Catfish spine envenomation and bacterial abscess with Proteus and Morganella: a case report

Abstract

Introduction: Abscess formation and cellulitis in the setting of envenomation are rare complications of handling catfish. To the best of our knowledge, isolation of Proteus vulgaris has not been previously recorded, and recovery of Morganella morganii has been reported in only one prior case from wound cultures in patients injured by catfish stings. We report a case of catfish envenomation characterized by abscess formation and cellulitis, in which wound cultures grew these unusual organisms.

Case presentation: A 52-year-old Chinese-American man was hospitalized with erythema and swelling of his right arm of 10 days' duration after skin penetration by a catfish barb. An abscess of his right thumb had undergone incision and drainage, with purulent drainage sent for wound culture immediately prior to admission. Laboratory studies revealed elevated white blood count, sedimentation rate, and C-reactive protein. The patient was treated with intravenous ampicillin-sulbactam and vancomycin during his hospitalization, and symptoms improved. Wound cultures obtained prior to presentation grew many Proteus vulgaris and Morganella morganii. He was subsequently discharged on a 10-day course of oral ciprofloxacin and amoxicillin-clavulanate. At a 12-month telephone follow-up, the patient denied developing further symptoms and reported that the wound had healed completely without complication.

Conclusion: Although envenomation and secondary infection are not uncommon sequelae of handling catfish, the present case is unique by virtue of the infecting organisms isolated. Given the prevalence of injury from catfish stings, a review of the literature is presented in order to provide recommendations for prevention and treatment of catfish envenomation.

Figure 1

Right thumb radiographs taken on admission to the hospital. Plain films show cellulitis and edema of the skin overlying the interphalangeal joint of the first digit. There is no evidence of fracture, dislocation, or osteomyelitis.

Figure 2

Photographs of channel catfish, Ictalurus punctatus, with exposed pectoral (A) and dorsal spines (B). Note the sharp and deeply serrated contours of the spines.

Figure 3

Dorsal spine of the striped eel catfish, Plotosus lineatus [1]. Permission for use obtained from Darwin Press, Inc.