Shanghai fever: a distinctPseudomonas aeruginosaenteric disease

Abstract

BackgroundShanghai fever, a community-acquired enteric illness associated with sepsis caused by Pseudomonas aeruginosa, was first described in 1918. The understanding of Shanghai fever is incomplete.ObjectiveTo delineate the clinical features and to examine the host and microbial factors associated with Shanghai fever.MethodsWe prospectively enrolled 27 consecutive previously healthy children with community-acquired P aeruginosa enteritis and sepsis between July 2003 and June 2012. An immunological investigation, including measurement of serum immunoglobulin levels and lymphocyte subpopulations, was performed. The clonal relationship of bacterial isolates was determined by multilocus sequence typing (MLST) and the virulence of isolates was measured using cellular and animal models.ResultsThe median age of the patients was 7 months; 24 (89%) were aged <1 year. The most common clinical manifestations were fever (100%), diarrhoea (96%) and shock (81%). Leucopenia, thrombocytopenia, high C-reactive protein levels, coagulopathy and hypoalbuminaemia were the key laboratory findings. Necrotising enteritis with or without bowel perforation, ecthyma gangrenosum and seizures were main complications. The death rate was 15%. No common primary immune deficiency was identified. MLST genotypes indicated that isolates from Shanghai fever were non-clonal, but they shared similar phenotypes which were invariably cytotoxic, invasive and adhesive in cellular experiments and caused prolonged gut colonisation and more death than respiratory and laboratory control strains in mice.ConclusionsShanghai fever is a sporadic community-acquired disease of previously healthy infants that manifests as sepsis associated with P aeruginosa enteric disease. Both host and microbial factors play a role in pathogenesis.

Ecthyma gangrenosum and ecthyma-like lesions: review article

“…Few articles described several cases, i.e., eight [19,20], six [21,22], and seven cases [23]. The most recent article of Chuang et al in 2014 described 17 cases of EG that were found among 27 cases of Shanghai fever of P. aeruginosa etiology [24].…”

Ecthyma gangrenosum, a skin manifestation of Pseudomonas aeruginosa sepsis in a previously healthy child

“…In our patient, neutropenia was probably induced by Pa infection rather than being a predisposing factor for the infection. [11] …”

“…[7,8,11] Bodey et al [20] reported an overall cure rate of 67% for patients receiving appropriate antibiotics but only 14% for those receiving inappropriate antibiotics. Moreover, this retrospective analysis of Pseudomonas bacteremia cases indicated that in cases where optimal antimicrobial therapy was delayed (24–48 hours), the healing rate decreased from 74% to 46%.…”

Ecthyma gangrenosum of the scrotum: a case report

“…Other diseases associated with EG include Shanghai fever, which is a community-acquired enteric illness associated with sepsis caused by Pseudomonas. More than 50% of patients with Shanghai fever develop EG [9].…”