Abstract
IntroductionAbscess formation and cellulitis in the setting of envenomation are rare complications of handling catfish. To the best of our knowledge, isolation of Proteus vulgaris has not been previously recorded, and recovery of Morganella morganii has been reported in only one prior case from wound cultures in patients injured by catfish stings. We report a case of catfish envenomation characterized by abscess formation and cellulitis, in which wound cultures grew these unusual organisms.Case presentationA 52-year-old Chinese-American man was hospitalized with erythema and swelling of his right arm of 10 days’ duration after skin penetration by a catfish barb. An abscess of his right thumb had undergone incision and drainage, with purulent drainage sent for wound culture immediately prior to admission. Laboratory studies revealed elevated white blood count, sedimentation rate, and C-reactive protein. The patient was treated with intravenous ampicillin-sulbactam and vancomycin during his hospitalization, and symptoms improved. Wound cultures obtained prior to presentation grew many Proteus vulgaris and Morganella morganii. He was subsequently discharged on a 10-day course of oral ciprofloxacin and amoxicillin-clavulanate. At a 12-month telephone follow-up, the patient denied developing further symptoms and reported that the wound had healed completely without complication.ConclusionAlthough envenomation and secondary infection are not uncommon sequelae of handling catfish, the present case is unique by virtue of the infecting organisms isolated. Given the prevalence of injury from catfish stings, a review of the literature is presented in order to provide recommendations for prevention and treatment of catfish envenomation.
Highlights
Abscess formation and cellulitis in the setting of envenomation are rare complications of handling catfish
Given the prevalence of injury from catfish stings, a review of the literature is presented in order to provide recommendations for prevention and treatment of catfish envenomation
Candiru is a small Amazonian catfish that is attracted to urine and may penetrate the urethral orifice of mammals, including humans, requiring surgical intervention [2]
Summary
Catfish stings are a common occurrence among those who regularly handle catfish. Symptoms range from the localized, short-lived inflammatory effects of envenomation to the more severe systemic, long-term complications of secondary bacterial infection. Effective medical management of superficial skin infections usually only involve antibacterial coverage of Gram-positive organisms, including Streptococcus and Staphylococcus. Superficial skin infections resulting from catfish stings are likely to be caused by Gram-negative organisms, including Enterobacteriaceae. As illustrated by this case, empiric antibiotic treatment for these infections should include, in addition to Gram-positive coverage for Streptococcus and Staphylococcus, broadspectrum Gram-negative coverage. Authors’ contributions GH was the chief author of the manuscript. RG and DM were involved in revising the manuscript critically for important intellectual content. All authors read and approved the final manuscript. Author details 1Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, USA. Author details 1Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, USA. 2Sound Shore Medical Center, 16 Guion Place, New Rochelle, NY 10802, USA. 3Beth Israel Medical Center, Milton and Carroll Petrie Division, First Avenue at 16th Street, New York, NY 10003, USA
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