Fulminant Edwardsiella tarda bacteremia following near-drowning episode in a patient without cirrhosis: A case report

Abstract

Edwardsiella tarda is a Gram-negative intracellular pathogen within the Enterobacterales order, recognized as a causative agent of hemorrhagic septicemia in fish but also pathogenic to humans. However, the clinical course and prognostic factors of E. tarda bacteremia are not fully understood. We present a case of fulminant E. tarda bacteremia in a 90-year-old Japanese man without significant immunosuppression, developing after exposure to freshwater. The patient was admitted to the intensive care unit with septic shock following an accidental fall into an irrigation ditch. Despite appropriate empiric treatment, he passed away within 18 hours of admission. Blood cultures identified E. tarda, while Aeromonas hydrophila was detected in sputum. This case highlights the rapid progression and high mortality risk associated with E. tarda bacteremia; prolonged exposure to contaminated water and delayed transport to medical care were likely contributory factors to the fatal outcome. Furthermore, the detection of waterborne pathogens like A. hydrophila in respiratory samples may serve as a clue to consider possible water exposure in diagnostic reasoning.