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Shewanella algae: a rare cause of necrotizing fasciitis.

BACKGROUND
The genus Shewanella consists of motile, gram-negative, facultative anaerobes found in marine environments. Shewanella putrefaciens and Shewanella algae are the two species with documented pathogenicity in human beings. Most documented cases of S. algae infection worldwide have been reported in the context of bacteremia, cellulitis, and acute exacerbations of chronic otitis media in predisposed individuals. We report a rare case of necrotizing soft tissue infection by S. algae in an immunocompetent individual. The infection followed exposure to S. algae in contaminated water in New York City, New York.


METHODS
We reviewed the English-language literature on similar cases of soft tissue infection using PubMed. Search terms included "Shewanella algae" and "Shewanella putrefaciens" in conjunction with "necrotizing" and "infection." Cognizant that this search method may not have yielded early (pre-1985) reports about Shewanella because of changes in classification and nomenclature, we also searched for "Pseudomonas putrefaciens."


RESULTS
After prompt surgical debridement and culture-directed antibiotic therapy, the patient recovered from his infection without the need for re-intervention.


CONCLUSIONS
This case may reflect the geographic spread and emergence of S. algae infection in the United States. Clinicians should be aware of the virulence of S. algae and potential for the rapid clinical deterioration of persons it infects even among immunocompetent individuals.