<i>Shewanella algae</i>bacteremia from a foot ulcer exposed to seawater during a Caribbean vacation
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.005 | 0.005 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".