Untitled

• Edwardsiella tarda


  The most commonly isolated species in the Edwardsiella genus and the main species known to cause disease in humans
• Edwardsiella tarda


  • Motile, facultative anaerobic gram-negative rod-shaped bacteria
  • Often found in fresh and brackish water environments
• Edwardsiella genus infection


  Rare but can be serious for those who are immunocompromised
• Edwardsiella tarda infection


  Predominantly associated with gastrointestinal illness, rarely leads to septicemia but can be fatal, particularly in vulnerable populations
• Edwardsiella tarda infection


  • Bacterial illness caused by the gram-negative bacterium Edwardsiella Tarda
  • While primarily affecting aquatic animals, it can also cause infections in humans, leading to a range of symptoms from gastrointestinal issues to systemic infections
• Edwardsiella tarda


  • Primarily inhabits fresh and brackish water environments and is often found among wildlife such as reptiles, amphibians, and fish
  • In humans, infection typically occurs through the consumption of contaminated water or raw seafood, particularly in individuals with underlying medical conditions or compromised immune systems
• Edwardsiella tarda infection in humans


  • Can lead to a spectrum of diseases, with gastroenteritis being the most common presentation
  • In immunocompromised individuals or those with underlying medical conditions, E. tarda infection can result in more severe manifestations such as bacteremia, septicemia, and extraintestinal infections
• Laboratory investigations revealed leukopenia, thrombocytopenia, elevated liver enzymes, hyperbilirubinemia, and elevated inflammatory markers
• Abdominal imaging showed ascites and hepatic lesions, consistent with the patient's medical history of liver disease
• Differential diagnosis considered


  • Bacteremia
  • Recurrence of macrophage activation syndrome
  • Viral process in the presence of pancytopenia
  • Bacterial gastroenteritis
  • Spontaneous bacterial peritonitis (SBP) given ascites and fever
• Given the laboratory findings, imaging results, and differential diagnosis, a likely diagnosis is cirrhosis with complications such as ascites and spontaneous bacterial peritonitis (SBP)
• Blood cultures


  Showed positive results for E. tarda within 15 hours of specimen loading, with identical isolates recovered from both aerobic and anaerobic bottles
• Peritoneal fluid culture


  Yielded E. tarda after 2 days of incubation
• Genomic characterization revealed a high genetic similarity between the patient's E. tarda isolate and strain KC-Pc-HB1, indicating a close relationship
• The patient's E. tarda isolate was categorized as Edwardsiella sequence type 6
• Antimicrobial resistance gene analysis did not yield the presence of significant AMR genes, consistent with the pan-susceptible phenotypic profile of the isolate
• Prophylaxis


  1. The patient was empirically started on broad spectrum antibiotics intravenous vancomycin and meropenem

  2. Continued monitoring and management of ascites are crucial to prevent recurrence of spontaneous bacterial peritonitis

  3. Multiple therapeutic paracentesis procedures that showed improving leukocytosis

  4. The patient was also advised to avoid future consumption of raw sea food given her underlying medical conditions and high infection risk

  5. Completed 4-week course of antibiotic with no detectable E. tarda infection
• Prevention & Control


  • Be careful whenever you expose to aquatic environments, exotic animals and people with underlying disease
  • Avoid swallowing lake or pool water while swimming (prolonged contact with water)
  • Avoid eating raw and undercooked seafoods (Ingestion of raw fish are the major risk factor associated with E.tarda)
  • Be careful when eating some freshwater foods
• For blood cultures BD BACTEC™ FX was used
• The bacterial isolate from blood cultures and peritoneal fluid was identified using modern techniques such as MALDI-TOF mass spectrometry (bioMérieux, VITEK® MS)
• Genomic characterization of the E. tarda blood isolate was performed using DNA extraction
• Trends & Recommendations


  • Early diagnosis and prompt antibiotic therapy
  • Source identification and preventive measures in water and food (fish)
  • Immunocompromised patient care to minimize complications