Fatal Necrotizing Soft Tissue Infection by Aeromonas hydrophila

Abstract

Aeromonas infections in healthy individuals are self limiting, but those in patients with immuno-compromised conditions are frequently associated with significant morbidity and mortality. The current case report describes a fatal case of necrotizing soft tissue infection by Aeromonas hydrophila in an immuno-competent patient. CASE REpoRTA 28-year-old female, residing in the rural Alwar district of Rajasthan, India presented to the Emergency Department of a tertiary care hospital in Jaipur, India with complaints of breathlessness and swelling in right arm with pain. On admission, the patient was found to have a body temperature of 101ºF, accompanied by hypotension (71/45 mmHg), tachycardia (160/min), tachypnea (44/min) and oxygen saturation of 64%. Examination of the right upper limb revealed a tender edematous swelling on the entire arm extending up to the digits, with multiple bleb formations and ecchymosis over the skin. A provisional diagnosis of septic shock with cellulitis of the right arm was made.The patient provided a recent history of acute gastroenteritis, for which she had received an I.V. infusion at a rural health care centre. The I.V. line was established on the right arm. The patient subsequently developed swelling and pain in the same arm. Due to progressive clinical deterioration in her condition over the next five days, the patient was admitted and treated conservatively for septic shock in a local hospital in Alwar, before being referred to our hospital. The treatment details of the same were not available with the patient. There was no history of any comorbidity such as hypertension, tuberculosis, diabetes mellitus or asthma.Following admission, the patient was immediately intubated and put on mechanical ventilation. Antibiotics (Piperacillin/Tazobactam and Amikacin) and ionotropes were started as initial treatment for septic shock. Her laboratory investigations revealed marginally increased renal and hepatic function tests:(Serum BUN-49mg/dl, creatinine -2.8mg/dl, SGOT-115 u/l, Alkaline phosphatase-171u/l, total bilirubin-6.15 mg/dl, prothrombin time-28.8seconds), accompanied by thrombocytopenia (platelet count-40 thousand/microlitre) and leucocytosis (TLC-22.4 thousand/microlitre). The blood and urine cultures were sterile.A surgical consultation, taken for the right arm, suggested gangrene on the right upper limb with compartment syndrome. An axial fasciotomy with releasing incision was performed under sedation in the Intensive Care Unit (ICU). During the procedure, a deep wound sample was collected from the necrotic tissue and sent for culture and sensitivity to the microbiology lab. After the procedure, Levofloxacin, Teicoplanin and Clindamycin were added to the existing antibiotic regimen. Over the next few hours, the patient developed conjunctival haemorrhage in the left eye and ecchymotic patches over the left ankle and left wrist. Repeat laboratory investigations revealed a further deranged coagulation profile, liver function tests and renal function tests. The haemoglobin ha...

Chronic osteomyelitis by Aeromons hydrophilal: A silent cause of concern

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“…Although rare, extra-intestinal Aeromonas infections (skin and soft tissue infections, pneumonia, endocarditis, and meningitis) have also been reported. [ 2 3 4 ] This is a case of chronic osteomyelitis of the lower limb due to A. hydrophila , which occurred as a delayed complication following open reduction and internal fixation.…”

Development of cross-priming amplification assays for rapid and sensitive detection of Aeromonas hydrophila

“…The majority of patients with severe Aer. hydrophila infection live in poor health conditions and living facilities, and peripheral health care settings are typically their first consultation sites (Janda and Abbott 2010;Sood and Nerurkar 2014). Therefore, a detection method that could be used in primary care facilities and smaller clinical laboratories is necessary.…”

“…The mere presence of Aer. hydrophila in an infected wound is an independent predictor of death among patients with necrotizing fasciitis (Huang et al 2011;Sood and Nerurkar 2014). Hence, its earlier and accurate identification along with appropriate antibiotic therapy may be crucial for patient prognosis.…”

Obligate anaerobes are abundant in human necrotizing soft tissue infection samples – a metagenomics analysis

“…One theory is that the host determines the trajectory of the infection process. Patients with co‐morbidities, such as diabetes and obesity, or those who are immunosuppressed, are more susceptible to NSTIs than those without significant co‐morbidities or immunosuppression . However, NSTIs also occur in seemingly healthy patients .…”