Acute arthritis caused by Aeromonas hydrophola: clinical and therapeutic aspects

Septic arthritis due to Aeromonas hydrophila: case report and review of the literature

Aeromonas hydrophila is a rare human pathogen, and worldwide, soft tissue infections following water-related injuries are the most common. However, septic arthritis due to A. hydrophila remains uncommon with only seven cases previously reported in the English literature. In this report, we describe the important clinical features, microbiological findings and management of severe septic arthritis of the knee due to A. hydrophila in a healthy 13-year-old girl following an injury sustained in a private fresh water lake. A review of seven previously reported cases of septic arthritis due to A. hydrophila and the present case suggests that the infection commonly affected the knee and the meta-/intercarpal-phalangeal joint and was frequently rapidly progressive following trauma in fresh water and or associated with leukaemia. Second and third generation cephalosporins, gentamicin, trimethoprim, ciprofloxacin and appropriate orthopaedic management should be promptly instituted. After chemical treatment and chlorination, fresh water becomes free of coliforms, but A. hydrophila persists more compared with the other strains of aeromonas, namely A. sobria and A. caviae. Seawater injuries, unlike freshwater injuries, are not usually associated with aeromonas infections. Further workup on the mechanisms of A. hydrophila resistance to chlorination could probably yield useful information in achieving new procedures of preventing and controlling such infections in public and private fresh water recreational facilities.

Musculoskeletal and soft tissue Aeromonas infection: an environmental disease

During a 4-year period from November 1985 to November 1989, Aeromonas was isolated from wounds and soft tissues with clinical evidence of infection in 28 patients at our institution. Of the 28 patients, 23 (82%) had sustained an acute open or penetrating injury, more than half of which (13 of the 23) were water-related trauma. One patient had Aeromonas osteomyelitis. Five patients had no history of trauma, and three of these five had an underlying chronic disease. Treatment included débridement and antimicrobial agents. Susceptibility testing on 25 isolates from 23 patients showed uniform resistance to ampicillin and considerable resistance to cefazolin sodium (68%), but all isolates were sensitive to gentamicin sulfate, cefuroxime sodium, and the third-generation cephalosporins.

Aeromonas as a human pathogen

Although the first Aeromonas strain was described by Zimmermann as early as in 1890, it took 60 years until Caselitz established human pathogenicity of strains then called "Vibrio jamaicensis". Since then, and especially in the last 10 years, there have been increasing numbers of reports on different infections caused by members of the genus Aeromonas. These include sepsis; meningitis; cellulitis; necrotizing fasciitis; ecthyma gangrenosum; pneumonia; peritonitis; conjunctivitis; corneal ulcer; endophthalmitis; osteomyelitis; suppurative arthritis; myositis; subphrenic abscess; liver abscess; cholecystitis and/or ascending cholangitis; urinary tract infection; endocarditis; ear, nose, and throat infections; balanitis; etc. The role of Aeromonas in gastrointestinal disease is very controversial. Increasing epidemiological data suggest that these organisms play a major role in enteric infections, but so far enteropathogenicity has not been demonstrable in experiments where volunteers were given high numbers of Aeromonas possessing different virulence factors. Virulence factors include hemolysin(s), enterotoxin(s), hemagglutinins, invasivity, and others; but these are not found more frequently in strains isolated from patients with diarrhea than from healthy controls. Whether there is a correlation between species and disease remains to be elucidated and requires more information about the taxonomy of this genus.

Bacteriology of the freshwater environment: implications for clinical therapy

Water and animal tissue samples were obtained from sources in Tennessee, California, and Florida. Purified bacterial colonies were isolated and organisms identified. Fifty-eight isolates were recovered. Twenty-seven Gram-negative isolates were identified. Gram-positive organisms were of the coryneform group or Bacillus species. Antibiotic susceptibility testing showed that Aeromonas species were relatively resistant to a wide variety of antimicrobials, which included trimethoprim, cefazolin, and ampicillin. Antibiotics effective against more than 90% of Gram-negative isolates included ciprofloxacin, imipenem, ceftazidime, and trimethoprim-sulfamethoxazole. Freshwater Gram-positive organisms did not display any unexpected susceptibility features. Recommendation for treatment are based on sensitivity in culture and the potentially serious nature of infections caused by Aeromonas species.

Pneumonia and bacteremia due to Aeromonas hydrophila

Aeromonas hydrophila is a gram-negative bacillus which has been rarely identified as a human pathogen except in immunologically compromised hosts. We have recently treated three patients for severe A hydrophila pneumonia and sepsis. Two of these patients were healthy young men who aspirated the organism from contaminated water associated with near drowning. One patient survived severe ARDS and gram-negative sepsis. A third patient with chronic renal failure acquired A hydrophila pneumonia at home and quickly died from the infection. A hydrophila is becoming more commonly recognized as a lethal pathogen and should be sought when gram negative infection is suspected.

Septic arthritis of the glenohumeral joint. Unique clinical and radiographic features and a favorable outcome

Seven patients (eight shoulders) with sepsis of the glenohumeral joint were studied clinically and radiographically. Despite the advanced age of the patients, the presence of gram-negative organisms, and multiple risk factors in each patient (including serious chronic underlying diseases), needle drainage and parenteral antibiotics were all that were required for successful management, provided early diagnosis with prompt institution of antibiotics and drainage occurred. Contrast arthrography safely guided therapy and revealed rotator cuff tears in four of six shoulders as well as frequent extra-articular extensions of the disease. A nonleukemic patient with Aeromonas hydrophilia sepsis and arthritis is reported who survived with eradication of infection and preservation of joint function. A poor prognosis for shoulder sepsis is not substantiated.