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Nongastrointestinal Aeromonas hydrophila Infections in Patients With Cancer

Casanas, Beata C. DO, FACP*; Kass, Jonathan BA; Pathak, Amit MD; Tucci, Veronica T. MD, JD§; Payor, Austin DO§; Vincent, Albert L. PhD*; Greene, John N. MD, FACP; Sandin, Ramon L. MD, MS, FCAP

Infectious Diseases in Clinical Practice: July 2012 - Volume 20 - Issue 4 - p 268–271
doi: 10.1097/IPC.0b013e318245d37a
Original Articles

Abstract: Aeromonas hydrophila is an aquatic bacterium that causes sporadic, opportunistic warm-weather soft tissue infections and bacteremias, classically among men with predisposing liver disorders or leukemias. Although the portal of entry often remains elusive, the end result in these immunodeficient populations can be devastating.

At our institution, we exhaustively reviewed patient charts and records and identified A. hydrophila from fluid specimens in 24 symptomatic patients with cancer over a period of 23 years. Seven of our patients were male and the other 17 patients were female, and the median age was 64 years.

Predisposing conditions were identified as follows: Six of them had solid organ malignancies, and two had a diagnosis of hematologic malignancies; four patients had altered hepatic function, whereas 3 patients had neutropenia. Only one patient was found to have the classical risk factor of liver cirrhosis, in this case, secondary to chemotherapy.

The 2 patients exhibiting soft tissue manifestations of Aeromonas acquired the bacterium in the community and presented with local abscess and fever. Only one of the 2 patients gave a history of fresh water exposure. We successfully managed these 2 patients with nonsurgical intervention.

A. hydrophila hydrophilia is frequently encountered in the human gastrointestinal tract, but instances of A. hydrophila bacteremia are rare. During the last decade, the medical literature attests to the high mortality rate among immunocompromised patients who undergo extraintestinal Aeromonas infections, and it is thus important to be aware of the variable presentation in this infection. While Aeromonas is often associated with fresh water exposure, only one of these eight patients presented with this history. The fact that Aeromonas infection can arise in immunocompromised patients without a recollection or history of exposure to contaminated water is of paramount importance in appropriately considering Aeromonas among the differential diagnoses. Liver damage was also found to be an important factor in many of these patients, and cirrhosis is discussed as a possible predisposing factor for septicemia.

From the *Division of Infectious Disease and International Medicine, Department of Internal Medicine, University of South Florida College of Medicine; †University of South Florida College of Medicine; ‡International Scholar Program, Moffitt Cancer Center; §Department of Emergency Medicine, University of South Florida College ofMedicine; ∥Infectious Diseases, Moffitt Cancer Center; and Division of Infectious Diseases and International Medicine, University of South Florida College of Medicine; and ¶Clinical Microbiology and Virology Laboratories, Moffitt Cancer Center; and University of South Florida College of Medicine, Tampa, FL.

Correspondence to: John N. Greene, MD, FACP, Moffitt Cancer Center; and Internal Medicine and Oncological Sciences, University of South Florida College of Medicine, 12902 Magnolia Dr, FOB-3, Tampa, FL 33612-9497. E-mail: john.greene@moffitt.org.

The authors have no funding or conflicts of interest to disclose.

© 2012 Lippincott Williams & Wilkins, Inc.