Erwinia aphidicola: An unusual cause of septicemia, Morocco, 2024

This case report describes a rare and potentially fatal human infection caused by Septic Shock associated with Erwinia aphidicola, a bacterium traditionally recognized as an insect and plant-associated microorganism with poorly understood pathogenicity in humans. We report the case of a 2-month-old infant admitted for severe abdominal trauma and intestinal evisceration following a dog bite. Surgical exploration revealed multiple gastrointestinal perforations and extensive intestinal necrosis requiring bowel resection and anastomosis. Despite intensive postoperative care, the patient developed persistent fever, disseminated edema, thrombocytopenia, renal failure, metabolic acidosis, and progressive hemodynamic instability. Blood cultures collected on the tenth day of hospitalization yielded Erwinia aphidicola, identified twice by MALDI-TOF mass spectrometry, while urine and bronchial cultures were positive for Candida albicans. Broad-spectrum antimicrobial therapy, including imipenem, levofloxacin, trimethoprim/sulfamethoxazole, fluconazole, and vancomycin, failed to improve the patient’s condition, which ultimately evolved to refractory septic shock and death. This report highlights the emerging opportunistic potential of Erwinia aphidicola in critically ill patients and emphasizes the importance of advanced microbiological identification techniques in recognizing rare pathogens. To our knowledge, this is the first documented case of human septicemia attributed to Erwinia aphidicola, underscoring the need for further investigation into its pathogenic mechanisms, antimicrobial susceptibility, and clinical significance in human infections.