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[Near-drowning associated Aeromonas pneumonia]
H Fouquet1, M Guimas1, S Teulier1
1Service de pneumologie et oncologie thoracique, CHU de Caen, centre régional de compétence des HTAP sévères, 14033 Caen, France.
Introduction:
Aeromonas pneumonia associated with near-drowning, though uncommon, is serious and a major morbidity factor for patients.
Clinical Case:
A healthy 30-year-old man nearly drowned in a pound. He was admitted to the medical intensive care unit and required intubation and mechanical ventilation. He was given antibiotic therapy in the form of amoxicillin/clavulanic acid. After a brief stable period post immersion, he rapidly developed fever and respiratory failure. The thoracic scan revealed bilateral alveolar infiltrates and led to a fibreoptic bronchoscopy. Aeromonas veroniiandPseudomonas aeruginosa were found on culture of the bronchial aspirate. A change of antibiotic therapy appropriate to these bacteria led to clinical improvement and allowed complete withdrawal of ventilation.
Conclusion:
Rapid respiratory deterioration following near-drowning should raise the suspicion of pulmonary infection with the bacteria usually found in the respiratory tract during ventilation but without overlooking the possibility of unusual organisms, particularly Aeromonas.It is usuallysensitive to third generation cephalosporins and fluoroquinolones. Ideally, Aeromonas should be sought in pulmonary aspirates and samples of the water where immersion occurred.
Insights
Near-drowning can lead to serious Aeromonas pneumonia, a rare but significant complication. Early suspicion and targeted antibiotics are crucial for recovery from this unusual bacterial lung infection.
Area of Science:
- Infectious Diseases
- Pulmonology
- Critical Care Medicine
Background:
- Near-drowning incidents can result in severe pulmonary complications.
- Aeromonas pneumonia, while uncommon, poses a significant morbidity risk following near-drowning events.
Observation:
- A healthy 30-year-old male developed rapid respiratory failure post-near-drowning.
- Fever and bilateral alveolar infiltrates were noted, necessitating mechanical ventilation.
- Bronchial aspirate cultures identified Aeromonas veronii and Pseudomonas aeruginosa.
Findings:
- Initial antibiotic therapy (amoxicillin/clavulanic acid) was ineffective.
- A change to antibiotics targeting Aeromonas and Pseudomonas led to clinical improvement.
- Successful withdrawal of mechanical ventilation was achieved.
Implications:
- Rapid respiratory deterioration after near-drowning warrants suspicion of pulmonary infection, including unusual organisms like Aeromonas.
- Aeromonas species are often susceptible to third-generation cephalosporins and fluoroquinolones.
- Diagnostic efforts should include pulmonary aspirates and environmental water samples for Aeromonas identification.
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