A Kiwi man who returned from the Cook Islands with fever, severe leg pain and a rapidly developing skin infection was found to have a rare bloodstream infection caused by a marine bacterium.
Doctors detailed the case in the latest edition of the New Zealand Medical Journal, describing how the 68-year-old Cook Island Māori man presented to hospital with four days of fever, swelling, blistering and redness affecting both legs.
The man was admitted to hospital with signs of sepsis, including low blood pressure and fever.
Doctors initially treated him with broad-spectrum antibiotics while they searched for the source of the infection.
The patient had recently returned to the country from the Cook Islands, where he had been staying in a coastal area on one of the outer islands while visiting family.
He said he had not been immersed in seawater or suffered a coral injury, but told doctors he had consumed raw fish during his trip.
The authors of the report believe the bacterium likely entered the man's body through his gastrointestinal tract after consuming contaminated seafood. It then spread through his bloodstream and into both legs.
"Shewanella species are found in aquatic environments and can cause skin and soft tissue infections, bloodstream infections and other serious illnesses," they said.
Documented infections of this bacterium are rare in New Zealand.
Two local cases
According to the report, only two locally acquired Shewanella infections have previously been described in New Zealand medical literature.
One involved a fisherman in the Bay of Plenty who developed cellulitis after sustaining cuts from a fishing bin, while another followed freshwater exposure in the Rotorua region.
The patient responded to antibiotic treatment and was discharged 10 days later.
However, his recovery was complicated by underlying diabetes and poor wound healing.
Later that year, he developed a severe bone infection in his left foot and ankle, ultimately requiring a below-knee amputation. Samples taken during surgery again identified Shewanella algae among the organisms present.
The authors of the report said the case was a reminder for marine bacteria to be considered in patients with severe infections after overseas travel.
They also urged clinicians not to dismiss cellulitis simply because both legs are affected, especially when a patient shows signs of serious infection.
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