Abstract
Marine microorganisms are uncommon etiologies of skin and skin structure infections, that is, wound infections. We report a case of severe wound infection, caused by the marine Photobacterium damselae (Vibrionaceae), in a 64-year-old male patient, returning from Australia. The isolate tested positive for pPHDD1, a plasmid conferring high-level virulence. Furthermore, the wound was coinfected with Vibrio harveyi, a halophile bacterium, which has never been reported from human infections before. Identification was achieved by use of Matrix-Assisted Laser Desorption-Ionization Time of Flight Mass Spectrometry (MALDI-TOF) and confirmed by 16S rDNA sequencing. Data retrieval from bibliography was complicated since P. damselae has been renamed often with a number of synonyms present in the literature: Photobacterium damsela, Vibrio damselae, Vibrio damsela, Pasteurella damselae, and Listonella damsela. With all synonyms used as query terms, a literature search provided less than 20 cases published worldwide. A majority of those cases presenting as severe wound infection are even fatal following progression into necrotizing fasciitis. Management with daily wound dressing and antibiotic therapy (ofloxacin empirically, followed by doxycycline after availability of microbiology) led in the reported case to a favorable outcome, which seems to be, however, the exception based on a review of the available literature.
Highlights
Global traveling contributes to rapid dispersal of pathogens from regions, where they are endemic to countries, where they have never been seen before
We report a case of severe wound infection, caused by the marine Photobacterium damselae (Vibrionaceae), in a 64-year-old male patient, returning from Australia
Even bacteria supposed to be nonpathogenic, which have marine seawaters as primary habitat, may be able to cause disease or at least to participate in infections as has been reported here with the detection of V. harveyi
Summary
Global traveling contributes to rapid dispersal of pathogens from regions, where they are endemic to countries, where they have never been seen before. In the current case report, we present such an unexpected finding, which—upon discussion with the attending surgeon—turned out to be a zoonosis of uncommon etiology, caused by marine bacteria of the family Vibrionaceae. Despite their relative infrequency, zoonotic infections by members of the Genus Vibrio are well known. Physicians must be aware that in patients presenting with wound infections and reporting contact to seawater and fish or exposure to seafood, the abovementioned Vibrio species may be the cause of infection In such cases, early empiric antibiotic treatment is required [3], and bacteriology is imperative. In order to guarantee accurate diagnostic service, it is mandatory to include as much information as possible into the diagnostic request to enable the microbiologist to interpret the findings of bacteriology
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