Unusual marine pathogens causing cellulitis and bacteremia in hemodialysis patients: report of two cases and review of the literature

Abstract

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 unpredictable pathogenicity can cause infections. We present two cases with isolates that are usually encountered in coastal waters. The first case describes a 71-year-old African-American ESRD patient who presented with bacteremia secondary to a wound infection after exposure to flood waters in a tropical storm. The second case describes a 70-year-old Caucasian male ESRD patient who developed septic shock after a trivial wound inflicted while on a shrimp boat. Both patients were successfully treated with appropriate antibiotics and supportive measures. The infective agents in both cases belong to the halophilic Vibrio species. The causative agent of cellulitis and bacteremia in the first hemodialysis patient was identified as Vibrio alginolyticus, a non-lactose-fermenting gram-negative bacillus that is rarely isolated from blood. The second patient presented with septic shock owing to Vibrio vulnificus, which is a lactose-fermenting bacillus known to produce severe localized or systemic illness. In both cases, the common features were ESRD-related immunocompromised state and exposure to marine environments. These two cases of life-threatening cellulitis and bacteremia are presented as examples of environmental pathogens common to a marine environment in coastal areas and the imperative need of rapid identification and prompt initiation of treatment in immunocompromised hosts.