Vibrio vulnificus septicemia

We report a case of Vibrio vulnificus infection in a middle-aged alcoholic man with Laennec's cirrhosis. The patient had recently received a puncture wound from the shell of a shrimp while fishing in the Gulf of Mexico. He presented with acrally distributed urticarial plaques, purpura, and bullae, as well as signs and symptoms of septic shock. Vibrio vulnificus was isolated from the blood, and histologic examination of the skin biopsy specimen demonstrated a devitalized, inflammatory, cell-poor superficial dermis and an acute cellulitis of the subcutis, with extensive tissue destruction. In addition, a necrotizing vasculitis, with a relative paucity of inflammatory cells but numerous bacilli around dermal vessels, was noted.     

Prognostic factors and antibiotics in Vibrio vulnificus septicemia

BACKGROUND: Immunocompromised patients with Vibrio vulnificus septicemia are at high risk for fatality. When a hemorrhagic bullous necrotic cutaneous lesion (HBNCL) and decreased blood pressure develop, approximately 50% of V vulnificus septicemic patients die within 48 hours. This study aimed to evaluate the risk factor(s) for fatality among patients with V vulnificus septicemia, emphasizing the role of prescribed antimicrobial agents in general and the therapeutic efficacy of the combination of a third-generation cephalosporin and tetracycline or its analogue in particular. METHODS: Patients with the diagnosis of V vulnificus infection admitted to 5 large medical centers in Taiwan between 1995 and 2003 were included in this retrospective study. Patients were divided into 2 groups: those without [corrected] HBNCLs (group 1) [corrected] and those with [corrected] HBNCLs (group 2) [corrected]Patients were further divided into subgoups with [corrected] fatalities (fatal subgroup) and those without fatalities (nonfatal subgroup). RESULTS: A total of 93 patients participated in the study. In group 1, the fatal subgroup had higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (P = .006) and a higher proportion of shock at arrival at the medical center (P = .015) than the nonfatal subgroup. In group 2, the effect of a first- or second-generation cephalosporin plus an aminoglycoside was negative (P = .01) and that of combined third-generation cephalosporin and tetracycline or its analogue was positive (P<.001); significant differences were found between the fatal and nonfatal subgroups in the APACHE II score (P<.001), number who were in shock at arrival at the medical center (P = .02), delayed surgical intervention (P = .03), and peripheral leukocytosis (P = .03). Shock at arrival at the medical center (odds ratio [OR], 19.25; 95% confidence interval [CI], 1.768-209.54; P = .02) was an independent risk factor for fatality in patients without HBNCLs. Use of a third-generation cephalosporin and tetracycline or its analogue significantly reduced fatality rates in patients with HBNCLs (OR, 0.037; 95% CI, 0.007-0.192; P<.001). CONCLUSION: Septic shock is a determinant of fatality in patients with V vulnificus septicemia without HBNCLs; our data suggest that the combination of a third-generation cephalosporin and tetracycline or its analogue may be a better choice in antimicrobial treatment of V vulnificus septicemic patients with HBNCLs.     

An autopsied case of septicemia due to Vibrio vulnificus

A 63-year-old male with liver cirrhosis due to type-C hepatitis virus was admitted on June 14, 1999 to our hospital with complaints of dyspnea, and blisters, swelling and purpuras on his legs. He had consumed raw fish one or two days before. He was already in a state of shock with sepsis and disseminated intravascular coagulation shortly after the admission. Although treatment with MEPM and MINO for sepsis, and daltepalin sodium, antithrombin III and gabexate mesilate for disseminated intravascular coagulation was begun within 12 hours, he died only 30 hours after admission. The causative organism was detected from the blood and the contents of blisters, and was determined as Vibrio vulnificus. On autopsy, Vibrio vulnificus was also detected from skin and muscular tissue of his legs, but necrotizing fasciitis were not apparently revealed. Coagulating necrosis and acute tubular necrosis were verified in intestine and kidneys respectively probably due to ischemic changes. Pseudolobuli were formed and a small hepatocellular carcinoma was detected in the liver. Vibrio vulnificus has two infection channels; one is oral intake and the other is an external wound. The former is said to become serious. It has a rather short period from the starting of the symptom to death, and is highly fatal. If this bacteria is suspected by the clinical coarse of the patients or the laboratory examinations, it is necessary to dose effective antibiotics in its early stage. And for prevention, susceptible patients must be informed of the existence of this disease and the necessity of adequately heating raw seafood.     

Hemochromatosis, iron and septicemia caused by Vibrio vulnificus

Vibrio vulnificus is killed by normal human blood but grows rapidly in blood from patients with hemochromatosis. It also grows in normal blood if the saturation of the transferrin is increased or if hematin, which contains iron, is added. It is suggested that the increased availability of iron in the blood of patients with chronic iron overload is responsible for their enhanced susceptibility to infection with V vulnificus.     

Identification of Vibrio vulnificus from patients with otitis media and septicemia by PCR method

Sucrose-negative colonies were isolated on TCBS agar plate from otorrhea specimens from otitis media patient in the Adult Diseases Examination Center, Hirosaki Medical Association. The isolate was identified as Vibrio vulnificus by nested PCR method which amplify V. vulnificus-specific sequences directed against 23S rRNA genes. The PCR method was applied to identify 6 strains originally isolated from septicemia patients in Kurashiki Central Hospital and formerly identified as V. vulnificus by phenotypic characteristics. When examined by the API20E system, the above PCR confirmed-V. vulnificus isolates were correctly identified as V. vulnificus with % ID 99.8, though this gave 3 different profiles. Cytotoxin-hemolysin gene was detected in otorrhea strain as well as septicemia strains by PCR method. The above results suggest that PCR method targeted cytotoxin-hemolysin gene is suitable for rapid and accurate identification of the isolate, because the result is obtained in less than 4 h. To our knowledge this is the first report on the V. vulnificus infection in Aomori Prefecture and the isolation from otorrhea.     

Vibrio vulnificus infection

We report 3 cases of Vibrio vulnificus infections from Taiwan. Patient 1, who manifested symptoms of primary septicemia, died after 2 days. Patient 2, who had a wound infection and signs and symptoms of sepsis but negative blood cultures, responded to tobramycin and chloramphenicol plus surgical debridement, and recovered after 26 days of hospitalization. Patient 3 had secondary septicemia originating from a wound inflicted by a shrimp. Originally, the patient seemed to respond to ceftazidime and amikacin treatment along with surgical debridement, but subsequently died from adult respiratory distress syndrome (ARDS) induced by several episodes of aspiration which occurred after initial clinical improvements. We conclude that, for patients with severe wounds and evidence of V. vulnificus infection, an appropriate, powerful antibiotic, such as one of the third generation cephalosporins should be used as initial therapy unless the nature of the infection indicates other treatment.     

A case of a sudden death from Vibrio vulnificus septicemia in a patient with liver cirrhosis

A 46-year-old male patient with alcoholic cirrhosis of the liver was carried to our out-patient clinic as he had developed shock while under routine follow-up, and died on the way to the hospital. He had been admitted several times since the diagnosis eight years ago, and was finally discharged from the hospital six weeks ago with improved physical condition and laboratory findings. A vesicle and bulla formation with phlegmon on the skin of right leg and sole of foot was noticed. Vibrio vulnificus was detected from the purulent discharge of the skin on culture. We conclude that the patient developed V. vulnificus-septicemia which resulted in sudden death. Since V. vulnificus infection may frequently take a fulminant course in patients with liver cirrhosis, adequate measures should be taken for early diagnosis and treatment to prevent the fatal outcome.     

Vibrio vulnificus septicemia. Isolation of organism from stool and demonstration of antibodies by indirect immunofluorescence

Vibrio vulnificus was isolated from blood and stool cultures from a 65-year-old man who had underlying alcoholic liver disease. The patient had eaten raw oysters the day before he became ill. To our knowledge, this is the first published report of isolation of the organism from stool in a patient with primary septicemia, and it provides support for epidemiologic studies suggesting that the infection is acquired through the gastrointestinal tract by eating raw seafood containing the organism. It was also possible, in this case, to demonstrate the presence of high antibody titers to the blood isolate by indirect immunofluorescence but not by agglutinating or vibriocidal tests.     

A case of septicemia type Vibrio vulnificus infection with necrotizing fasciitis rescued by lower extremity amputation]

We report a case of septicemia type Vibrio vulnificus infection. The patient was a 74-year-old man who had liver cirrhosis and hepatocelluler carcinoma. He felt a pain in the right femoral lesion after eating raw shellfish (Japanese "Umitake") two days ago. He was admitted to our emergency center due to his shock status and thrombocytopenia two days after the onset. We diagnosed necrotizing fasciitis due to Vibrio vulnificus infection, his life was saved by emergency amputation of the right lower extremity. The culture of the blood and vesicle fluid showed Vibrio vulnificus. There are some reports that the debridement was effective to necrotizing fasciitis due to Vibrio vulnificus infection, but these reports are all about single upper extremity lesion. As far as we know, this is the second report of lower extremity necrotiaong fasciitis due to septicemia type Vibrio vulnificus infection rescued by extremity amputation in Japan. The mortality of septicemia type Vibrio vulnificus infection with necrotizing fasciitis is very high, this is quite a valuable report in making a decision for therapy of septicemia type Vibrio vulnificus infection.     

Septicaemia caused by Vibrio vulnificus

Vibrio vulnificus is an uncommon cause of septicaemia. A few reports suggest that patients with chronic liver disease are more susceptible. We report two cases of septicaemia caused by this organism and emphasise the need for early empirical therapy.     

Chronic liver disease and consumption of raw oysters: a potentially lethal combination--a review of Vibrio vulnificus septicemia

Vibrio vulnificus septicemia is the most common cause of fatality related to seafood consumption in the United States. It occurs predominantly in patients with chronic liver disease following consumption of raw oysters. V. vulnificus is a highly virulent human pathogen, normally found in warm estuarine and marine environment. It lodges in filter feeders like oysters. The onset of this illness is abrupt, rapidly progressing to septic shock with a high mortality. Clinicians managing patients with chronic liver disease need to educate their patients of the risk associated with the consumption of raw seafood, especially oysters. A high index of suspicion is necessary for appropriate treatments, as doxycycline, the antibiotic of choice, is not usually a part of the empiric therapy for septicemia. The high mortality associated with this septicemia demands aggressive preventive measures: susceptible individuals must be forewarned by signs displayed in restaurants; physicians must educate patients with chronic liver disease about the risk of raw oyster consumption; and harvesting methods which reduce contamination by V. vulnificus must be utilized.     

Quantitative detection of Vibrio vulnificus in seafood

To quantify the number of Vibrio vulnificus in shellfish, we compared the most probable number (MPN) combined with a culture (MPN-culture) or polymerase-chain reaction (PCR) assay (MPN-PCR) to a quantitative PCR assay. Enrichment in alkaline peptone water by MPN was conducted at 25 and 35 degrees C. Enrichment at 35 degrees C was superior or similar to enrichment at 25 degrees C in over 65% of samples by MPNculture and in more than 75% of samples by MPN-PCR assay. V. vulnificus was more easily isolated on chromogenic agar medium during culture, MPN-PCR assay was superior or similar to MPNculture in over 90% of samples by enrichment at 25 degrees C and to over 88% of samples by enrichment at 35 degrees C. The number of V. vulnificus by quantitative PCR assay was similar to that of MPN-PCR assay in 6 of 8 samples but not from MPNculture. V. vulnificus contamination was frequently detected in samples from Kyushu Island.     

创伤弧菌的药物敏感性

目的创伤弧菌(Vibrio vulnificus)是"人鱼共患病"的重要致病菌,从患"腐皮病"卵形鲳鲹(Trachinotus ovatus)鱼中分离到创伤弧菌TO-3,以阿莫西林等44种药物进行敏感性试验。结果对青霉素类抗菌药物不敏感,对头孢菌素类等抗菌药物很强的耐药性,而对氟哌酸、头孢氯氨苄、氟嗪酸、米诺环素、呋喃妥因、复达欣、萘啶酸、四环素、庆大霉素等抗菌药物高度敏感。在17味中草药中对五倍子、诃子、黄连、石榴皮等中草药极为敏感。     

A successful treatment of Vibrio vulnificus infection

A 65-year-old male patient with a history of alcoholism visited our outpatient clinic complaining of nausea and diarrhea followed by dizziness. Erythema and swelling with partial exfoliation on the right forearm to hand and right thigh were noticed. Vibrio vulnificus was isolated from the purulent discharge of the skin. Due to urgent and intensive treatment of bacterial shock and antimicrobial drugs, the patient fully recovered three months later. We believe that the patient survived from this fatal infection because; 1) the isolates were highly sensitive to a wide variety of antibiotics, 2) the antibiotic therapy was started immediately, with an alternative usage of different antibiotics, and 3) the liver dysfunction of the patient had not been severely damaged by alcohol before the infection.