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Qian B, Ishikawa K, Nakamura T, Kinoshita K, Masaki T, Matsuo T, Kawai F, Mori N. A Rare Cause of Empyema and Bacteremia Due to Shewanella Species in Alcoholic Cirrhosis Patients: A Case Report and Comprehensive Review of Literature. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e941952. [PMID: 38594894 PMCID: PMC11022664 DOI: 10.12659/ajcr.941952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 02/24/2024] [Accepted: 01/05/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Shewanella spp. are gram-negative facultative anaerobic, oxidase-positive, motile bacilli that are ubiquitous but commonly occur in seawater and can cause opportunistic infection. Reports on the risk factors for Shewanella infection, its severity, antibiotic susceptibility, and prognosis are limited. This report is of a 78-year-old man with alcoholic cirrhosis presenting with bacteremia and empyema due to infection with Shewanella spp. CASE REPORT A 78-year-old man with alcoholic cirrhosis (Child-Pugh B) presented to our emergency room with a high fever. He had eaten raw fish one week prior to admission. Chest computed tomography showed a right unilateral pleural effusion, and he was hospitalized with suspected empyema. Shewanella spp. was detected in the pleural effusion and blood cultures. We initiated piperacillin/tazobactam and vancomycin empirically and switched to ceftriaxone; the effusion was successfully treated using antibiotics and pleural drainage. However, on hospitalization day 53, the patient died of aspiration pneumonia. In our literature review, we extracted 125 reported cases (including our case) and found that men were disproportionately affected (81%); median age was 61.6 (56-75) years; underlying diseases included hepatobiliary disease (33%), malignancy (25%), and cardiac disease (24%); Shewanella spp. infection sites were skin and soft tissue (35%), respiratory system (18%), and hepatobiliary system (11%); and management included antibiotics (100%), drainage (16%), and debridement (16%). The survival rate was 74% with antibiotics alone. CONCLUSIONS Our case highlights that clinicians should recognize Shewanella spp. as a cause of empyema and bacteremia in patients with liver cirrhosis, and that microbiological diagnosis with antibiotic sensitivity testing and treatment should be undertaken urgently to prevent fatal sepsis.
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Affiliation(s)
- Bohui Qian
- Department of Infectious Diseases, St. Luke’s International Hospital, Tokyo, Japan
| | - Kazuhiro Ishikawa
- Department of Infectious Diseases, St. Luke’s International Hospital, Tokyo, Japan
| | - Tomoaki Nakamura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke’s International Hospital, Tokyo, Japan
| | - Katsuhito Kinoshita
- Department of Pulmonary Medicine, Thoracic Center, St. Luke’s International Hospital, Tokyo, Japan
| | - Tetsuhiro Masaki
- Department of Infectious Diseases, St. Luke’s International Hospital, Tokyo, Japan
| | - Takahiro Matsuo
- Department of Infectious Diseases, St. Luke’s International Hospital, Tokyo, Japan
| | - Fujimi Kawai
- Library, Center for Academic Resources, St. Luke’s International University, Tokyo, Japan
| | - Nobuyoshi Mori
- Department of Infectious Diseases, St. Luke’s International Hospital, Tokyo, Japan
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Müller S, von Bonin S, Schneider R, Krüger M, Quick S, Schröttner P. Shewanella putrefaciens, a rare human pathogen: A review from a clinical perspective. Front Cell Infect Microbiol 2023; 12:1033639. [PMID: 36817694 PMCID: PMC9933709 DOI: 10.3389/fcimb.2022.1033639] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/04/2022] [Indexed: 02/05/2023] Open
Abstract
Shewanella putrefaciens is a gramnegative, facultatively anaerobic, rod shaped bacterium. It belongs to the class of the Gammaproteobacteria and was first described in 1931. S. putrefaciens is part of the marine microflora and especially present in moderate and warm climates. The bacterium is a rare oppurtonistic human pathogen associated mainly with intra-abdominal as well as skin and soft tissue infections. However, it has also been reported in association with more severe diseases such as pneumonia, intracerebral and ocular infections and endocarditis. In these cases the clinical courses are often associated with underlying, predisposing diseases and risk factors. For successful treatment of S. putrefaciens, a combination of appropriate local therapy, e.g. surgical treatment or drainage, and antibiotic therapy should be performed. Since multiple resistances to antibiotics are described, the results of the antimicrobial susceptibility testing must be considered for effective therapy as well. Furthermore, a main challenge in clinical practice is the accurate microbiological identification, and especially the correct differentiation between S. putrefaciens and S. algae. Under certain circumstances, Shewanella-infections can have severe, sometimes even fatal consequences. Therefore, we decided to present the current state of knowledge as well as further aspects with regard to future diagnostics, therapy and research.
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Affiliation(s)
- Stephanie Müller
- Department of Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany,*Correspondence: Stephanie Müller,
| | - Simone von Bonin
- Department of Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ralph Schneider
- Department of Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Martin Krüger
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Susanne Quick
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Percy Schröttner
- Institute for Medical Microbiology and Virology, University Hospital Carl Gustav Carus, Dresden, Germany
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Yu K, Huang Z, Xiao Y, Wang D. Shewanella infection in humans: Epidemiology, clinical features and pathogenicity. Virulence 2022; 13:1515-1532. [PMID: 36065099 PMCID: PMC9481105 DOI: 10.1080/21505594.2022.2117831] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The genus Shewanella consists of Gram-negative proteobacteria that are ubiquitously distributed in environment. As the members of this genus have rapidly increased within the past decade, several species have become emerging pathogens worldwide, attracting the attention of the medical community. These species are also associated with severe community- and hospital-acquired infections. Patients infected with Shewanella spp. had experiences of occupational or recreational exposure; meanwhile, the process of infection is complex and the pathogenicity is influenced by a variety of factors. Here, an exhaustive internet-based literature search was carried out in PUBMED using terms “Achromobacter putrefaciens,” “Pseudomonas putrefaciens,” “Alteromonas putrefaciens” and “Shewanella” to search literatures published between 1978 and June 2022. We provided a comprehensive review on the epidemiology, clinical features and pathogenicity of Shewanella, which will contribute a better understanding of its clinical aetiology, and facilitate the timely diagnosis and effective treatment of Shewanella infection for clinicians and public health professionals.
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Affiliation(s)
- Keyi Yu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China.,Center for Human Pathogenic Culture Collection, China CDC, Beijing, China
| | - Zhenzhou Huang
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China.,Center for Human Pathogenic Culture Collection, China CDC, Beijing, China
| | - Yue Xiao
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China.,Center for Human Pathogenic Culture Collection, China CDC, Beijing, China
| | - Duochun Wang
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China.,Center for Human Pathogenic Culture Collection, China CDC, Beijing, China
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4
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Talbot Z, Amble A, Delva G, Eddib A, Muddassir S. Severe Sepsis and Wet Gangrene Requiring Foot Amputation Caused by an Emerging Human Pathogen - Shewanella algae. Cureus 2019; 11:e5668. [PMID: 31720144 PMCID: PMC6823033 DOI: 10.7759/cureus.5668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 69-year-old woman with type 2 diabetes mellitus, peripheral vascular disease, and other comorbidities presented with recurrent syncopal episodes. Cellulitic skin changes in her right lower extremity were noted, as well as a large hemorrhagic bulla on the dorsum of her right foot. Severe sepsis was determined to be the reason for her syncopal episodes. Blood cultures and the bulla aspirate culture were positive for Shewanella algae that was pan-sensitive to antibiotics. Her clinical status was stabilized with a regimen of intravenous fluids and broad-spectrum antibiotics. However, due to the development of right foot gangrene, she underwent debridement and eventually required transmetatarsal open amputation.
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Affiliation(s)
- Zuzana Talbot
- Internal Medicine, Oak Hill Hospital, Brooksville, USA
| | - Arun Amble
- Internal Medicine, Oak Hill Hospital, Brooksville, USA
| | - Guesly Delva
- Internal Medicine, Oak Hill Hospital, Brookville, USA
| | - Abdulmagid Eddib
- Internal Medicine: Critical Care, Oak Hill Hospital, Brooksville, USA
| | - Salman Muddassir
- Internal Medicine, Hospital Corporation of America West Florida GME Consortium / Oak Hill Hospital, Brooksville, USA
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Torri A, Bertini S, Schiavone P, Congestrì F, Matteucci M, Sparacino M, Testa G, Pedna MF, Sambri V. Shewanella algae infection in Italy: report of 3 years' evaluation along the coast of the northern Adriatic Sea. New Microbes New Infect 2018; 23:39-43. [PMID: 29556408 PMCID: PMC5854895 DOI: 10.1016/j.nmni.2018.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/29/2017] [Accepted: 01/04/2018] [Indexed: 11/02/2022] Open
Abstract
Shewanella algae are Gram-negative, nonfermentative, motile bacilli, classified in the genus Shewanella in 1985. These environmental bacteria are occasionally identified in human infections, with a relatively strong association with exposure to seawater during warm seasons. This report describes a case series of 17 patients with infection correlated to S. algae in the coastal area of Romagna, Italy, from 2013 to 2016. The types of infection included otitis, pneumonia, sepsis and soft tissue (wound). Exposure to the marine environment during hot months was confirmed in 12 of 17 patients. An apparent correlation between increased severity of infection and patient age was also observed.
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Affiliation(s)
- A Torri
- Unit of Microbiology, The Great Romagna Hub Laboratory, Pievesestina (FC), Italy
| | - S Bertini
- Unit of Microbiology, The Great Romagna Hub Laboratory, Pievesestina (FC), Italy
| | - P Schiavone
- Unit of Microbiology, The Great Romagna Hub Laboratory, Pievesestina (FC), Italy
| | - F Congestrì
- Unit of Microbiology, The Great Romagna Hub Laboratory, Pievesestina (FC), Italy
| | - M Matteucci
- Unit of Microbiology, The Great Romagna Hub Laboratory, Pievesestina (FC), Italy
| | - M Sparacino
- Unit of Microbiology, The Great Romagna Hub Laboratory, Pievesestina (FC), Italy
| | - G Testa
- Unit of Microbiology, The Great Romagna Hub Laboratory, Pievesestina (FC), Italy
| | - M F Pedna
- Unit of Microbiology, The Great Romagna Hub Laboratory, Pievesestina (FC), Italy
| | - V Sambri
- Unit of Microbiology, The Great Romagna Hub Laboratory, Pievesestina (FC), Italy.,DIMES, University of Bologna, Bologna, Italy
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Martín-Rodríguez AJ, Martín-Pujol O, Artiles-Campelo F, Bolaños-Rivero M, Römling U. Shewanella spp. infections in Gran Canaria, Spain: retrospective analysis of 31 cases and a literature review. JMM Case Rep 2017; 4:e005131. [PMID: 29623211 PMCID: PMC5857365 DOI: 10.1099/jmmcr.0.005131] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 11/14/2017] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Shewanella spp. can cause severe skin and soft-tissue infections, gastrointestinal infections, otitis and bacteraemia, generally upon contact with seawater or consumption of raw seafood. Recently, a new condition termed 'patera foot' characterized by acute skin and soft-tissue infection has been described in irregular immigrants arriving to the Canary Islands, Spain, in rudimentary boats. Most infections are caused by a single species, Shewanella algae. The improvement of the diagnostic capabilities in clinical microbiology laboratories has resulted in a growing number of cases being reported worldwide, most of them coming from warm regions. CASE PRESENTATION In this work, we reviewed the medical records of all the patients with Shewanella infections in the two university hospitals of Gran Canaria (the Canary Islands, Spain) during the period 2000-2016, resulting in the identification of 31 cases. We also conducted a literature review of Shewanella infections reported worldwide in recent years. CONCLUSION This case series suggests that Shewanella infections are nosocomially acquired more frequently than previously thought. In addition, the unexpectedly high proportion of multidrug-resistant isolates raises concerns.
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Affiliation(s)
- Alberto J. Martín-Rodríguez
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Instituto Universitario de Biorgánica “Antonio González”, Universidad de La Laguna, Tenerife, Spain
- Present address: Swedish Medical Nanoscience Center, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Ute Römling
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
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Yousfi K, Bekal S, Usongo V, Touati A. Current trends of human infections and antibiotic resistance of the genus Shewanella. Eur J Clin Microbiol Infect Dis 2017; 36:1353-1362. [PMID: 28299457 DOI: 10.1007/s10096-017-2962-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 03/05/2017] [Indexed: 10/20/2022]
Abstract
Shewanella spp. are commonly known as environmental bacteria and are most frequently isolated from aquatic areas. Currently, diseases syndromes and multidrug resistance have increasingly been reported in the genus Shewanella. Some species are associated with various infections, such as skin and soft tissue infections, as well as bacteremia. Generally, these bacteria are opportunistic and mostly affect people with an impaired immune system. This genus is also a probable vehicle and progenitor of antibiotic resistance genes. In fact, several resistance genes and mobile genetic elements have been identified in some resistant species isolated from environmental or clinical settings. These genes confer resistance to different antibiotic classes, including those used in therapies such as β-lactams and quinolones, and are generally located on the chromosome. Recently, a multidrug-resistant (MDR) plasmid harboring several drug resistance genes associated with transposons and integrons has been identified in Shewanella xiamenensis. These antibiotic resistance genes can circulate in the environment and contribute to the emergence of antibiotic resistance. This review describes different aspects of Shewanella, focusing on the infections caused by this genus, as well as their role in the propagation of antibiotic resistance via mobile genetic elements.
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Affiliation(s)
- K Yousfi
- Laboratoire d'Écologie Microbienne, FSNV, Université de Bejaia, Bejaia, 06000, Algeria.,Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, QC, Canada
| | - S Bekal
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, QC, Canada
| | - V Usongo
- Laboratoire d'Écologie Microbienne, FSNV, Université de Bejaia, Bejaia, 06000, Algeria.,Department of Food Science and Agricultural Chemistry, McGill University, Montreal, QC, Canada
| | - A Touati
- Laboratoire d'Écologie Microbienne, FSNV, Université de Bejaia, Bejaia, 06000, Algeria.
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