Aeromonas sobria necrotizing fasciitis and sepsis in an immunocompromised patient: a case report and review of the literature

Journal of Medical Case Reports

Carlo Alberto Volta¹  Silvia Zardi¹  Riccardo Ragazzi¹  Maria Vittoria Colamussi¹  Anna Romanello¹  Elisabetta Marangoni¹  Angela Berselli¹  Savino Spadaro¹ 

[1] Department of Morphology, Surgery and Experimental Medicine, Sant’ Anna Hospital, University of Ferrara, Via Aldo Moro 8, Ferrara, FE 44124, Italy

关键词: Sepsis;    Necrotizing fasciitis;    Immunocompromised host;    Aeromonas sobria;   

Others  :  1181037
DOI  :  10.1186/1752-1947-8-315

 received in 2014-04-05, accepted in 2014-07-24,  发布年份 2014

【 摘 要 】

Introduction

Aeromonas veronii biovar sobria is a rare cause of bacteremia, with several studies indicating that this isolate may be of particular clinical significance since it is enterotoxin producing. A wide spectrum of infections has been associated with Aeromonas species in developing countries that include gastroenteritis, wound infections, septicemia and lung infections. This infection, caused by Aeromonas species, is usually more severe in immunocompromised than immunocompetent individuals. We here describe a case of soft tissue infection and severe sepsis due to Aeromonas sobria in an immunocompromised patient.

Case presentation

A 74-year-old Caucasian man with a clinical history of chronic lymphocytic leukemia and immune thrombocytopenia, periodically treated with steroids, was admitted to our Intensive Care Unit because of necrotizing fasciitis and multiorgan failure due to Aeromonas sobria, which resulted in his death. The unfortunate coexistence of a Candida albicans infection played a key role in the clinical course.

Conclusion

Our experience suggests that early recognition and aggressive medical and surgical therapy are determinants in the treatment of severe septicemia caused by an Aeromonas sobria in an immunocompromised patient.

【 授权许可】

   
2014 Spadaro et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Minnaganti VR, Patel PJ, Iancu D, Schoch PE, Cunha BA, Brook M, Brook S: Necrotizing fasciitis caused by Aeromonas hydrophila. Hearth Lung 2000, 29(4):306-308.
• [2]Chen IC, Li WC, Hong YC, Shie SS, Fann WC, Hsiao CT: The microbiological profile and presence of bloodstream infection influence mortality rates in necrotizing fasciitis. Crit Care 2011, 15(3):R152. BioMed Central Full Text
• [3]Cheung JP, Fung B, Tang WM, Ip WY: A review of necrotising fasciitis in the extremities. Hong Kong Med J 2009, 15(1):44-52.
• [4]Stano F, Brindicci G, Monno R, Rizzo C, Ghezzani F, Carbonara S, Guaglianone E, Donelli G, Monno L: Aeromonas sobria sepsis complicated by rhabdomyolysis in an HIV-positive patient: case report and evaluation of traits associated with bacterial virulence. Int J Infect Dis 2009, 13:e113-e118.
• [5]Ko WC, Chuang YC: Aeromonas bacteremia: review of 59 episodes. Clin Infect Dis 1995, 20:1298-1304.
• [6]Chang H, Hung YS, Shie SS, Lin TL: Fulminant necrotizing fasciitis caused by Aeromonas sobria in neutropenic patients. Intern Med 2012, 51:3287-3290.
• [7]Janda JM, Reitano M, Bottone EJ: Biotyping of Aeromonas isolates as a correlate to delineating a species-associated disease spectrum. J Clin Microbiol 1984, 19:44-47.
• [8]Daily OP, Joseph SW, Coolbaugh JC, Walker RI, Merrell BR, Rollins DM, Seidler RJ, Colwell RR, Lissner CR: Association of Aeromonas sobria with human infection. J Clin Microbiol 1981, 13:769-777.
• [9]Martino R, Santamaria A, Pericas R, Sureda A, Brunet S: Acute rhabdomyolysis and myonecrosis complicating aeromonas bacteremia in neutropenic patients with hematologic malignancies: report of two cases. Haematologica 1997, 82:692-694.
• [10]Laohachai KN, Bahadi R, Hardo MB, Hardo PG, Kourie JI: The role of bacterial and non-bacterial toxins in the induction of changes in membrane transport: implications for diarrhea. Toxicon 2003, 42(7):687-707.
• [11]Janda JM: Recent advances in the study of the taxonomy, pathogenicity, and infectious syndromes associated with the genus Aeromonas. Clin Microbiol 1991, 4:397-410.
• [12]Tsai MS, Kuo CY, Wang MC, Wu HC, Chien CC, Liu JW: Clinical features and risk factors for mortality in Aeromonas bacteremic adults with hematologic malignancies. J Microbiol Immunol Infect 2006, 39:150-154.
• [13]Lin SH, Shieh SD, Lin YF, De Bauer E, Van Landuyt HW, Gordts B, Boelaert JR: Fatal Aeromonas hydrophila bacteremia in a hemodialysis patient treated with deferoxamine. Am J Kidney Dis 1996, 27:733-735.
• [14]Tsai YH, Huang KC, Huang TJ, Hsu RW: Case reports: fatal necrotizing fasciitis caused by Aeromonas sobria in two diabetic patients. Clin Orthop Relat Res 2009, 467(3):846-849.
• [15]Hsiao CT, Weng HH, Yuan YD, Chen CT, Chen IC: Predictors of mortality in patients with necrotizing fasciitis. Am J Emerg Med 2008, 26:170-175.
• [16]Kao TL, Lao ML: A fatal case of necrotizing Aeromonas schubertii fasciitis after penetrating injury. Am J Emerg Med 2012, 30(1):258. e3-5
• [17]Furusu A, Yoshizuka N, Abe K, Sasaki O, Miyazaki K, Miyazaki M, Hirakata Y, Ozono Y, Harada T, Kohno S: Aeromonas hydrophila necrotizing fasciitis and gas gangrene in a diabetic patient on haemodialysis. Nephrol Dial Transplant 1997, 12:1730-1734.
• [18]Apisarnthanarak A, Pheerapiboon P, Apisarnthanarak P, Kiratisin P, Mundy LM: Fulminant epiglottitis with evolution to necrotizing soft tissue infections and fasciitis due to Aeromonas hydrophila. Infection 2008, 36(1):94-95.
• [19]Kumar S, Mukhopadhyay P, Chatterjee M, Bandyopadhyay MK, Bandyopadhyay M, Ghosh T, Samaddar D: Necrotizing fasciitis caused by Aeromonas caviae. Avicenna J Med 2012, 2(4):94-96.