Arunava Saha, MD Saint Vincent Hospital, Worcester, MA
Introduction: The genus Aeromonas consists of Gram-negative rods found in aquatic environments and soil. They commonly cause diarrhea, but have been associated with extraintestinal manifestations such as bacteremia. Drug-resistant strains are being increasingly identified, which are acquired in both community and hospital settings; and can affect both immunocompetent and immunocompromised patients.
Case Description/Methods: A gentleman in his late 30s presented with a month of high-grade fever with chills, abdominal distension, nausea with vomiting, and weight loss. He had a history of alcoholic chronic liver disease, consumed 200ml of hard liquor daily for 15 years. On admission he was tachycardic and had a temperature of 102F. General examination revealed pallor. The liver edge was palpable 1 cm below the right costal margin with a liver span of 12 cm. Abdominal distension with diffuse tenderness was present, but no guarding or rigidity. Free fluid was present. There was no encephalopathy. Laboratory investigations revealed anemia, thrombocytopenia and normal leukocyte count with neutrophilic predominance. Liver functions showed hyperbilirubinemia with transaminitis and hypoalbuminemia. Blood borne virus screen was negative. Ascitic fluid analysis revealed SAAG of 1.6mg/dl, 17,448 WBCs per mm3 with 96% polymorphonuclear cells. Ultrasound abdomen showed features of cirrhosis with ascites without any hepatic vein obstruction. He was diagnosed with spontaneous bacterial peritonitis with underlying decompensated chronic liver disease (Child Pugh-C, MeldNa-25). Blood and ascitic fluid cultures were sent, and IV Meropenem was started.
The blood cultures isolated Aeromonas Caviae, which was sensitive to Levofloxacin. The ascitic fluid culture was sterile. The antibiotic was switched to IV Levofloxacin for a two-week course. A repeat ascitic fluid count was 104 WBCs/mm3. The patient symptomatically improved, remained afebrile and started tolerating his diet. He was continued on his management for chronic liver disease and discharged. In a follow-up visit, he was found to be asymptomatic.
Discussion: Aeromonas species can cause invasive and fatal infections in immunocompromised hosts. Initial empiric therapy of suspected Aeromonas infections is with a fluoroquinolone or carbapenem, as resistance rates are high for cephalosporins around the world. Although rare, the Aeromonas species should be considered as one of the causative agents of bacteremia in patients with hepatobiliary diseases or underlying malignancy.
Disclosures:
Arunava Saha indicated no relevant financial relationships.
Arunava Saha, MD. C0551 - Aeromonas caviae Bacteremia in a Patient With Spontaneous Bacterial Peritonitis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
