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Shewanella Haliotis Associated with Severe Soft Tissue Infection

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Shewanella Haliotis Associated with Severe Soft Tissue Infection LETTERS Muhammad Masroor Alam, 10. Altaf A, Luby S, Ahmed AJ, Zaidi N, description, to our knowledge, of S. Adnan Khurshid, Khan AJ, Mirza S, et al. Outbreak of haliotis involved in human disease. Crimean-Congo haemorrhagic fever in Salmaan Sharif, Quetta, Pakistan: contact tracing and In September 2012, a 52-year-old Shahzad Shaukat, risk assessment. Trop Med Int Health. woman, living in Bangkok, Thailand, Rana Muhammad Suleman, 1998;3:878–82. http://dx.doi.org/10.1046/ was hospitalized after experiencing Mehar Angez, j.1365-3156.1998.00318.x drowsiness for 2 hours. She had a and Syed Sohail Zahoor Zaidi low-grade fever, chills, and swelling, Address for correspondence: Syed Sohail Author affiliation: National Institute of Health, erythema, and tenderness in her left Zahoor Zaidi, Department of Virology, National Chak Shahzad, Islamabad, Pakistan leg. During the previous week, she Institute of Health, Chak Shahzad, Park Rd, had handled fresh seafood in a market DOI: http://dx.doi.org/10.3201/eid1906.120771 Islamabad-44000, Pakistan; email: zaidis@pak. and had eaten cooked mackerel. She emro.who.int denied having eaten uncooked food or References wading into flooded areas or the sea. 1. Grard G, Drexler JF, Fair J, Muyembe JJ, She had undergone orthotopic liver Wolfe ND, Drosten C, et al. Re-emergence transplantation 6 months previously of Crimean-Congo hemorrhagic fever to excise hepatocellular carcinoma re- virus in Central Africa. PLoS Negl Trop Dis. 2011;5:e1350. http://dx.doi. lated to Child-Pugh class C hepatitis C org/10.1371/journal.pntd.0001350 cirrhosis; since that procedure, she had 2. Mild M, Simon M, Albert J, Mirazimi A. Shewanella haliotis been under treatment with immunosu- Towards an understanding of the migra- pressive drugs. She also had diabe- tion of Crimean-Congo hemorrhagic fe- Associated with ver virus. J Gen Virol. 2010;91:199–207. Severe Soft tes, hypertension, and nephrotic syn- http://dx.doi.org/10.1099/vir.0.014878-0 drome. Physical examination revealed 3. Chinikar S, Ghiasi SM, Hewson R, Mo- Tissue Infection, that in addition to above-named symp- radi M, Haeri A. Crimean-Congo hemor- toms, multiple blisters were noted rhagic fever in Iran and neighboring coun- Thailand, 2012 tries. J Clin Virol. 2010;47:110–4. http:// (Figure, panel A). Her oral tempera- dx.doi.org/10.1016/j.jcv.2009.10.014 To the Editor: Marine bacteria ture was 37.8°C, blood pressure 80/40 4. Burt FJ, Swanepoel R. Molecular epide- of the family Shewanellaceae, genus mm Hg, pulse was 110 bpm, and re- miology of African and Asian Crimean- Shewanella, are gram-negative, mo- spiratory rate was 24 breaths/minute. Congo haemorrhagic fever isolates. Epi- demiol Infect. 2005;133:659–66. http:// tile bacilli that grow aerobically or A complete blood count showed a leu- dx.doi.org/10.1017/S0950268805003730 anaerobically and produce hydrogen kocyte count of 2,250 cells/μL (91.2% 5. Schwarz TF, Nsanze H, Longson M, sulfide (1). Organisms belonging to a neutrophils). Despite adequate rehy- Nitschko H, Gilch S, Shurie H, et al. Shewanella species were first isolated dration, monitored by central venous Polymerase chain reaction for diagnosis and identification of distinct variants of in 1931 by Derby and Hammer from pressure, the patient required norepi- Crimean-Congo hemorrhagic fever virus dairy products and classified asAchro - nephrine to stabilize her vital signs. in the United Arab Emirates. Am J Trop mobacter putrefaciens (2). Members The clinical diagnosis of her condition Med Hyg. 1996;55:190–6. of Shewanella species usually are was septic shock with suspected nec- 6. Yashina L, Petrova I, Seregin S, Vyshem- irskii O, Lvov D, Aristova V, et al. Genetic found in marine environments in warm rotizing fasciitis. variability of Crimean-Congo haemor- climates or during summer in temper- After tissue and blood samples rhagic fever virus in Russia and Central ate climates (3). In humans, most She- were collected and submitted for mi- Asia. J Gen Virol. 2003;84:1199–206. wanella species infections occur in crobiological analysis, shock resusci- http://dx.doi.org/10.1099/vir.0.18805-0 7. Suleiman MN, Muscat-Baron JM, Harries skin and soft tissues (4). One species tation and an emergency fasciotomy JR, Satti AG, Platt GS, Bowen ET, et al. (S. algae) and possibly a second (S. (Figure, panel B) were performed, Congo/Crimean haemorrhagic fever in putrefaciens) have been isolated from and antimicrobial drug treatment with Dubai. An outbreak at the Rashid Hospital. human samples on multiple occasions meropenem and vancomycin was Lancet. 1980;316:939–41. http://dx.doi. org/10.1016/S0140-6736(80)92103-0 (5). A third species, S. haliotis, was started. Surgeons did not confirm the 8. Hewson R, Gmyl A, Gmyl L, Smirnova implicated in human infections dur- suspected necrotizing fasciitis. Two SE, Karganova G, Jamil B, et al. Evidence ing 2010 (6) and S. xiamenensis was sets of blood cultures and fluid culture of segment reassortment in Crimean- reported as the fourth infectious spe- sampled from the left leg identified S. Congo haemorrhagic fever virus. J Gen Virol. 2004;85:3059–70. http://dx.doi. cies among humans during 2011 (7). algae by conventional biochemical org/10.1099/vir.0.80121-0 S. haliotis is a novel bacterial species methods. The MICs of antimicrobial 9. Hoogstraal H. The epidemiology of that was isolated from the gut micro- drugs were determined by Etest (bio- tick-borne Crimean-Congo hemorrhagic flora of abalones (Haliotis discus han- Mérieux, Solna, Sweden). This strain fever in Asia, Europe, and Africa. J Med Entomol. 1979;15:307–417. nai) in 2007 (8). We report the second was susceptible to ciprofloxacin (0.25 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 19, No. 6, June 2013 1019 LETTERS 16S rRNA gene sequencing can be used to differentiate the 2 species. In summary, this case suggests that im- mune-compromised persons in tropi- cal climates could be susceptible to S. haliotis soft tissue infection in the absence of typical exposures. Acknowledgments We thank the staff of the Gastroen- terology Unit, Department of Medicine, Figure. Shewanella haliotis severe soft tissue infection of woman in Thailand, 2012. The Liver Transplant Unit, Center of Excel- patient sought treatment for painful erythematous swelling of the left leg. A) Arrow indicates lence in Clinical Virology, Faculty of affected area. B) Postsurgical fasciotomy wound with necrotic tissue. Medicine, Chulalongkorn University and Hospital, and the Thai Red Cross Society. mg/L), piperacillin-tazobactam (1.0 nih.gov/Blast.cgi) analysis, JX968803 We also thank Petra Hirsch for reviewing mg/L), ceftriaxone (1.0 mg/L), and showed the closest match (99.9%; 1 the manuscript. meropenem (0.38 mg/L). The patient base difference) with Alteromonada- This work was supported by the had fever for the first 2 days of hospi- ceae bacterium PH39 (AF513471). Higher Education Research Promotion talization. After 2 weeks of treatment, The strain was confirmed as S. and National Research University Project the antimicrobial drug was switched to haliotis by using additional biochemi- of Thailand, Office of the Higher Educa- oral ciprofloxacin; treatment was con- cal tests and API 20 NE System (bio- tion Commission (HR1155), Thailand tinued after dressing and debridement Mérieux, Durham, NC, USA). It was Research Fund (DPG5480002), Center of the fasciotomy wound. positive for ornithine decarboxylase, of Excellence in Clinical Virology, Chu- The organism produced yellow- gelatinase, reduction of nitrates to ni- lalongkorn University, Integrated Inno- ish-brown mucoid colonies on sheep trites, tolerance to 6% NaCl, and as- vation Academic Center, Chulalongkorn blood agar and chocolate agar after 18 similation of caprate and malate, but University Centenary Academic Devel- hours of incubation at 35°C under CO2 negative for citrate utilization, argi- opment Project (CU56-HR01), and King atmosphere. MacConkey agar showed nine dihydrolase, lysine decarboxyl- Chulalongkorn Memorial Hospital. non–lactose-fermenting colonies that ase, urease, indole production, assimi- were oxidase-positive, motile, and pro- lation of mannose, glucose, arabinose, duced hydrogen sulfide on triple sugar mannitol, maltose, adipate, and acidi- Kittiyod Poovorawan, iron agar. Growth at 42°C with 6.5% fication of glucose. This strain was re- Tanittha Chatsuwan, NaCl suggested that this organism was sistant to polymyxin B (300 µg/disc). Narisorn Lakananurak, S. algae. Because phylogenetically re- More than 50 species of She- Jira Chansaenroj, lated Shewanella species may be mis- wanella have been reported. The route Piyawat Komolmit, identified by routine biochemical tests, of Shewanella infection is associated and Yong Poovorawan the strain was confirmed by using 16S with direct contact with the organism Author affiliation: Chulalongkorn University, rRNA gene sequencing. through seawater or ingestion of raw Bangkok, Thailand Molecular characterization of seafood (9). Japan reported 1 case of DOI: http://dx.doi.org//10.3201/eid1906.121607 16S rRNA gene sequencing was per- S. haliotis infection in an elderly pa- formed by using PCR with Shewanel- tient in whom Vibrio vulnificus infec- References la species consensus primers (online tion was initially suspected (6), and Technical Appendix Table, wwwnc. various clinical manifestations of S. 1. Ivanova EP, Flavier S, Christen R. Phy- cdc.gov/EID/article/19/6/12-1607- algae infection have been reported (5). logenetic relationships among marine Al- Techapp.pdf) and direct sequencing Community- and hospital-acquired in- teromonas-like proteobacteria: emended description of the family Alteromonada- from PCR product (JX968803). Phy- fection with Shewanella species from ceae and proposal of Pseudoalteromon- logenetic analysis of the 16S rRNA contaminated medical devices have adaceae fam. nov., Colwelliaceae fam. gene sequence showed clustering with also been reported (10). S. haliotis nov., Shewanellaceae fam. nov., Moritel- S. haliotis (NR_044134T) and 99.9% and S.
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