Hara Chisato, Tanaka Tetsuya, Nishiwada Satoshi, Kirihataya Yuki, Yoshimura Atsushi
Department of Surgery, Minami-Nara General Medical Center, 8-1 Oaza-Fukugami Oyodo-cho, Yoshino-gun, Nara, 638-8551, Japan.
Surg Case Rep. 2023 Oct 24;9(1):184. doi: 10.1186/s40792-023-01763-z.
Edwardsiella tarda (E. tarda) is a Gram-negative facultative anaerobe belonging to Enterobacteriales and is commonly isolated from fishes and reptiles. Infection due to E. tarda is uncommon among humans, with a reported human retention rate of 0.001%. It can cause sepsis in the elderly or those with pre-existing conditions such as liver failure, autoimmune disease, or malignancy. E. tarda is susceptible to many antibiotics; however, a high mortality rate (approximately 40%) has been reported with sepsis.
A 65-year-old woman presented to our hospital with a chief complaint of fever and abdominal pain for 2 days. Her blood tests showed elevated inflammatory markers, and contrast-enhanced computed tomography showed distention and wall thickening of the gallbladder and inflammation of peri-gallbladder fat. Subsequently, a diagnosis of cholecystitis with systemic inflammatory response syndrome was made. Laparoscopic cholecystectomy was performed after starting antimicrobial therapy. Blood culture of samples obtained on admission were positive for E. tarda, which was also detected in bile juice culture. Therefore, she was diagnosed with bacteremia caused by E. tarda, and postoperative antimicrobial therapy was continued. The patient improved, and there were no complications.
We experienced an extremely rare case of acute cholecystitis caused by E. tarda. Only a few cases of acute cholecystitis due to E. tarda have been reported. Furthermore, similar to this case, no previous study has reported the detection of E. tarda in both blood and bile cultures in acute cholecystitis cases. In addition to appropriate surgical intervention, continuous administration of antibiotics based on culture results resulted in a favorable outcome.
迟缓爱德华氏菌是一种革兰氏阴性兼性厌氧菌，属于肠杆菌目，常见于鱼类和爬行动物中。迟缓爱德华氏菌感染在人类中并不常见，据报道人类感染率为0.001%。它可导致老年人或患有诸如肝功能衰竭、自身免疫性疾病或恶性肿瘤等基础疾病的人发生败血症。迟缓爱德华氏菌对多种抗生素敏感；然而，败血症的死亡率较高（约40%）。
一名65岁女性因发热和腹痛2天为主诉前来我院就诊。她的血液检查显示炎症指标升高，增强CT显示胆囊扩张、壁增厚以及胆囊周围脂肪炎症。随后，诊断为胆囊炎伴全身炎症反应综合征。在开始抗菌治疗后进行了腹腔镜胆囊切除术。入院时采集的样本血培养显示迟缓爱德华氏菌阳性，胆汁培养中也检测到该菌。因此，她被诊断为迟缓爱德华氏菌引起的菌血症，并继续术后抗菌治疗。患者病情好转，无并发症发生。
我们遇到了一例极为罕见的由迟缓爱德华氏菌引起的急性胆囊炎病例。仅有少数几例由迟缓爱德华氏菌引起的急性胆囊炎病例被报道。此外，与本病例类似，此前尚无研究报道在急性胆囊炎病例的血液和胆汁培养中均检测到迟缓爱德华氏菌。除了适当的手术干预外，根据培养结果持续使用抗生素取得了良好的治疗效果。
