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Pyogenic Flexor Tenosynovitis Caused by Shewanella algae.

Erin C Fluke¹, Nikoletta L Carayannopoulos¹, Ronald W Lindsey¹

¹Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX.

The Journal of Hand Surgery

|May 22, 2016

Summary

Shewanella algae, a rare bacterium, can cause severe flexor tenosynovitis, an orthopedic emergency. Prompt surgical intervention is crucial for this aggressive infection, especially after water exposure.

Keywords:

Flexor tenosynovitis Shewanella algae tendon sheath infection

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Area of Science:

Infectious Diseases
Orthopedic Surgery
Microbiology

Background:

Pyogenic flexor tenosynovitis is a common orthopedic emergency.
Staphylococcus aureus and streptococci are typical pathogens.
Mycobacterium marinum is occasionally implicated, particularly after water exposure.

Observation:

Shewanella algae, a gram-negative bacillus from warm saltwater, rarely causes severe soft tissue infections.
This case details S. algae causing complicated flexor tenosynovitis.
The infection presented rapidly with Kanavel's signs, purulence, ischemia, and necrosis.

Findings:

S. algae infection met criteria for a poor prognosis (Pang et al group III).
The condition necessitated open surgical irrigation and debridement.
The rapid progression and severity highlight the bacterium's virulence.

Implications:

Shewanella algae should be considered in flexor tenosynovitis cases linked to traumatic water exposure.
Early recognition and treatment are vital to minimize patient morbidity.
This case underscores the importance of considering unusual pathogens in infectious emergencies.