EDWARDSIELLA TARDA: A PISCINE CULPRIT OF ACUTE CHOLANGITIS K Obi MD, HH Hajebian Department of Internal Medicine, Ochsner Medical Center, New Orleans, LA
INTRODUCTION Edwardsiella tarda , a member of Enterobacteriaceae family, is a gram negative, facultative anaerobe found in the digestive tracts of eels, flounder, and most notably, catfish. Although rare in humans, Edwarsiella tarda bacteremia have been reported in Japan, from consumption of infected wild-caught eel and catfish. Consumers of wild-caught catfish, a cultural past-time and culinary delicacy to the Louisiana region may be at high risk. CASE: An 82-year-old man with diabetes mellitus and hyperlipidemia who was admitted for a non-ST elevation myocardial infarction with plan for a percutaneous coronary intervention. The patient was incidentally found to have leukocytosis and bacteremia. The patient complained of abdominal pain, fevers, chills and decreased appetite. Social history was pertinent for a fishing trip two weeks prior along with frequent catfish consumption. The patient was hemodynamically stable and physical examination was unremarkable. Significant labs included a WBC of 18,000, Alkaline Phosphatase of 950, AST 95, ALT 65, GGT 1450. Blood cultures were positive for Edwardsiella tarda. An abdominal ultrasound revealed mild prominence of the common bile duct (CBD) and intrahepatic biliary duct dilatation. A magnetic resonance cholangiopancreatography (MRCP) revealed intra and extrahepatic biliary dilatation. The patient underwent an endoscopic retrograde cholangiopancreatography (ERCP) with a biliary sphincterotomy and removal of a stone from the CBD. The patient was initiated on aztreonam, de-escalated to oral amoxicillin-clavulanate for a total of fourteen days. Follow up liver enzymes weeks after the procedure had markedly improved. DISCUSSION: Cases of Edwarsiellatarda bacteremia are limited, however several studies includea link toconsumptionof raw, undercooked, or wild-caught fish, with evidence of a fatal water and food-borne infection. Our patient’s history of frequent fishing and catfish consumption, in combination with a history of gallstone disease, likely reflects the etiology of the acute cholangitis. Edwardsiella tarda is considered pan-sensitive to antimicrobial therapy, with natural resistance to benzylpenicillin, polymyxin B, colistin and reports of mixed sensitivity to tetracyclines.
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