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      Skin and Soft Tissue Infections (Patera Foot) in Immigrants, Spain

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          Abstract

          An unusual skin and soft tissue infection of the lower limbs has been observed in immigrants from sub-Saharan Africa who cross the Atlantic Ocean crowded on small fishing boats ( pateras). Response to conventional treatment is usually poor. Extreme extrinsic factors (including new pathogens) may contribute to the etiology of the infection and its pathogenesis.

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          Biochemical and pathogenic properties of Shewanella alga and Shewanella putrefaciens.

          S Khashe, J. Janda (1998)
          We characterized 49 strains of Shewanella spp. from clinical (n = 31) and nonhuman (n = 18) sources. Most Shewanella alga organisms (Gilardi biovar 2; Centers for Disease Control and Prevention [CDC] biotype 2) originated from clinical material (92%), failed to produce acid from carbohydrates other than D-ribose, and were biochemically and enzymatically fairly homogeneous. In contrast, Shewanella putrefaciens organisms (Gilardi biovars 1 and 3; CDC biotype 1) were more often associated with nonhuman sources (70%), were able to utilize a number of sugars (sucrose, L-arabinose, and maltose), and were found to exhibit wider variations in biochemical characteristics; three biotypes within S. putrefaciens were detected. Notable differences between the two species in enzymatic activity, determined with the API-ZYM system (bioMérieux, Hazelwood, Mo.), and cellular fatty acid profiles, determined by the MIDI system (Microbial ID Inc., Newark, Del.), were also detected. Pathogenicity studies of mice indicate that S. alga appears to be the more virulent species, possibly due to the production of a hemolytic substance.
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            Isolation and characterization of Shewanella alga from human clinical specimens and emendation of the description of S. alga Simidu et al., 1990, 335.

            T Ezaki, Y Terawaki, Y Hashimoto … (1992)
            Genetic and phenotypic studies on the strains biochemically identified as Shewanella putrefaciens, which had a G+C content ranging from 52 to 54 mol% were conducted. The moles percent G+C of the type strain of S. putrefaciens is 46. Surprisingly, DNA homology experiments revealed that all these strains are genetically related to Shewanella alga (which was reported to produce tetrodotoxin), not to the type strain of S. putrefaciens. In this study, we reidentified clinical strains of S. putrefaciens which have a high range of moles percent G+C, as does S. alga. We also characterized the reidentified strains and found that the original description of S. alga (U. Simidu, K. Kita-Tsukamoto, T. Yasumoto, and M. Yotsu, Int. J. Syst. Bacteriol. 40:331-336, 1990) is insufficient to identify this strain. An emended description of S. alga is given.
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              Skin and soft-tissue manifestations of Shewanella putrefaciens infection.

              L Wann, Albert Liu, D Cheng … (1997)
              Shewanella putrefaciens, a saprophytic gram-negative rod, is infrequently recovered from clinical specimens. Although a number of clinical syndromes have been attributed to S. putrefaciens, the pathogenic role of this agent remains largely undefined. We report 16 cases of S. putrefaciens infection that occurred at the Veterans General Hospital-Kaohsiung in Taiwan between 1990 and 1995. S. putrefaciens infection was associated with a wide clinical spectrum including bacteremia/septicemia, skin and soft-tissue infection, biliary tract infection, peritonitis, and empyema. Five of our patients had skin and soft-tissue manifestations, including fulminant periorbitofacial cellulitis, dacryocystitis, perineal abscess, finger abscess, and postcholecystectomy wound infection. These clinical features deviated from the chronic ulcers or infected burns of the lower extremities that have been described in previous reports. Seven (44%) of our 16 patients had bacteremia/septicemia, and all seven had underlying hepatobiliary diseases. S. putrefaciens was isolated in mixed cultures of specimens from 14 patients; Escherichia coli was the most common coisolate. Hepatobiliary diseases and malignancy were the major predisposing factors for S. putrefaciens infection of the biliary tract and S. putrefaciens bacteremia/septicemia.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Emerg Infect Dis
                Journal ID (publisher-id): EID
                Title: Emerging Infectious Diseases
                Publisher: Centers for Disease Control and Prevention
                ISSN (Print): 1080-6040
                ISSN (Electronic): 1080-6059
                Publication date (Print): April 2009
                Volume: 15
                Issue: 4
                Pages: 598-600
                Affiliations
                [1]Hospital Universitario of Salamanca, Salamanca, Spain (H.-G. Ternavasio-de la Vega)
                [2]Clinica Puerta de Hierro, Madrid, Spain (A. Ángel-Moreno)
                [3]Hospital Universitario Insular of Gran Canaria, Gran Canaria, Spain (M. Hernández-Cabrera, E. Pisos-Álamo, M. Bolaños-Rivero, C. Carranza-Rodriguez, A. Calderín-Ortega, J.L. Pérez-Arellano)
                [4]University of Las Palmas of Gran Canaria, Gran Canaria (M. Hernández-Cabrera, C. Carranza-Rodriguez, J.L. Pérez-Arellano)
                Author notes
                Address for correspondence: José Luis Perez Arellano, Department of Medical and Surgical Sciences, Health Sciences Faculty, University of Las Palmas of Gran Canaria, Gran Canaria, Spain 35080; email: jlperez@ 123456dcmq.ulpgc.es
                Article
                Publisher ID: 08-1457
                DOI: 10.3201/eid1504.081457
                PMC ID: 2671408
                PubMed ID: 19331742
                SO-VID: 97cd83b2-2e71-4a9f-a00f-eee811caf49b
                History
                Categories
                Subject: Dispatch

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: spain,skin and soft tissue infection,shewanella algae,dispatch,patera foot,immigrant,sub-saharan africa
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: spain, skin and soft tissue infection, shewanella algae, dispatch, patera foot, immigrant, sub-saharan africa

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