49 EDWARDSIELLA TARDA LIVER ABSCESSES Malaysian J Pathol 2006; 28 : 49 – 53 CASE REPORT Edwardsiella tarda septicemia with underlying multiple liver abscesses RM Yousuf MD, SH How M Med, M Amran M Amran M Radiology, KT Hla FRCS (Ed), A Shah MSc, and A Francis* MSc (Microbiology) Department of Internal Medicine, Kulliyyah of Medicine, International Islamic University Malaysia and *Department of Microbiology, Hospital Tengku Ampuan Afzan Kuantan. Abstract Edwardsiella tarda has recently been described as a member of the family Enterobacteriaceae. The genus Edwardsiella contains three species; E. hoshinae, E. ictaluri and E. tarda. Edwardsiella tarda is the only species which has been recognised as pathogenic to humans, especially in those with an underlying disease. The most common presentation is watery diarrhoea. Extra intestinal infections have been reported infrequently. Humans seem to be infected or colonised with Edwardsiella through ingestion or inoculation of a wound. This report is of a patient with multiple liver abscesses due to E. tarda who later developed bacterial peritonitis and septicaemic shock. Key words: Edwardsiella tarda, liver abscesses INTRODUCTION The genus Edwardsiella was frst described by Ewing in 1965 and consisted of a single species, Edwardsiella tarda, until 1980-1981 when two other species, Edwardsiella hoshinae and Edwardsiella ictaluri, were added to the genus. E. tarda is the most common of the three, and is the only species which has recently been implicated in human disease. The organism is widely distributed in nature. It is common in tropical and subtropical environments and appears to be spread by contact with infected marine life, including ornamental fsh and turtles, or by eating raw fsh. 1 E. tarda is an oxidase-negative, catalase- positive, facultative, anaerobic, motile, Gram- negative bacillus. Certain biochemical properties are useful in distinguishing E. tarda from other Enterobacteriaceae such as Salmonella and Proteus species. The non-lactose fermenting colonies of E. tarda produce hydrogen sulphide and indole but do not produce D-manitol, urease, oxidase and D-sorbital. E. tarda causes illness in both humans and animals. The asymptomatic carrier state is rare but documented. 2 Humans are regarded as an occasional host, and are prone to suffer from serious disease. E. tarda most frequently causes gastroenteritis with acute watery diarrhoea 3 , but dysentery-like presentations also occur. 4 We recently encountered a case of multiple liver abscesses complicated by peritonitis due to E. tarda infection without any predisposing illness. CASE REPORT A 27-year-old Indonesian male presented at the Accident and Emergency Department of the Hospital Tengku Ampuan Afzan, Kuantan, Pahang with a two-week history of fever, chills and rigors associated with right upper abdominal pain. The fever was intermittent and was associated with generalised body weakness. He had about four to fve loose stools/day alternating with constipation but gave no history of vomiting or yellow discoloration of the eyes. He was admitted to the hospital for further investigation. He did not have any history of chronic illnesses like liver disease, diabetes mellitus or renal problems. No other co-worker living in the immediate environment suffered from a similar illness. On examination, he looked ill and was drowsy and febrile, with a temperature of 37.8 0 C, pulse Address for correspondence and reprint requests: R M Yousuf, MD, Kulliyyah of Medicine, Department of Internal Medicine, International Islamic University Malaysia. P.O. Box 141, 27510 Kuantan, Pahang, Malaysia. Phone (O): 09-5132797; E mail: drmyrathor@yahoo.com; Fax: (609) 5133615.