Background: Aeromonas hydrophila, a Gram-negative, motile, facultative anaerobe, is emerging as a serious pathogen. It is found in water, soil, and food, causing various infections, from mild diarrhoea to life-threatening sepsis. Young children, older people, and immunocompromised people are most susceptible. While treatable with antibiotics, A. hydrophila’s growing resistance to penicillin and other commonly available antibiotics complicates treatment. This case report highlights a rare instance of A. hydrophila sepsis in a young child in rural Gambia.

Case summary: A 6-month-old African female child with high fever, cough, fast breathing, and vomiting was diagnosed with septicemia caused by Aeromonas hydrophila, a waterborne bacteria. The infant likely contracted the infection from contaminated fish or water. We started the child on the initial first-line empirical antibiotics but later switched to ceftriaxone due to antibiotic resistance, and the child recovered fully. This case highlights the importance of appropriate diagnosis, antibiotic susceptibility and surveillance of emerging antibiotic-resistant pathogens in young children.

Conclusion: This report describes the infection of emerging antibiotic-resistant A. hydrophila sepsis in an African female child. A. hydrophila is an emerging pathogen causing opportunistic infections in both immunocompetent and immunocompromised patients. This study suggests that prompt identification of bacterial pathogens, coupled with targeted antimicrobial therapy guided by local antibiogram data and blood culture for antibiotic susceptibility, is likely a crucial factor for optimal patient outcomes. Furthermore, we advocate for more comprehensive surveillance systems to effectively track and monitor these emerging antibiotic-resistant pathogens.