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Pseudomonas oryzihabitans Cutaneous Ulceration From Octopus vulgaris Bite:  A Case Report and Review of the Literature FREE

Birgit Angela Aigner, MD; Markus Ollert, MD; Florian Seifert, MD; Johannes Ring, MD, DPhil, PhD; Sabine Gisela Pl ötz, MD, PD
[+] Author Affiliations

Author Affiliations: Dermatology Munich-Harlaching (Drs Aigner and Pl ötz) and Department of Dermatology and Allergy, Technical University Munich (Drs Ollert, Seifert, and Ring), Munich, Germany.


Arch Dermatol. 2011;147(8):963-966. doi:10.1001/archdermatol.2011.83.
Text Size: A A A
Published online

Background Octopus vulgaris is a common marine animal that can be found in nearly all tropical and semitropical waters around the world. It is a peaceful sea dweller with a parrotlike beak, and its primary defense is to hide through camouflaging adjustments. Bites from animals of the class Cephalopoda are very rare. We describe a boy who was bitten on his forearm by an Octopus vulgaris.

Observation A 9 -year-old boy was bitten by an Octopus vulgaris while snorkeling. There was no strong bleeding or systemic symptoms; however, 2 days later, a cherry-sized, black, ulcerous lesion developed, surrounded by a red circle that did not heal over months and therefore had to be excised. Histologic examination showed ulceration with extensive necrosis of the dermis and the epidermis. A microbial smear revealed Pseudomonas (formerly known as Flavimonas) oryzihabitans. After excision, the wound healed within 2 weeks, without any complications or signs of infection.

Conclusions To the best of our knowledge, this case represents the first report of an Octopus vulgaris bite resulting in an ulcerative lesion with slow wound healing owing to P oryzihabitans infection. We recommend greater vigilance regarding bacterial contamination when treating skin lesions caused by marine animals.

Figures in this Article

Octopus vulgaris is a marine animal of the order Octopoda and part of the class Cephalopoda, which means “head foot. ” This class also includes calamari and cuttlefish.1,2 The term octopus originates from the Greek word oktapous, which means “eight-footed. ” Octopus vulgaris is a common sea dweller that can be found in nearly all tropical and semitropical waters around the world, including the Mediterranean Sea. The common octopus is a mollusk; its body consists of an enormous head and 4 pairs of arms with 2 rows of suction cups. Its arms are symmetrically situated along the length of its body, enabling it to move very agilely and quickly in water. It has a radula and a very small parrotlike beak at the center point of its arms. It is an intelligent peaceful marine animal and normally a loner. If the octopus feels threatened, it squirts ink —with melanin as the main coloring agent —to obscure its attacker's view, giving it time to swim away. Also, the ink contains a substance that dulls the attacker's sense of smell, making it harder to track the fleeing octopus and thus further hindering pursuit. The primary defense of the octopus is to hide in plain view through camouflaging adjustments in posture, texture, and color. Most octopuses have a span of about 60 cm. However, the biggest known octopus, Enteroctopus dofleini, can have a diameter as large as 7 m.1,2

Most lesions caused by marine animals are harmless, but a variety of marine animals can cause significant injuries, to the point of death.3,4 Bites from animals of the class Cephalopoda are very rare.5 There have been single reports of octopus bites resulting in cutaneous ulceration,6 severe systemic reactions due to envenomation,7,8 and giant cell –rich granulomatous dermatitis/panniculitis.9 Wounds in healthy people normally heal within days. To the best of our knowledge, the present report is the first of an O vulgaris bite resulting in a chronic skin ulcer that did not heal for months, probably as a result of infection with Pseudomonas (formerly known as Flavimonas) oryzihabitans.

A 9 -year-old white boy was snorkeling and fishing in the Adriatic Sea in Croatia in August 2010. His uncle, a skilled fisherman, had been living in Croatia for many years and was therefore well informed about marine life in the region and its risks. One day, the boy's uncle was swimming in the sea, with an octopus sitting on his shoulder. The boy got very excited and grabbed the octopus (Figure 1). Presumably, the octopus felt threatened, so it squirted its ink and bit the boy's right forearm with its parrotlike beak. It immediately swam away. At the time, the boy did not experience pain, and the wound was not bleeding strongly. It was never itchy, purulent, or weeping. The boy did not feel nauseous or have to vomit, and he showed no systemic reactions. No medical treatment was required. Two days later, the boy noticed a cherry-sized, red, erythematous wound with a hemorrhagic nodus in the center. His uncle identified the animal as an O vulgaris with a length of approximately 30 cm.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 1. Patient grabbing an Octopus vulgaris ; this photograph was coincidentally taken at the moment of the described bite.

In September 2010, the boy presented with a badly healing wound on his right forearm. The wound was a the size of a cherry and had a black, seemingly necrotic, ulcerous zone in the center, surrounded by bright-red erythema (Figure 2). The boy had no pain, and his arm was not swollen or rough, yet the ulcer showed no tendency to heal. His blood cell count was normal, and routine serum testing, including measurement of liver enzyme levels, revealed no abnormalities. Antitetanic prophylaxis was administered. The skin lesion was treated topically with betamethasone, fusidic acid, and retapamulin. During the following week, the erythema faded slightly, but the black central lesion remained, which was suggestive of other possible causal factors. The patient was otherwise in good health, with no other medical history or history of immunosuppression, and took no medication. Neither a thorough personal history nor a family history revealed any wound-healing deficits. After 8 weeks, we decided to excise the tissue.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 2. Cutaneous ulceration in a 9-year-old patient with a wound-healing deficiency after an octopus bite.

A microscopic examination of the wound smear yielded no pathologic finding. However, P oryzihabitans, a gram-negative, aerobic, facultative pathogenic organism, was found in the bacteriologic culture. No other organisms, including anaerobic bacteria, were found. Therefore, we performed an assessment of antibiotic sensitivity for P oryzihabitans, which revealed a resistance to aztreonam but a sensitivity to piperacillin, cefepime, ciprofloxacin, tobramycin, amikacin, imipenem, and ceftazidime.

Microscopic examination of the excised material showed circumscribed ulceration and extensive necrosis of the upper connective tissue layer (Figure 3). The adjoining connective tissue and subcutaneous tissue displayed a dense perivascular and interstitial lymphohistocytic inflammatory response with numerous eosinophil granulocytes. Moreover, multiple multinuclear foreign body cells with foamy cytoplasm were found in the subcutaneous tissue. After excision, the wound healed within 2 weeks without any complications or signs of infection, and no further systemic antibiotic therapy was needed. At the patient's latest follow-up visit, 4 months after the excision, the wound had healed completely and was free of infection.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 3. Histologic specimen shows extensive necrosis of the epidermis and upper connective tissue layer (hematoxylin-eosin, original magnification   ×  10).

To the best of our knowledge, the present report describes the first case of a bite by an O vulgaris that resulted in an ulcerous cutaneous lesion with wound-healing deficiency apparently due to P oryzihabitans infection. Although bites from class Cephalopoda animals are rare, occasional cases of octopus bites were reported in the early 1960s.10

In 1998, Burnett11 published a review of cases involving human injuries caused by octopuses. Most species of octopuses cause only mild reactions, such as swelling or redness.11 However, bites by the blue-ringed octopus (Hapalochlaena maculosa)8 have been known to lead to severe systemic or even fatal reactions.7,9,11,12 Its saliva contains a neuromuscular toxin that can be released through its powerful beak13 and can produce respiratory arrest within minutes. Other symptoms are vomiting, muscle weakness, speech difficulties, visual disturbances, hypotension, and bradycardia.8,14 The only animal known to survive the effects of this toxin is the octopus itself, but not every bite results in intoxication.15

In 2002, Taylor et al5 reported on injuries caused by marine animals in Australia. The injuries occurred predominantly after contact with jellyfish. Bites by cephalopods, such as the octopus, were very rare; spikes, spines, and barbs of other marine animals represented the majority of injury cases. Misago et al9 described a man who presented with a giant cell –rich granulomatous dermatitis/panniculitis after an octopus bite. Their patient had granuloma anulare –like lesions and small numerous papules on his limbs as a delayed reaction to the bite. Granuloma anulare had already been described after an octopus bite in 1986.16 Furthermore, superficial granulomas have also been reported to occur through coral injury.17

In 2008, Campanelli et al6 reported on a cutaneous ulceration that developed after an octopus bite that was caused by Vibrio alginolyticus, an anerobic, gram-negative bacillus. Vibrio alginolyticus was previously believed to be nonpathogenic in humans, but the patient who was bitten by the octopus showed a wound-healing deficit that was triggered by this bacillus. Campanelli and colleagues recommended greater vigilance for V alginolyticus as a cause of skin infections, especially in immunocompromised patients.6Vibrio is a common genus that can be found in wounds acquired from marine animals.13

Our intraoperative sampling confirmed a bacillus (P oryzihabitans), and antibiotic sensitivity was assessed. Pseudomonas is a genus of gram-negative, aerobic bacteria18,19; many Pseudomonas species are noted for their fluorescent pigment and often show resistance to disinfectants and antibiotics. Pseudomonasoryzihabitans is believed to be a saprophyte of humans and various warm-blooded animals,20,21 in which it may be pathogenic21; it has been isolated from rice paddy and clinical specimens.22 Notably, it also has been detected in marine organisms and is known to survive in water.21

Pseudomonas oryzihabitans has been called a potential nosocomial pathogen in recent years; however, a report on community-acquired soft-tissue infections due to Flavimonas oryzihabitans had already appeared in 1994.23 Still, reports of this bacillus being pathogenic in humans are rare23,24; P oryzihabitans has most often been reported in immunocompromised hosts,25 and the infections due to P oryzihabitans usually occur in cases involving catheters,26 peritoneal dialysis, bacteremia,18 or even sepsis.27 The presence of a foreign body and previous trauma or surgery predispose patients to contamination by Poryzihabitans.27 We believe that the superinfection by P oryzihabitans was the cause for the wound-healing deficit in our patient, especially as the histologic examination revealed severe ulceration and extensive necrosis. Marine animals may act as reservoirs and vectors for pathogens that are potentially harmful to humans. Every wound that occurs in the marine environment can become infected.13 The presence of an infection is a medical indication for debridement as well as for antibiotic therapy if necessary. Tetanus vaccination should be renewed if it is not current.13

In conclusion, we recommend greater vigilance regarding bacterial contamination by P oryzihabitans when treating skin lesions due to marine animals.

Correspondence: Sabine Gisela Pl ötz, MD, PD, Dermatology Munich-Harlaching, Gr ünwalderstrasse 248, D-81545 Munich, Germany (hautarzt@aerztehaus-harlaching.de).

Accepted for Publication: February 22, 2011.

Published Online: April 11, 2011. doi:10.1001/archdermatol.2011.83

Author Contributions: All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Aigner and Pl ötz. Acquisition of data: Aigner, Seifert, and Pl ötz. Analysis and interpretation of data: Aigner, Ollert, Ring, and Pl ötz. Drafting of the manuscript: Aigner, Seifert, and Pl ötz. Critical revision of the manuscript for important intellectual content: Ollert, Ring, and Pl ötz. Administrative, technical, and material support: Aigner and Seifert. Study supervision: Ollert, Ring, and Pl ötz.

Financial Disclosure: None reported.

Boyle P, Rodhouse P. Cephalopods. Oxford, England: Wiley-Blackwell; 2005
Norman M. Cephalopods: A World Guide. Hackenheim, Germany: ConchBooks; 2000
Williamson J, Fenner P, Burnett J. The injuries, their incidence and the toxins that produce them. In: Williamson J, Fenner P, Burnett J, Rifkin J, eds. Venomous and Poisonous Marine Animals. Sydney, Australia: University of New South Wales Press; 1996:329-334
Angelini G, Bonamonte D. Aquatic Dermatology. New York, NY: Springer-Verlag NY Inc; 2001
Taylor DM, Ashby K, Winkel KD. An analysis of marine animal injuries presenting to emergency departments in Victoria, Australia.  Wilderness Environ Med. 2002;13(2):106-112
PubMed
Campanelli A, Sanchez-Politta S, Saurat JH. Cutaneous ulceration after an octopus bite: infection due to Vibrio alginolyticus, an emerging pathogen.  Ann Dermatol Venereol. 2008;135(3):225-227
PubMed
Brazzelli V, Baldini F, Nolli G, Borghini F, Borroni G. Octopus apollyon bite.  Contact Dermatitis. 1999;40(3):169-170
PubMed
Cavazzoni E, Lister B, Sargent P, Schibler A. Blue-ringed octopus (Hapalochlaena sp.) envenomation of a 4-year-old boy: a case report.  Clin Toxicol (Phila). 2008;46(8):760-761
PubMed
Misago N, Inoue T, Narisawa Y. Delayed reaction after an octopus bite showing a giant cell –rich granulomatous dermatitis/panniculitis.  J Cutan Pathol. 2008;35(11):1068-1072
PubMed
Lane WR, Sutherland SK. The ringed octopus bite: a unique medical emergency.  Med J Aust. 1967;2(18):475-476
Burnett JW. Aquatic adversaries: human injuries induced by octopi.  Cutis. 1998;62(3):124
PubMed
Williamson JA. The blue-ringed octopus bite and envenomation syndrome.  Clin Dermatol. 1987;5(3):127-133
PubMed
Auerbach PS. Marine envenomations.  N Engl J Med. 1991;325(7):486-493
PubMed
Flecker H, Cotton BC. Fatal bite from octopus.  Med J Aust. 1955;42(9):329-331
PubMed
Sutherland SK. Australian Animal Toxins: The Creatures, Their Toxins, and the Care of the Poisoned Patient. New York, NY: Oxford University Press Inc; 1983
Fulghum DD. Octopus bite resulting in granuloma annulare.  South Med J. 1986;79(11):1434-1436
PubMed
Miracco C, Lalinga AV, Sbano P, Rubegni P, Romano C. Delayed skin reaction to Red Sea coral injury showing superficial granulomas and atypical CD30+ lymphocytes: report of a case.  Br J Dermatol. 2001;145(5):849-851
PubMed
Verhasselt B, Claeys G, Elaichouni A, Verschraegen G, Laureys G, Vaneechoutte M. Case of recurrent Flavimonas oryzihabitans bacteremia associated with an implanted central venous catheter (Port-A-Cath): assessment of clonality by arbitrarily primed PCR.  J Clin Microbiol. 1995;33(11):3047-3048
PubMed
Hawkins RE, Moriarty RA, Lewis DE, Oldfield EC. Serious infections involving the CDC group Ve bacteria Chryseomonas luteola and Flavimonas oryzihabitans Rev Infect Dis. 1991;13(2):257-260
PubMed
Giacometti A, Cirioni O, Quarta M, Schimizzi AM, Del Prete MS, Scalise G. Unusual clinical presentation of infection due to Flavimonas oryzihabitans Eur J Clin Microbiol Infect Dis. 1998;17(9):645-648
PubMed
Molinari LM, de Oliveira Scoaris D, Bocchi Pedroso R,  et al.  Bacterial microflora in the gastrointestinal tract of Nile tilapia, Oreochromis niloticus, cultured in a semi-intensive system.   Acta Sci Biol Sci. 2003;25(2):267-271
Kodama K, Kimura N, Komagata K. Two new species of Pseudomonas: P. oryzihabitans isolated from rice paddy and clinical specimens and P. Luteola isolated from clinical specimens.  Int J Syst Bacteriol. 1985;35:467-474
Lam S, Isenberg HD, Edwards B, Hilton E. Community-acquired soft-tissue infections caused by Flavimonas oryzihabitans [published correction appears in Clin Infect Dis. 1995;20(4):1085].  Clin Infect Dis. 1994;18(5):808-809
PubMed
Lin RD, Hsueh PR, Chang JC,  et al.  Flavimonas oryzihabitans bacteremia: clinical features and microbiological characteristics of isolates.  Clin Infect Dis. 1997;24(5):867-873
PubMed
Decker CF, Simon GL, Keiser JF. Flavimonas oryzihabitans (Pseudomonas oryzihabitans ; CDC group Ve-2) bacteremia in the immunocompromised host.  Arch Intern Med. 1991;151(3):603-604
PubMed
Mar ín M, Garc ía de Viedma D, Mart ín-Rabad án P, Rodr íguez-Cr éixems M, Bouza E. Infection of hickman catheter by Pseudomonas (formerly Flavimonas) oryzihabitans traced to a synthetic bath sponge.  J Clin Microbiol. 2000;38(12):4577-4579
PubMed
Lucas KG, Kiehn TE, Sobeck KA, Armstrong D, Brown AE. Sepsis caused by Flavimonas oryzihabitans Medicine (Baltimore). 1994;73(4):209-214
PubMed

Figures

Place holder to copy figure label and caption
Graphic Jump Location

Figure 1. Patient grabbing an Octopus vulgaris ; this photograph was coincidentally taken at the moment of the described bite.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 2. Cutaneous ulceration in a 9-year-old patient with a wound-healing deficiency after an octopus bite.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 3. Histologic specimen shows extensive necrosis of the epidermis and upper connective tissue layer (hematoxylin-eosin, original magnification   ×  10).

Tables

References

Boyle P, Rodhouse P. Cephalopods. Oxford, England: Wiley-Blackwell; 2005
Norman M. Cephalopods: A World Guide. Hackenheim, Germany: ConchBooks; 2000
Williamson J, Fenner P, Burnett J. The injuries, their incidence and the toxins that produce them. In: Williamson J, Fenner P, Burnett J, Rifkin J, eds. Venomous and Poisonous Marine Animals. Sydney, Australia: University of New South Wales Press; 1996:329-334
Angelini G, Bonamonte D. Aquatic Dermatology. New York, NY: Springer-Verlag NY Inc; 2001
Taylor DM, Ashby K, Winkel KD. An analysis of marine animal injuries presenting to emergency departments in Victoria, Australia.  Wilderness Environ Med. 2002;13(2):106-112
PubMed
Campanelli A, Sanchez-Politta S, Saurat JH. Cutaneous ulceration after an octopus bite: infection due to Vibrio alginolyticus, an emerging pathogen.  Ann Dermatol Venereol. 2008;135(3):225-227
PubMed
Brazzelli V, Baldini F, Nolli G, Borghini F, Borroni G. Octopus apollyon bite.  Contact Dermatitis. 1999;40(3):169-170
PubMed
Cavazzoni E, Lister B, Sargent P, Schibler A. Blue-ringed octopus (Hapalochlaena sp.) envenomation of a 4-year-old boy: a case report.  Clin Toxicol (Phila). 2008;46(8):760-761
PubMed
Misago N, Inoue T, Narisawa Y. Delayed reaction after an octopus bite showing a giant cell –rich granulomatous dermatitis/panniculitis.  J Cutan Pathol. 2008;35(11):1068-1072
PubMed
Lane WR, Sutherland SK. The ringed octopus bite: a unique medical emergency.  Med J Aust. 1967;2(18):475-476
Burnett JW. Aquatic adversaries: human injuries induced by octopi.  Cutis. 1998;62(3):124
PubMed
Williamson JA. The blue-ringed octopus bite and envenomation syndrome.  Clin Dermatol. 1987;5(3):127-133
PubMed
Auerbach PS. Marine envenomations.  N Engl J Med. 1991;325(7):486-493
PubMed
Flecker H, Cotton BC. Fatal bite from octopus.  Med J Aust. 1955;42(9):329-331
PubMed
Sutherland SK. Australian Animal Toxins: The Creatures, Their Toxins, and the Care of the Poisoned Patient. New York, NY: Oxford University Press Inc; 1983
Fulghum DD. Octopus bite resulting in granuloma annulare.  South Med J. 1986;79(11):1434-1436
PubMed
Miracco C, Lalinga AV, Sbano P, Rubegni P, Romano C. Delayed skin reaction to Red Sea coral injury showing superficial granulomas and atypical CD30+ lymphocytes: report of a case.  Br J Dermatol. 2001;145(5):849-851
PubMed
Verhasselt B, Claeys G, Elaichouni A, Verschraegen G, Laureys G, Vaneechoutte M. Case of recurrent Flavimonas oryzihabitans bacteremia associated with an implanted central venous catheter (Port-A-Cath): assessment of clonality by arbitrarily primed PCR.  J Clin Microbiol. 1995;33(11):3047-3048
PubMed
Hawkins RE, Moriarty RA, Lewis DE, Oldfield EC. Serious infections involving the CDC group Ve bacteria Chryseomonas luteola and Flavimonas oryzihabitans Rev Infect Dis. 1991;13(2):257-260
PubMed
Giacometti A, Cirioni O, Quarta M, Schimizzi AM, Del Prete MS, Scalise G. Unusual clinical presentation of infection due to Flavimonas oryzihabitans Eur J Clin Microbiol Infect Dis. 1998;17(9):645-648
PubMed
Molinari LM, de Oliveira Scoaris D, Bocchi Pedroso R,  et al.  Bacterial microflora in the gastrointestinal tract of Nile tilapia, Oreochromis niloticus, cultured in a semi-intensive system.   Acta Sci Biol Sci. 2003;25(2):267-271
Kodama K, Kimura N, Komagata K. Two new species of Pseudomonas: P. oryzihabitans isolated from rice paddy and clinical specimens and P. Luteola isolated from clinical specimens.  Int J Syst Bacteriol. 1985;35:467-474
Lam S, Isenberg HD, Edwards B, Hilton E. Community-acquired soft-tissue infections caused by Flavimonas oryzihabitans [published correction appears in Clin Infect Dis. 1995;20(4):1085].  Clin Infect Dis. 1994;18(5):808-809
PubMed
Lin RD, Hsueh PR, Chang JC,  et al.  Flavimonas oryzihabitans bacteremia: clinical features and microbiological characteristics of isolates.  Clin Infect Dis. 1997;24(5):867-873
PubMed
Decker CF, Simon GL, Keiser JF. Flavimonas oryzihabitans (Pseudomonas oryzihabitans ; CDC group Ve-2) bacteremia in the immunocompromised host.  Arch Intern Med. 1991;151(3):603-604
PubMed
Mar ín M, Garc ía de Viedma D, Mart ín-Rabad án P, Rodr íguez-Cr éixems M, Bouza E. Infection of hickman catheter by Pseudomonas (formerly Flavimonas) oryzihabitans traced to a synthetic bath sponge.  J Clin Microbiol. 2000;38(12):4577-4579
PubMed
Lucas KG, Kiehn TE, Sobeck KA, Armstrong D, Brown AE. Sepsis caused by Flavimonas oryzihabitans Medicine (Baltimore). 1994;73(4):209-214
PubMed

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