We report a severe and poorly documented infection resulting from a Tayassu pecari bite, a wild mammal from the Amazon. A 65-year-old previously healthy man suffered a deep laceration on the right leg during rural activity and did not seek immediate care. Five days later, he developed intense pain, tense edema, expanding erythema, hemorrhagic bullae, and purulent exudate. He was admitted with systemic inflammatory status, leukocytosis of 26,290/µL, C-reactive protein (CRP) 553 mg/L, and mildly elevated CK. Rabies prophylaxis was initiated with heterologous serum and vaccine, tetanus booster, and antibiotic therapy with ceftriaxone plus clindamycin. In the first 96 hours, there was progression of cutaneous necrosis, risk of compartment syndrome, and persistence of inflammatory markers, characterizing therapeutic failure. Therapy was escalated to piperacillin-tazobactam and vancomycin. Two pairs of blood cultures and a deep secretion sample were collected, and ultrasound and Doppler were performed, revealing subfascial collections and imminent vascular compromise. Vascular surgery performed complete fasciotomy, aggressive debridement, and vacuum-assisted drainage, repeating debridements on days 8 and 12. The initial intraoperative culture showed no growth, hindering antimicrobial targeting and reinforcing the need for broad empiric coverage against gram-negative agents, anaerobes, and resistant staphylococci. Rabies prophylaxis with vaccine was maintained on days 0, 3, 7, 14, and 28. By day 17, the patient had CRP 6.08 mg/L, normal leukogram, no sepsis, and preserved motor function, with assisted ambulation and discharge after definitive closure of tissue planes. This report highlights the aggressiveness of infections associated with wild fauna, the limitation of negative cultures for etiologic definition, the importance of early surgery to save the limb, and the need for comprehensive zoonotic prophylaxis in scenarios of human expansion into natural habitats.
Perondi et al. (Sun,) studied this question.