Fulminant septic shock due to Edwardsiella tarda infection associated with multiple liver abscesses: a case report and review of the literature

Abstract

Introduction Edwardsiella tarda uncommonly infects humans. The usual presentation is mild gastroenteritis, but systemic manifestations may occur. Lethal infections are rarely documented in patients with underlying disorders. Case presentation A previously healthy 37-year-old Southeast Asian woman presented to our hospital with recent onset of abdominal pain, fever, and vomiting. Her condition rapidly deteriorated with signs and symptoms of fulminant septic shock; thus, she was intubated, supported with intravenous vasopressors and fluids, and transferred to the intensive care unit. An abdominal computed tomographic scan with contrast revealed multiple liver abscesses. Blood cultures were obtained and computed tomography–guided percutaneous drainage of the liver abscesses with supplementary cultures was performed; thereafter, empirical broad-spectrum antibiotics were initiated. All cultures grew E. tarda, whereas an antibiogram showed resistance to broad-spectrum antibiotics and sensitivity to ciprofloxacin and aminoglycosides; thus, the antibiotic regimen was updated accordingly. The patient made an uneventful recovery and was discharged from the intensive care unit 14 days after admission. Conclusion E. tarda human infection can present as liver abscess and fulminant septic shock. E. tarda strains can be resistant to broad-spectrum antibiotics; hence, culture-based antibiotics should be used accordingly. Clinicians should be aware of this rare and potentially lethal infection.

Edwardsiella tarda Bacteremia With Tubo-Ovarian Abscess

“…Edwardsiella species are generally found in marine animals and their habitats, but humans may be incidentally infected through exposure to water environments or ingestion of contaminated raw seafood 1 . Although the gastrointestinal tract is the site most often involved (presenting as a self-limited gastroenteritis), other manifestations such as pelvic or intra-abdominal abscesses, vertebral osteomyelitis and epidural abscess, wound infections and myonecrosis, and bacteremia can occur 2–8 . Systemic infection usually presents in patients with underlying chronic conditions, and mortality rates in these patients can be as high as 50% 9–11 .…”

“…1 Although the gastrointestinal tract is the site most often involved (presenting as a self-limited gastroenteritis), other manifestations such as pelvic or intra-abdominal abscesses, vertebral osteomyelitis and epidural abscess, wound infections and myonecrosis, and bacteremia can occur. [2][3][4][5][6][7][8] Systemic infection usually presents in patients with underlying chronic conditions, and mortality rates in these patients can be as high as 50%. [9][10][11] Predisposing illnesses include diabetes, hepatobiliary and bowel diseases, sickle cell disease, and immunodeficiencies.…”

Edwardsiella tarda: A Classic Presentation of a Rare Fatal Infection, with Possible New Background Risk Factors

“…The most serious presentation is a systemic manifestation complex that can include septic shock, osteomyelitis, cholecystitis, and meningitis. Systemic manifestations carry a high risk of mortality [ 12 ]. Cirrhosis of the liver, immunocompromised state, and liver disease with iron overload have been the only risk factors reported for severe sepsis with E. tarda in humans.…”

Concomitant <i>Clostridioides difficile</i> and<i> Edwardsiella tarda</i> Infection in a Patient with Ulcerative Colitis

“…E. tarda is a Gram-negative, facultative, anaerobic bacterium belonging to the Enterobacteriaceae family. Although E. tarda is an unusual human pathogen that mostly causes mild GI diseases in humans, it can occasionally cause invasive infections, such as abscesses, in extraintestinal organs, including the liver, biliary duct, pelvis, brain, and digestive tract (10)(11)(12)(13)(14). Some previous reports have shown that E. tarda induces gastroenteritis associated with ulceration and pseudomembranes (15)(16)(17).…”