<i>Shewanella algae</i>bacteremia from a foot ulcer exposed to seawater during a Caribbean vacation
Notice bibliographique
Résumé
We cared for a 65-year-old male who was admitted to our institution with a fever of 38.3°C and rigors. His past medical history included chronic foot ulceration secondary to poorly controlled type 2 diabetes, hypertension and chronic kidney disease. Upon presentation to hospital he was febrile, tachycardic and tachypneic. His ulcers appeared unremarkable with no surrounding erythema or purulence. He had an elevated white blood cell count (18.5 × 109/l) with a neutrophilic predominance. CT imaging of the foot revealed small plantar ulcers without evidence of osteomyelitis. He was empirically treated with ceftriaxone (1 g IV daily) for consideration of streptococcal or gram-negative infections from his foot ulcers, and quickly improved. After 3 days of incubation one of two blood cultures returned positive for Shewanella algae, susceptible to ceftriaxone, ciprofloxacin, gentamicin, piperacillin, ceftazidime, meropenem and trimethoprim-sulfamethoxazole. Subsequent history revealed that the patient had been vacationing in the Barbados 3 weeks prior to presentation. He brought watertight boot designed to prevent contact between his foot ulcers and seawater, however on one occasion water entered his boot and rose above the level of his ulcers. The patient defervesced and normalized his hemodynamic parameters after 1 day of antibiotics. He was switched to oral ciprofloxacin (renally dosed at 250 mg twice daily for 7 days) after 3 days of IV ceftriaxone. He remained well with no evidence of systemic or local signs of infection at a follow-up clinic appointment 3 weeks after hospital discharge. Shewanella spp., including S. algae, are a rare but increasingly recognized infectious disease. Identified risk factors for infection with Shewanella spp. include presence of a cutaneous ulcer, exposure to marine environments, hepatobiliary disease and immunocompromised states.1–3 Bacteremia is uncommon but has been reported in association with infections of skin and soft tissue, and intra abdominal or respiratory infections.1 There is a broad spectrum of clinical illness in patients presenting with skin and soft tissue infections related to Shewanella spp., ranging from uncomplicated cellulitis, to progressive hemorrhagic bullae, skin necrosis and severe sepsis.2,4 Characteristically, S. algae is resistant to first and second generation cephalosporins and penicillin, and sensitive to carbapenems, aminoglycosides, fluoroquinolones, and third and fourth generation cephalosporins. Resistance to carbapenems has been described.5 Shewanella spp. should be included on the differential diagnosis of infections following exposure to marine environments, and travellers with skin ulcerations should be counselled to minimize direct contact of skin lesions with water.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,001 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,005 | 0,005 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».