Aeromonas hydrophila is a rare human pathogen, and worldwide, soft tissue infections following water-related injuries are the most common. However, septic arthritis due to A. hydrophila remains uncommon with only seven cases previously reported in the English literature. In this report, we describe the important clinical features, microbiological findings and management of severe septic arthritis of the knee due to A. hydrophila in a healthy 13-year-old girl following an injury sustained in a private fresh water lake. A review of seven previously reported cases of septic arthritis due to A. hydrophila and the present case suggests that the infection commonly affected the knee and the meta-/intercarpal-phalangeal joint and was frequently rapidly progressive following trauma in fresh water and or associated with leukaemia. Second and third generation cephalosporins, gentamicin, trimethoprim, ciprofloxacin and appropriate orthopaedic management should be promptly instituted. After chemical treatment and chlorination, fresh water becomes free of coliforms, but A. hydrophila persists more compared with the other strains of aeromonas, namely A. sobria and A. caviae. Seawater injuries, unlike freshwater injuries, are not usually associated with aeromonas infections. Further workup on the mechanisms of A. hydrophila resistance to chlorination could probably yield useful information in achieving new procedures of preventing and controlling such infections in public and private fresh water recreational facilities.
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