Edwardsiella tarda: A Classic Presentation of a Rare Fatal Infection, with Possible New Background Risk Factors

Abstract

BACKGROUND Edwardsiella tarda is a facultative anaerobic bacterium that is rarely pathogenic to humans, but, in patients with certain risk factors, it can lead to severe, disseminated infections. Humans are inoculated through the gastrointestinal tract while consuming undercooked or raw seafood or through skin penetration. E. tarda has been isolated from marine environments, including lakes, rivers, wells, and sewage water. Although the bacterium has not been directly isolated from seawater, it has been cultured from animals inhabiting seawater environments. In the United States, E. tarda is predominantly localized along the coastline of the Gulf of Mexico. Complications from this bacterium usually arise in patients with liver disease, iron overload, or cirrhosis or in those who are immunocompromised or on immunosuppressive therapy. CASE REPORT Our patient was a 59-year-old woman with a history of advanced lung cancer, pulmonary hypertension, liver cirrhosis, hepatitis C, and alcoholism. She initially presented to the Emergency Department in the Florida Panhandle on June 16 with colitis, which then progressed to fulminant sepsis with septic shock. Despite aggressive interventions, including intravenous hydration, broad-spectrum antibiotics, and vasopressor support, our patient succumbed to her illness approximately 34 h after initial presentation. CONCLUSIONS Although severe cases of E. tarda have been reported in patients with liver dysfunction, we believe this is the first reported case potentially complicated by concomitant lung cancer. The rise in sea water temperature, increased human consumption of raw seafood, and increased prevalence of nonalcoholic steatohepatitis may increase the incidence and mortality of E. tarda in the near future.