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Pyogenic Flexor Tenosynovitis Caused by Shewanella algae

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Pyogenic flexor tenosynovitis is an orthopedic emergency most commonly caused by Staphylococcus aureus and streptococci and occasionally, when associated with water exposure, Mycobacterium marinum. Shewanella algae, a gram-negative bacillus found in warm saltwater environments, has infrequently been reported to cause serious soft tissue infections and necrosis. In this case, S. algae caused complicated flexor tenosynovitis requiring open surgical irrigation and debridement. Flexor tenosynovitis caused by S. algae rapidly presented with all 4 Kanavel cardinal signs as well as subcutaneous purulence, ischemia, and necrosis, thus meeting the requirements for Pang et al group III classification of worst prognosis. Because of its rarity and virulence, S. algae should always be considered in cases of flexor tenosynovitis associated with traumatic water exposure to treat and minimize morbidity appropriately.

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Case Report

A 39-year-old man presented to our emergency department reporting pain and swelling in the right ring finger, which he had stuck with a fishhook while fishing in saltwater offshore 2 days prior. At the time of injury, the patient removed the fishhook and applied topical bacitracin. At presentation he was experiencing fever, chills, nausea, vomiting, lightheadedness, and weakness along with burning pain radiating from the right hand toward the elbow. His medical history was unremarkable.

Physical

Discussion

Shewanella algae is an oxidase-positive, non-fermenter, gram-negative rod that produces H2S gas in triple sugar iron slant. It can be differentiated from other species within its genus by its growth at 42°C, growth in the presence of high NaCl concentration (6.5%), and hemolysis on 5% sheep blood agar, all within 24 hours.3 Shewanella algae is found in warm saltwater environments4 and rarely causes infections in humans. It is the most virulent species in its genus and predominates in the

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Cited by (10)

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    Immunocompromised patients are at risk for several less common bacteria, such as Streptococcus mitis, a strain of Streptococcus viridans,8 as well as gram-negative organisms or mixed flora. Inoculations in marine environments have led to infections from less common pathogens, such as Mycobacterium marinum and Shewanella algae.9,10 Even more rare species have been isolated from the flexor tendon sheath, such as Nocardia nova, a gram-positive, acid-fast filamentous bacterium that is better known as a cause of pulmonary infections.11

  • Palmar Soft Tissue Infection From Shewanella putrefaciens

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    The patient also presented with all 4 Kanavel signs and was taken to the operating room for treatment. Shewanella algae and Proteus vulgaris were isolated and the patient was discharged on levofloxacin.10 These cases confirm that Shewanella species should be considered in wounds exposed to saltwater regardless of immune status.

  • Isolation, identification and characterization of Shewanella algae from reared tongue sole, Cynoglossus semilaevis Günther

    2017, Aquaculture
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    Some argue that S. algae may be a more virulent species and the most important pathogen in Shewanella (Khashe and Janda, 1998). S. algae usually infects ears and soft tissues of humans in clinics, and causes more serious infections, such as bacteremia, peritonitis, neonatal sepsis and pyogenic flexor tenosynovitis (Charles et al., 2015; Fluke et al., 2016; Kim et al., 2014). Recently, this pathogen has also been isolated from aquatic animals including Scinenops ocellata, marine sponge Callyspongia diffusa, Babylonia sp. (Chen et al., 2003; Li et al., 2015; Rachanamol et al., 2014; Zhang et al., 2013).

  • A Low Virulence Infective Tenosynovitis Triggered by a Neisseria Species

    2022, Journal of Hand Surgery Asian-Pacific Volume
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