Severe Wound Infection with Photobacterium damselae ssp. damselae and Vibrio harveyi, following a Laceration Injury in Marine Environment: A Case Report and Review of the Literature

Abstract

Marine microorganisms are uncommon etiologies of skin and skin structure infections, that is, wound infections. We report a case of severe wound infection, caused by the marine Photobacterium damselae (Vibrionaceae), in a 64-year-old male patient, returning from Australia. The isolate tested positive for pPHDD1, a plasmid conferring high-level virulence. Furthermore, the wound was coinfected with Vibrio harveyi, a halophile bacterium, which has never been reported from human infections before. Identification was achieved by use of Matrix-Assisted Laser Desorption-Ionization Time of Flight Mass Spectrometry (MALDI-TOF) and confirmed by 16S rDNA sequencing. Data retrieval from bibliography was complicated since P. damselae has been renamed often with a number of synonyms present in the literature: Photobacterium damsela, Vibrio damselae, Vibrio damsela, Pasteurella damselae, and Listonella damsela. With all synonyms used as query terms, a literature search provided less than 20 cases published worldwide. A majority of those cases presenting as severe wound infection are even fatal following progression into necrotizing fasciitis. Management with daily wound dressing and antibiotic therapy (ofloxacin empirically, followed by doxycycline after availability of microbiology) led in the reported case to a favorable outcome, which seems to be, however, the exception based on a review of the available literature.

Figure 1

Growth of P. damselae and V. harveyi on Columbia agar, (a) following 24 and (c) following approximately 48 hrs of incubation, as observed from the original inoculation. The colony marked with V. harveyi in (c) has a diameter of 2-3 mm. Note that (a), (b), and (d) were taken with flash against transmitting sunlight while (c) was taken with flashlight from above only. The section in (a) shows the growth after 24 hrs at 35 ± 1°C, and (b) is taken at the same time, but illustrating the hemolysis of P. damselae. (c) was taken following additional 24 hrs of incubation, however, at room temperature. While the images (a) and (c) show almost identical sections of the agar plates, they are not superimposable due to variations in the position. (d) illustrates the differences in color, seen especially after approximately 48 hrs, when V. harveyi was allowed to grow at a more ambient temperature (i.e., room temperature).

Figure 2

Wound, following seven days of ofloxacin (Tarivid) and following daily debridement, eight days after opening by removing the surgical threat. (Bar at the top is in cm.)