fishes and reptiles. Infection due to E. tarda is uncommon among humans, with a reported human retention rate of 0.001%. It can cause sepsis in the elderly or those with pre-existing conditions such as liver failure, autoimmune disease, or malignancy. E. tarda is susceptible to many antibiotics; however, a high mortality rate (approximately 40%) has been reported with sepsis. Case presentation A 65-year-old woman presented to our hospital with a chief complaint of fever and abdominal pain for 2 days. Her blood tests showed elevated inflammatory markers, and contrast-enhanced computed tomography showed distention and wall thickening of the gallbladder and inflammation of peri-gallbladder fat. Subsequently, a diagnosis of cholecystitis with systemic inflammatory response syndrome was made. Laparoscopic cholecystectomy was performed after starting antimicrobial therapy. Blood culture of samples obtained on admission were positive for E. tarda, which was also detected in bile juice culture. Therefore, she was diagnosed with bacteremia caused by E. tarda, and postoperative antimicrobial therapy was continued. The patient improved, and there were no complications. Conclusions We experienced an extremely rare case of acute cholecystitis caused by E. tarda. Only a few cases of acute cholecystitis due to E. tarda have been reported. Furthermore, similar to this case, no previous study has reported the detection of E. tarda in both blood and bile cultures in acute cholecystitis cases. In addition to appropriate surgical intervention, continuous administration of antibiotics based on culture results resulted in a favorable outcome.

Expanding the Spectrum of Diseases and Disease Associations Caused by Edwardsiella tarda and Related Species

“…Clinical isolates of E. tarda are uniformly susceptible to aminoglycosides, ampicillin, ampicillin/sulbactam, βlactam antibiotics (cephalosporins), β-lactamase-inhibitor agents, carbapenems, quinolones, aztreonam, and chloramphenicol. Such in vitro studies are supported by recent case studies [155,168,169] and one retrospective survey of E. tarda bacteremia in Japan [149] yielding identical results. The term "pan-susceptible" has been coined in referring to this unusual highly susceptible Edwardsiella species [155].…”

“…In addition to hepatobiliary disease being associated with E. tarda bacteremia [50,60,62,107,169], a variety of other rare complications have been attributed to edwardsiellosis. These maladies include peritonitis [51], urinary tract infections [44,56], respiratory tract disease [59], and endocarditis [170].…”