A Fishmonger's Tale
Fish are vectors of several zoonoses that can pose serious health problem in the immunocompromised patients. The clinical manifestation is often cutaneous and occurs at the site of inoculation. However, bacteremia and deep-seated infection have been described. We report a case of Pseudomonas aeruginosa causing ecthyma gangrenosum in an immunosuppressed patient after fish handling and review the literature of previously reported cases of fish handling infection.
We retrospectively reviewed the literature of all cases of infection among fishmongers utilizing the PUBMED database from 1990 to present. A comparative analysis was performed to explore the risk factors, bacterial pathogens, treatment, and outcomes.
Thirty-eight cases of infections acquired through fish handling were identified. The median age was 58 years. The most common underlying medical conditions were diabetes mellitus (DM), alcoholism, and rheumatic heart disease (RHD). The most common bacteria involved were Streptococcus iniae (11 cases), Vibrio vulnificus (7 cases), and Mycobacterium marinum (7 cases). Other pathogens reported were Erysipelothrix rhusiopathiae, Aeromonas hydrophila, Vibrio damsela, Proteus vulgaris, Morganella morganii, Lactococcus garvieae, Mycobacterium abscessus, Streptococcus halichoeri, and in our case Pseudomonas aeruginosa. Cellulitis was the most common manifestation but necrotizing fasciitis, tenosynovitis, osteomyelitis, endocarditis, and septic shock have been documented. Beta-lactam agents such as penicillin, or ampicillin-sulbactam were often prescribed for streptococcal infection while anti-mycobacterial agents such as rifampin, ethambutol, and clarithromycin were often used for M. marinum infection. Four cases of death were reported, representing a mortality of 11%.
Chronic medical conditions such as DM, alcoholism, and RHD can predispose patients to infection, particularly among fishmongers. These infections pose significant morbidity and mortality in the immunocompromised hosts if not recognized early. Thus, a thorough history, including occupational and recreational exposure, is essential to prompt the clinician to consider these atypical zoonotic pathogens in the differential diagnoses and provide the appropriate management.
A. Yacoub, None
T. Janz, None
J. Greene, None