10 April 2024: Articles
A Rare Cause of Empyema and Bacteremia Due to Species in Alcoholic Cirrhosis Patients: A Case Report and Comprehensive Review of Literature
Unusual clinical course
Bohui Qian1BCDEF, Kazuhiro Ishikawa1ABDEF*, Tomoaki Nakamura2CDEF, Katsuhito Kinoshita2CDEF, Tetsuhiro Masaki1CF, Takahiro Matsuo1ADE, Fujimi Kawai 3ABF, Nobuyoshi Mori 1DEDOI: 10.12659/AJCR.941952
Am J Case Rep 2024; 25:e941952
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.
Keywords: Bacteremia, Empyema, Shewanella, Shewanella algae
Introduction
Case Report
In this study, we report a case of empyema and bacteremia due to
On the day of admission, we inserted a chest tube to drain the empyema on the right side and started piperacillin/tazobactam (4.5 g every 8 h) and vancomycin. Cultures of blood and pleural effusion were positive for
Discussion
We encountered a case of a patient with liver cirrhosis who developed
In general,
We retrieved a total of 330 articles (80 from PubMed, 99 from Embase, and 151 from Ichushi). After removing records not reporting bacteremia due to
The results of the literature review and the case list are presented in Tables 2 and 3 [7–69].
Of the published cases, 35 were from the United States of America, 28 were from South Africa, 16 were from Japan, and 12 were from Taiwan. An analysis of all 124 patients from the studies revealed that 39 (31%) were infected with
In terms of portal of entry, skin lesions, seen in 21/35 patients (60%), constituted the most common portal, while an oral portal of entry was the second most common, seen in 9/35 patients (26%). The consumption of raw fish was assumed to be the cause of infection in the present case. There have been numerous reports of
In this literature review,
In terms of underlying diseases, hepatobiliary disease may be a result of
Some studies have reported that the prognosis of
This study had several limitations. As mentioned above, 16S rRNA gene sequencing analysis is more accurate than MALDITOF-MS in identifying
Conclusions
We report a case of
Figures
Figure 1.. Chest computed tomography (CT) on admission. Chest CT revealed pleural effusion and consolidation in the right lung (A) and pleural effusion with pleural thickening (B, red arrow heads). Figure 2.. Clinical course of disease in our patient. Shewanella species was detected in both pleural effusion and blood cultures on the day of admission. We inserted a chest tube, and initiated piperacillin/tazobactam and vancomycin empirically and switched to ceftriaxone. As a result, the effusion was successfully treated. However, on hospitalization day 53, the patient died of aspiration pneumonia. WBC – white blood cell; CRP – C-reactive protein; VCM – vancomycin; P/T – piperacillin/tazobactam; CTRX – ceftriaxone; MEPM – meropenem; MINO – minocycline; S. algae – Shewanella algae. Figure 3.. Flow chart of the literature review process.Tables
Table 1.. Minimum inhibitory concentrations required for antibiotic efficacy against Shewanella algae. Table 2.. Baseline characteristics of patients, management of infection, and prognosis. Table 3.. Baseline characteristics, management/treatment, and prognosis of patients with Shewanella spp. bacteremia.References:
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