Necrotizing fasciitis secondary to lake water inoculation with Aeromonas sobria

Abstract

Rationale: Necrotizing fasciitis (NF) is a rapidly progressing bacterial soft tissue infection with a high mortality rate. It is characterized by significant soft tissue destruction with associated sepsis. The mainstay of treatment is coverage with appropriate broad-spectrum antibiotic therapy and emergent surgical debridement. Patient concerns: A previously healthy 66-year-old female presented with a deep laceration to her right, posterior calf with subsequent contamination with lake water. After the wound was irrigated and closed, the patient developed NF. Diagnosis: Laceration of the right lower extremity complicated by NF secondary to Aeromonas sobria. Interventions: The patient underwent emergent surgical debridements with intravenous broad-spectrum antibiotics and negative pressure wound therapy. The lower extremity was reconstructed with split-thickness skin grafts. Outcomes: The patient's initial penetrating trauma was closed in the emergency room, and the patient was discharged home with antibiotics. She returned the next day with unstable vitals and was admitted to the intensive care unit. Her condition continued to deteriorate, and she underwent serial surgical debridements. Her condition improved and was discharged home after 13 days in the hospital. Lessons Learned: Close monitoring for NF is important for tissue infections sustained in aquatic environments. Timely identification and surgical management of NF increases overall survival.

Aeromonas sobria Serine Protease Degrades Several Protein Components of Tight Junctions and Assists Bacterial Translocation Across the T84 Monolayer

“…A. sobria opportunistically causes severe extraintestinal diseases, especially in immunocompromised patients and elderly individuals ( Spadaro et al., 2014 ; Bhowmick and Bhattacharjee, 2018 ; Hutchinson et al., 2021 ). Such extraintestinal infectious diseases have resulted in fatalities in Japan ( Shimoji et al., 2015 ; Nakao et al., 2016 ).…”

“…Aeromonas sobria is a Gram-negative bacterium that is widely distributed in both fresh and brackish water areas. A. sobria generally causes food-borne illness with watery diarrhea as a main symptom (Janda and Brenden, 1987;Janda and Abbott, 2010), and it opportunistically causes severe extraintestinal diseases including sepsis, peritonitis, and meningitis (Janda and Abbott, 1998;Spadaro et al, 2014;Song et al, 2019;Hutchinson et al, 2021) especially in immunocompromised patients and the elderly (Bhowmick and Bhattacharjee, 2018). These extraintestinal infections can be caused by A. sobria that has invaded the body through a wound, but they can be also caused by the bacteria that infect the intestinal tract.…”

Minocycline Activity against Unusual Clinically Significant Gram-Negative Pathogens

“…Aeromonas spp. have been associated with necrotizing fasciitis ( 7 , 8 ). Burkholderia cepacia species complex and Stenotrophomonas maltophilia have been recognized as causes of bloodstream infections and pneumonia in immunocompromised patients ( 9 , 10 ).…”