A Case of Severe Acute Hepatorenal Failure due to Aeromoas hydrophila Septicemia

Abstract

A case of septicemia due to Aeromonas hydrophila (A. hydrophila) in a 54-year-old male suffering from progressive severe jaundice and fatigue is reported. The patient developed multiple organ failure despite aggressive therapy including plasma exchange and glucose-insulin therapy. Upon admission to our hospital, therapy was started with ampicillin (ABPC) 4 g/day, gentamicin (GM) 120 mg/day, hemodialysis, continuous hemofiltration, catecholamines and a respirator, but he expired on the 2nd hospital day. Blood culture and histology revealed A. hydrophila. Postmortem examination showed alcoholic liver fibrosis which was most likely liver cirrhosis. In the literature, patients with septicemia due to Aeromonas had underlying hepatic cirrhosis more often than did those with septicemia due to other gram-negative bacilli. Therefore, it is important-to consider the possibility of liver cirrhosis in patients with A. hydrophila septicemia.

Aeromonas Infections in Patients with Liver Cirrhosis in Japan

“…The clinical characteristics and prognoses of 25 reported cases of Aeromonas infections in patients with LC in Japan reported from 1992 to 2016 are summarized in Table 1. Among the 25 cases, three were reported in English [4,13,14] and the remaining 22 in Japanese [9,11,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. The age at diagnosis of Aeromonas infection ranged between 40 and 78 years, and 19 patients were male and five were female with one case unknown.…”

“…The age at diagnosis of Aeromonas infection ranged between 40 and 78 years, and 19 patients were male and five were female with one case unknown. The etiology of LC was as follows: hepatitis C virus (HCV) infection in six cases [13,21,22,25,29], hepatitis B virus infection in six [9,11,16,26,27,30], alcohol-related in nine [4,14,15,17,20,21,23,28,31] HCV infection plus alcoholrelated in one [22], and unknown in three [18,19,24]. The Child-Pugh classification of underlying liver dysfunction was as follows; Child C in nine, Child B in one, and unknown in 15 cases.…”

“…The Child-Pugh classification of underlying liver dysfunction was as follows; Child C in nine, Child B in one, and unknown in 15 cases. A. hydrophila was isolated in 19 (76%) cases [9,11,[13][14][15][16]18,[20][21][22][24][25][26][27][29][30][31] and A. sobria in 6 (24%) [4,17,19,21,23,28]; no cases involving A. caviae was found. Consumption of Japanese cuisine, such as sashimi and sushi, were the cause of infection in 9 (36%) cases [11,17,[21][22][23][27][28][29]31] and complications of DM in 7 cases (28%) [9,[17][18][19]22,24,28].…”

“…One case of pneumonia caused by A. hydrophila infection of the lung tissues was found [13]. Meanwhile, septic shock and disseminated intravascular coagulation were confirmed in 18 [4,9,11,[13][14][15][16][18][19][20][23][24][25][26][27][29][30][31] and 11 cases [9,[15][16][17][18]23,24,26,[28][29][30], respectively.…”

Aeromonas sobria infection with severe soft tissue damage and segmental necrotizing gastroenteritis in a patient with alcoholic liver cirrhosis

“… 2 Most commonly, Aeromonas infection has been associated with gastroenteritis. 3–6 However, it is known that A. hydrophila causes bacteremia and soft‐tissue infection in immunocompromised hosts such as the patients with liver cirrhosis, malignancy, diabetes mellitus or other pre‐existing diseases, 7–14 similar to Vibrio vulnificus , from another group of Vibrio ‐ like organisms . 15–17 Despite the predominance of A. sobria among the Aeromonas species isolated from blood 18 and its stronger pathogenesis than A. hydrophila , 19 the association of A. sobria with human infection has been reported in only a few cases.…”