Emerging extra-intestinal infections with Aeromonas hydrophila in coastal region of southern Karnataka

Background: Aeromonas species are gram-negative rods usually isolated from the gastrointestinal tract. They have been occasionally reported as a cause of extra-intestinal infections such as cellulitis, cholangitis, necrotizing fascitis, meningitis, bacteremia, or peritonitis in both immunocompetent and immunocompromised patients. Aim: To determine the role and possible pathogenesis of Aeromonas in extra-intestinal infections. Settings and Design: Retrospective analysis carried out at Kasturba Hospital Manipal, Karnataka in the months of January and February 2007. Materials and Methods: Clinical manifestations and management of eight cases of extra-intestinal infections caused by A. hydrophila, from the south Karnataka coastal region were reviewed. The isolates were identified with the help of biochemical tests using standard guidelines. Results: All patients acquired Aeromonas infections in the community. Five (62.5%) had underlying illnesses, such as liver disease, diabetes mellitus or malignancy. Five (62.5%) had polymicrobial infections, and three (37.5%) were complicated with bacteremia. These included three patients with ulcers or abscess over the lower leg, two with cellulitis due to snake bite and one each with pelvic inflammatory disease, spontaneous bacterial peritonitis and pneumonia. A. hydrophila was found to be a causative agent of pelvic inflammatory disease or cellulitis following sea snake bite, and such a clinical scenario has not been previously described. Seven patients survived the illness. Conclusions: Isolation of A. hydrophila from extra-intestinal specimens demands utmost clinical and microbiological vigilance in diagnosis, since the organism can cause serious infections among immunocompromised as well as immunocompetent individuals.