Septicemia Progressing to Fatal Hepatic Dysfunction in an Cirrhotic Patient after Oral Ingestion of Photobacterium damsela: A Case Report

Abstract

Photobacterium damsela (formerly Vibrio damsela) is a pathogen found in both immunocompromised and healthy hosts. It can cause rapid, fulminate infections, such as septicemia, and is associated with a high death rate. Infections generally result from the exposure of subcutaneous tissue to contaminated seawater or from fish-fin puncture wounds [1]. The pathogen can also be transmitted through water or food [2,3]. Here, we discuss the case of a patient with liver cirrhosis who, following his consumption of raw seafood, developed P. damsela septicemia that subsequently resulted in fatal hepatic dysfunction.A 46-year-old man was admitted to our hospital with a 1-day history of fever, abdominal pain, and dyspnea. He had been diagnosed with Child-Pugh Class B alcoholic cirrhosis 2 years prior to presentation and had not consumed alcohol for the last year. The patient had eaten marinated raw fish the day before the symptoms started. On physical examination, his blood pressure was 110/60 mmHg, the pulse rate was 135 beats/min, the respiratory rate was 38/min, and his body temperature was 38.8°C. Abdominal examination revealed diffuse tenderness over the whole abdomen, diminished bowel sounds, and distension. The results of the laboratory tests were: hemoglobin concentration, 9.1 g/dl; leukocyte count, 7,090/l (21% band, 71% poly, 7% lymph); platelet count, 68,000/l; serum creatinine level, 2.0 mg/dl; serum bilirubin level, 8.4 mg/dl; serum albumin level, 2.0 g/dl; prothrombin time, 27.7 s. The arterial blood gas analysis showed metabolic acidosis (pH 7.05, pCO 2 17.6 mmHg, pO 2 83.3 mmHg, HCO 3 10 mmol/l). The ascitic fluid analysis revealed an albumin level of 0.3 g/dl and a leukocyte count of 12,050/l (100% poly). Early esophageal varices were observed during an upper gastrointestinal endoscopy. Coarse hepatic parenchymal echogenicity, ascites, and splenomegaly were evident on the abdominal ultrasonograph. Blood cultures were taken within 1 h of admission to hospital. The ascitic fluid was inoculated in aerobic and anaerobic blood culture bottles simultaneously [4].Three days after admission, analysis of the blood cultures using the BACTEC 9240 blood culture system (Becton Dickinson, Sparks, MD, USA) revealed Gramnegative bacilli that were subsequently identified as P. damsela using a VITEK GN card (bioMé rieux, Marcyl'Etoile, France). The phenotypes of this strain were analyzed biochemically using the API 20E test (bio-Mé rieux), as per the manufacturer's instructions. In this test, 20 conventional substrates are inoculated with a 0.85% saline suspension of the organism being tested. O'Hara et al. [5] found that the identification of P. damsela using the API and VITEK GN system was 100% accurate. The strain tested positive for glucose fermentation and the oxidase, urease, and arginine dihydrolase activity tests. The indole test was negative. The MIC of various antimicrobial agents for this isolate was determined by the microbroth dilution method using graded concentrations of antimicrobial agents [6]. This strain was ...

Phobalysin, a Small β-Pore-Forming Toxin of Photobacterium damselae subsp. damselae

“…damselae causes severe infections in wild marine animals and in aquaculture. Time and again, septicemia or necrotizing soft tissue infections in humans have also been reported (1)(2)(3)(4)(5)(6). In many cases, even radical surgery and antibiotic treatment fail to save the lives of patients.…”

Photobacterium damselae subsp. damselae Major Virulence Factors Dly, Plasmid-Encoded HlyA, and Chromosome-Encoded HlyA Are Secreted via the Type II Secretion System

“…In addition, this pathogen is of special concern for humans, since it can cause a highly severe necrotizing fasciitis that may lead to a fatal outcome (4,5). The majority of the reported infections in humans have their primary origin in wounds exposed to seawater (6), inflicted during fish and fishing tool handling (7), while practicing aquatic sports (8), and occasionally after consumption of seafood (9).…”

Synergistic and Additive Effects of Chromosomal and Plasmid-Encoded Hemolysins Contribute to Hemolysis and Virulence in Photobacterium damselae subsp. damselae

“…damselae (formerly Vibrio damsela) is a primary pathogen for a variety of marine animals, such as sharks, dolphins, crustaceans, mollusks, and fish (1)(2)(3). In addition, this bacterium can cause a highly severe necrotizing fasciitis in humans that may lead to a fatal outcome (4)(5)(6)(7).…”