Letter to the Editor
Septic shock by Shewanella algae cellulitis
Shock séptico secundaria a celulitis por Shewanella algae
Patricia Escudero-Acha, Carmen Blanco Huelga, Alejandro González-Castro
Corresponding author
Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
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The medical examination revealed a cutaneous-subcutaneous lesion on the right leg with exudative secretion and cellulitis. Three days earlier, the patient had hurt his leg while on the seashore, in the Cantabrian Sea.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The most relevant laboratory values showed an increase in serum <span class="elsevierStyleSmallCaps">C</span> reactive protein (CRP) >25<span class="elsevierStyleHsp" style=""></span>mg/dl and procalcitonin (PCT) of 46.43<span class="elsevierStyleHsp" style=""></span>ng/mL, with acute renal failure (serum creatinine level 5.90<span class="elsevierStyleHsp" style=""></span>mg/dl) and hyperlactatemia (52.5<span class="elsevierStyleHsp" style=""></span>mg/dl).</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient developed a septic <span class="elsevierStyleItalic">shock</span> with multiorgan dysfunction, requiring supportive treatments according to the clinical situation.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the first 24<span class="elsevierStyleHsp" style=""></span>h, microscopic examination showed growth of gram-negative bacilli in the blood culture. After 48<span class="elsevierStyleHsp" style=""></span>h, <span class="elsevierStyleItalic">Shewanella algae</span> was identified first in blood culture and then in exudate.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The most common microorganisms involved in soft tissue infections are Gram-positive bacteria, for which targeted antibiotic therapy is common.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In the present case, where the etiological agent of cellulitis is a Gram-negative bacteria, two issues arise. First, how this etiological modification may affect the course of the septic process, due to a possible delay in the start of targeted antibiotic therapy; and second, assess the origin of the pathogen and its future implications.</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Shewanella algae</span> is a facultative, Gram negative anaerobic microorganism that was first isolated from red algae. Since its natural habitat is an aquatic environment, it has rarely been reported as a human pathogen. Its clinical presentations include soft tissue infections, bloodstream infections, and biliary tract infections, which cause considerable morbidity and mortality.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The Cantabrian Sea traditionally maintains a temperature close to 10<span class="elsevierStyleHsp" style=""></span>°C in winter, which can reach 20<span class="elsevierStyleHsp" style=""></span>°C in the summer months. However, it is not exempt from the heat waves that occur under global warming.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In fact, the week of exposure of the patient to sea water according to data from the Spanish Meteorological Agency, the Cantabrian coast waters reached an average surface temperature of 23<span class="elsevierStyleHsp" style=""></span>°C.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Because <span class="elsevierStyleItalic">S. algae</span> is found in marine waters and is a mesophilic organism, it must survive many months of low water temperature during winter. The microorganism must also be able to cope with prolonged periods of low nutrient and energy availability. In addition, bacteria that adhere and form biofilms are generally more resistant to adverse conditions.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Escudero-Acha P, Blanco Huelga C, González-Castro A. <span class="elsevierStyleItalic">Shock</span> séptico secundaria a celulitis por <span class="elsevierStyleItalic">Shewanella algae</span>. 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