Hayashi Hirokatsu, Murase Yusuke, Sano Hitoya, Nishio Kimitosi, Kumazawa Iwao
Department of Surgery, JA GIFU Kouseiren Ibi Kosei Hospital, 2547-4 Miwa, Ibigawa-cho, Ibi-District, Gifu-Prefecture, 501-0696, Japan.
Int J Surg Case Rep. 2020;75:422-425. doi: 10.1016/j.ijscr.2020.09.126. Epub 2020 Sep 23.
Edwardsiella tarda is a member of the Enterobacteriaceae family of gram-negative bacilli isolated from animals. Gastroenteritis is the most common manifestation of E. tarda infection. However, extraintestinal infections can occur in immunocompromised hosts as well as patients with hepatobiliary disease, malignancy, and/or diabetes mellites. The prognosis of sepsis caused by E. tarda is extremely poor, with a mortality rate of 38%. Here we report the occurrence of spontaneous bacterial peritonitis associated with E. tarda infection.
An 87-year-old man with Child-Pugh A cirrhosis secondary to hepatitis C virus infection presented with diarrhea and sudden-onset pain in the abdomen. On arrival, guarding and rebound tenderness were observed over the entire abdomen. Computed tomography revealed circumferential thickening of the cecum and a small volume of ascites in the pelvic cavity. A diagnosis of peritonitis was made, and surgery was performed. Surgical findings included redness and thickening of the cecal wall and purulent ascites without intestinal contents. Peritoneal fluid culture revealed E. tarda as the sole pathogen. The abdominal cavity was washed, a drain was placed in the pelvic cavity, and postoperative intravenous antibiotic therapy was initiated. The postoperative course was uneventful.
E. tarda infection in the presence of an underlying disease such as hepatobiliary disease, malignancy, and/or diabetes mellitus has a poor prognosis.
Although E. tarda infection is extremely rare, it is a life-threatening illness that can cause intestinal and extraintestinal infections. If necessary, early surgical intervention should be considered for cases of extraintestinal infection.
迟缓爱德华氏菌是从动物中分离出的革兰氏阴性杆菌肠杆菌科的一员。胃肠炎是迟缓爱德华氏菌感染最常见的表现。然而，免疫功能低下的宿主以及患有肝胆疾病、恶性肿瘤和/或糖尿病的患者也可能发生肠外感染。迟缓爱德华氏菌引起的败血症预后极差，死亡率为38%。在此，我们报告一例与迟缓爱德华氏菌感染相关的自发性细菌性腹膜炎病例。
一名87岁男性，因丙型肝炎病毒感染继发Child-Pugh A级肝硬化，出现腹泻和突发腹痛。入院时，全腹均有肌紧张和反跳痛。计算机断层扫描显示盲肠周径增厚，盆腔有少量腹水。诊断为腹膜炎，并进行了手术。手术所见包括盲肠壁发红、增厚，以及脓性腹水但无肠内容物。腹水培养显示迟缓爱德华氏菌为唯一病原体。冲洗腹腔，在盆腔放置引流管，并开始术后静脉抗生素治疗。术后病程顺利。
在存在肝胆疾病、恶性肿瘤和/或糖尿病等基础疾病的情况下，迟缓爱德华氏菌感染预后不良。
尽管迟缓爱德华氏菌感染极为罕见，但它是一种危及生命的疾病，可引起肠道和肠外感染。如有必要，对于肠外感染病例应考虑早期手术干预。
