Unusual Marine Pathogens Causing Cellulitis and Bacteremia in Hemodialysis Patients: Report of Two Cases and Review of the Literature

Abstract

Cellulitis in immunocompetent hosts is usually caused by skin organisms and responds to oral antibiotics. In immunocompromised hosts, such as end-stage renal disease (ESRD) patients, unusual organisms with unpredictable pathogenicity can cause infections. We present two cases with isolates that are usually encountered in coastal waters. The first case describes a 71-year-old African-American ESRD patient who presented with bacteremia secondary to a wound infection after exposure to flood waters in a tropical storm. The second case describes a 70-year-old Caucasian male ESRD patient who developed septic shock after a trivial wound inflicted while on a shrimp boat. Both patients were successfully treated with appropriate antibiotics and supportive measures. The infective agents in both cases belong to the halophilic Vibrio species. The causative agent of cellulitis and bacteremia in the first hemodialysis patient was identified as Vibrio alginolyticus, a non-lactose-fermenting gram-negative bacillus that is rarely isolated from blood. The second patient presented with septic shock owing to Vibrio vulnificus, which is a lactose-fermenting bacillus known to produce severe localized or systemic illness. In both cases, the common features were ESRD-related immunocompromised state and exposure to marine environments. These two cases of life-threatening cellulitis and bacteremia are presented as examples of environmental pathogens common to a marine environment in coastal areas and the imperative need of rapid identification and prompt initiation of treatment in immunocompromised hosts.

Sepsis due to Vibrio Alginolyticus Isolated from Catheter of Young Patient with Hypercholesterolemy: the First Case from Turkey

“…In the search of the PUBMED database with keywords "V.alginolyticus bacteremia", we found few cases of bacteremia caused by V.alginolyticus. The similar features of these patients were their predisposing factors such as cirrhosis, cancer, hemodialysis, burn, leukemia, sarchoma, chronic osteomyelitis and streoid therapy (4,5,7,8,10,11). The patient who get routinally lipid apheresis in this report, had genetic hypercholesterolemy Type 2a and a catheter had inserted to him before one and a half years.…”

Characteristic and Otopathogenic Analysis of a Vibrio alginolyticus Strain Responsible for Chronic Otitis Externa in China

“…Recently, the reported incidence of extra-intestinal infections due to V. alginolyticus through exposure to seawater has dramatically increased, including skin wound infections (Bultmann et al, 2016), conjunctivitis (Lessner et al, 1985), endophthalmitis (Li et al, 2009), peritonitis (Taylor et al, 1981), necrotizing fasciitis (Gomez et al, 2003), osteomyelitis (Barbarossa et al, 2002), intracranial infection (Opal and Saxon, 1986), bacteremia (Ruiz and Agraharkar, 2003), and ear infections. These infections increase significantly during the summer due to the increased temperature of seawater.…”

Revisión y recomendaciones para el manejo de diarrea por Vibrio parahaemolyticus

“…No debe usarse antiespasmódicos ni inhibidores de la motilidad intestinal, no hay estudios con el uso de probióticos en infecciones por este agente. Tampoco se ha demostrado que el uso de antimicrobianos abrevie el curso de la infección; sin embargo, se recomienda su empleo cuando la diarrea excede más de 5 días, en infecciones extraintestinales y en pacientes con co-morbilidad 2,9,[40][41][42][43][44] .…”

“…En pacientes pediátricos pueden usarse cloranfenicol o cotrimoxazol, dependiendo de la susceptibilidad antimicrobiana, o ciprofloxacina en caso de no observarse respuesta al esquema inicial. En infecciones cutáneas o septicemia por este agente, se recomienda tratar agresivamente con antimicrobianos asociados, como cefalosporinas de tercera generación + doxiciclina o aminoglucósidos, o quinolonas + aminoglucósidos, esquema similar al empleado en infecciones causadas por Vibrio vulnificus 1,[40][41][42][43][44][45] . El uso de tetraciclina está avalado en los estudios iniciales por su acción en la síntesis proteica, lo que disminuye la liberación de la toxina TDH.…”

“…Desarrollan un cuadro de mayor gravedad los pacientes con hepatopatías de diverso origen, alcohólicos, diabéticos, individuos con aclorhidria, inmunocomprometidos, mujeres embarazadas y pacientes con edades extremas 6,9,40,41 .…”