C-188. Extraintestinal Manifestations of Edwardsiella tarda Infection: A 10-year Retrospective Review

J. J. Nelson, J. E. Carter;
Univ. of South Alabama, Mobile, AL.

Edwardsiella tarda, a member of the family Enterobacteriaceae found in aquatic environments, is an unusual cause of human disease, presenting most frequently as gastroenteritis. Extraintestinal manifestations of E. tarda infection are rare but have included meningitis, cholecystitis, endocarditis, osteomyelitis, soft tissue infections, bacteremia, and septicemia. Documented risk factors predisposing patients to extraintestinal E. tarda infection are hepatobiliary disease, malignancy, and diabetes mellitus. Over a 10-year period at our institution, a University-based health care system on the Gulf Coast, 10 cases of clinically-significant extraintestinal infection related to E. tarda were identified. The infections ranged from soft tissue infections secondary to trauma to intra-abdominal infections with abscess formation. Two cases were associated with fish bone foreign bodies, and another case involved an abscess of an arteriovenous fistula in a patient with end stage renal disease. Affected patients ranged in age from childhood to late adulthood with an average age of 36 years. Several of the patients had documented factors predisposing them to infection including diabetes mellitus and C1 esterase deficiency. Interestingly, two of the patients had chronic idiopathic inflammatory bowel disease, a possible predisposing factor for E. tarda infection. The majority of the cases occurred in the Spring and Summer months, the period of greatest water-related activity and exposure. Although the mortality rate for extraintestinal E. tarda infections has been as high as 22% in some studies, antimicrobial treatment was eventually successful in each of the ten cases at our institution. The expanding clinical spectrum of disease seen with extraintestinal E. tarda infections illustrates the need for prompt diagnosis and effective treatment.