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Unusual Pathogens Causing Cellulitis and Bacteremia in Hemodialysis Patients
Author(s) -
Ruiz CC,
Agraharkar M
Publication year - 2003
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1046/j.1492-7535.2003.01264.x
Subject(s) - medicine , cellulitis , bacteremia , hemodialysis , vibrio vulnificus , chills , vibrio alginolyticus , surgery , antibiotics , microbiology and biotechnology , vibrio , biology , genetics , bacteria
Cellulitis in immunocompetent hosts is usually caused by skin organisms and responds to oral antibiotics. In immunocompromised hosts, such as End‐Stage Renal Disease (ESRD) patients, unusual organisms with variable pathogenicity can cause infections. We present two cases with isolates that are usually encountered in coastal waters. Case 1. A 71‐year old African‐American ESRD patient presented with a painful lesion on the right leg for 3 weeks, and fever and chills for 2 days. He sustained a right leg wound 4 weeks prior to presentation. During that period a tropical storm flooded his house contaminating his open wound with salt water. He had a 3 cm erythematous and tender ulcer on his right leg. Blood cultures grew Vibrio alginolyticus . He was successfully treated with a 4‐week course of Gentamicin. Case 2. A 70 year‐old Caucasian male ESRD patient presented with severe tenderness and erythema of his left forearm after an injury on a shrimp boat 10 hours prior to presentation. He was hypotensive, febrile, and required intensive care for vasopressor support and intravenous antibiotics. His blood cultures grew Vibrio vulnificus and he was treated successfully with doxycyclin and ceftazidime. Vibrio species are halophilic marine gram‐negative bacteria. Vibrio alginolyticus was the causative agent of cellulitis and bacteremia in our first hemodialysis patient, who was exposed to flood waters. V. alginolyticus , a non‐lactose fermenting gram‐negative bacillus, has rarely been isolated from blood. Vibrio vulnificus was isolated from our first patient presenting with cellulitis and subsequent septicemia. V. vulnificus belongs to the lactose positive vibrio group, which is likely to produce severe localized or systemic disease. Both patients were successfully treated with appropriate antibiotics after obtaining the antibiotic sensitivities. In both cases, the common features were immunosuppression and exposure to marine environments. These two cases of life‐threatening cellulitis and bacteremia are presented as an example of environmental pathogens common to a selected environment, i.e., marine vibrio species, and the imperative need of rapid identification and treatment in immunocompromised hosts.