Correspondence

Necrotizing Fasciitis Due to Photobacterium damsela in a Man Lashed by a Stingray

N Engl J Med 2000; 342:824March 16, 2000

Article

To the Editor:

A variety of vibrio species can cause gastroenteritis, wound infections, and primary septicemia as well as illness among marine organisms.1,2 Photobacterium damsela (formerly Vibrio damsela) is similar to other species of the genus vibrio, which are halophilic, gram-negative bacilli.3 We describe a 43-year-old man with necrotizing fasciitis as a result of a laceration inflicted by a stingray while he was stepping off his sailboat in Tampa Bay, Florida.

The patient first presented to the emergency department of another hospital, where the wound to his right tibialis anterior muscle was irrigated and sutured approximately six hours after admission. Antimicrobial therapy was not prescribed, and the patient was released from the emergency department. Three days later, fever developed and erythema appeared along the wound margins, followed within the next 24 hours by the appearance of a 2.5-cm, malodorous, fluctuant lesion. The patient then came to our emergency department. His oral temperature was 39°C, his white-cell count was 15,500 per cubic millimeter, and he had a septic appearance. There was necrotizing fasciitis of his right tibialis anterior muscle. Administration of intravenous doxycycline (400 mg per day), cefazolin (3 g per day), and tobramycin (6.5 mg per kilogram of body weight per day) was begun and was continued until his discharge, seven days later. Deep surgical débridement of skin, fascia, and muscle was performed on an emergency basis, and the wound was again débrided in the operating room the following morning. Wound cultures yielded P. damsela, which was sensitive to our battery of antibiotics for gram-negative organisms, with the exception of amikacin, to which it had intermediate sensitivity. As an outpatient he received oral doxycycline and cephalexin for two weeks. Subsequently, he required physical therapy and a split-thickness skin graft for wound closure.

P. damsela is a pathogen in both immunocompromised and healthy hosts and can cause rapid, fulminant infection with a high rate of death.2,4 Clinicians should be aware of this organism and other vibrio species, particularly in cases of wounds exposed to salt or brackish water or wounds inflicted by marine animals living in such an environment.

Gerard R. Barber, R.Ph., M.P.H.
Jeffrey S. Swygert, M.D.
Lakeland Regional Medical Center, Lakeland, FL 33804

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Citing Articles (10)

Citing Articles

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   Marta O. Domingos, Márcia R. Franzolin, Marina Tavares dos Anjos, Thais M.P. Franzolin, Rosely Cabette Barbosa Albes, Gabrielle Ribeiro de Andrade, Rossivan J.L. Lopes, Katia C. Barbaro. (2011) The influence of environmental bacteria in freshwater stingray wound-healing. Toxicon 58:2, 147-153
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2. 2

   Carlos Osorio, Manuel Lemos. 2011. Photobacterium. , 959-968.
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3. 3

   Judith A. Johnson. 2010. Vibrio. .
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   Yojiro ISHIDA, Ashraf M. AHMED, Nadia B. MAHFOUZ, Tomomi KIMURA, Sabry A. EL-KHODERY, Amgad A. MOAWAD, Tadashi SHIMAMOTO. (2010) Molecular Analysis of Antimicrobial Resistance in Gram-Negative Bacteria Isolated from Fish Farms in Egypt. Journal of Veterinary Medical Science 72:6, 727-734
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   Lem Aigbivbalu, Nizar Maraqa. (2009) Photobacterium damsela Wound Infection in a 14-Year-Old Surfer. Southern Medical Journal 102:4, 425-426
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   Yoshitaka NAKAMURA, Miho UCHIHIRA, Makoto ICHIMIYA, Kazumasa MORITA, Masahiko MUTO. (2008) Necrotizing fasciitis of the leg due to Photobacterium damsela. The Journal of Dermatology 35:1, 44-45
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7. 7

   Richard F. Clark, Robyn Heister Girard, Daniel Rao, Binh T. Ly, Daniel P. Davis. (2007) Stingray Envenomation: A Retrospective Review of Clinical Presentation and Treatment in 119 Cases. The Journal of Emergency Medicine 33:1, 33-37
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8. 8

   Kristen H. Goodell, Michael R. Jordan, Roger Graham, Charles Cassidy, Stanley A. Nasraway. (2004) Rapidly advancing necrotizing fasciitis caused by Photobacterium (Vibrio) damsela: A hyperaggressive variant. Critical Care Medicine 32:1, 278-281
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9. 9

   L Dalla Valle. (2002) Use of random amplification to develop a PCR detection method for the causative agent of fish pasteurellosis, Photobacterium damselae subsp. piscicida (Vibrionaceae). Aquaculture 207:3-4, 187-202
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10. 10

    David V. Seal. (2001) Necrotizing fasciitis. Current Opinion in Infectious Diseases 14:2, 127-132
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