Identification of a binding site for quaternary amines in factor Xa

In the process of characterizing the Na(+)-binding properties of factor Xa, a specific inhibition of this enzyme by quaternary amines was identified, consistent with previous observations. The binding occurs with K(i) in the low millimolar range, with trimethylphenylammonium (TMPA) showing the highest specificity. Binding of TMPA inhibits substrate hydrolysis in a competitive manner, does not inhibit the binding of p-aminobenzamidine to the S1 pocket, and is positively linked to Na(+) binding. Inhibition by TMPA is also seen in thrombin and tissue plasminogen activator (tPA), though to a lesser extent compared to factor Xa. Computer modeling using the crystal structure of factor Xa suggests that TMPA binds to the S2/S3 specificity sites, with its hydrophobic moiety making van der Waals interactions with the side chains of Y99, F174, and W215, and the charged amine coupling electrostatically with the carboxylates of E97. Site-directed mutagenesis of factor Xa, thrombin, and tPA confirms the predictions drawn by docking calculations and reveal a dominant role for residue Y99. Binding of TMPA to factor Xa is drastically (25-fold) reduced by the Y99T replacement. Likewise, the Y99L substitution compromises binding of TMPA to tPA. On the other hand, the affinity of TMPA is enhanced 4-fold in thrombin with the substitution L99Y. The identification of a binding site for quaternary amines in factor Xa has a bearing on the rational design of selective inhibitors of this clotting enzyme.

Sequence determinants of function and evolution in serine proteases

Serine proteases of the chymotrypsin family have maintained a common fold over an evolutionary span of more than one billion years. Notwithstanding modest changes in sequence, this class of enzymes has developed a wide variety of substrate specificities and important biological functions such as fibrinolysis, blood coagulation, and complement activation. Recently it has become apparent that the protease domain, especially its C-terminal sequence, accounts fully for this functional diversity and is the most important element in shaping serine protease evolution.

Two distinct lineages of macaque gamma herpesviruses related to the Kaposi's sarcoma associated herpesvirus

BACKGROUND

KSHV, Kaposi's sarcoma-associated herpesvirus, is a necessary cofactor for the development of Kaposi's sarcoma (KS). We have previously reported KSHV-related DNA sequences in retroperitoneal fibromatosis (RF) tissue from two species of macaque. The putative herpesvirus was called RFHV for RF-associated herpesvirus. These data suggested that KSHV is a human representative of a larger family of primate herpesviruses.

OBJECTIVE

To identify and characterize other members of a putative family of KSHV-related herpesviruses in macaques in order to obtain information on the evolutionary history of KSHV infection in humans.

STUDY DESIGN

Lymphoid tissue cells and blood leukocytes from rhesus-, cynomolgus- and pigtailed-macaques were tested for the presence of unknown herpesviruses using degenerate primer-driven PCR amplification. The sequences obtained were compared against known herpesvirus sequences.

RESULTS

We have identified new herpesvirus DNA sequences in each of the three macaque species. Sequence comparisons indicate that these new viruses are most related to each other and form a separate phylogenetic lineage within the gamma herpesviruses. Screening of PBMC from Indonesian-origin quarantine animals suggests that these viruses (MGV, macaque gamma virus) are species-specific, and highly prevalent in the wild. They are readily cultured in vivo, and share a common tissue tropism with the previously identified RFHV.

CONCLUSIONS

MGV and RFHV represent two independent introductions of an ancestral gamma herpesvirus into macaque precursors.

Reducing nosocomial pressure ulcers in an acute care facility

In 1996, a nursing committee at an acute care facility organized the first pressure ulcer point prevalence survey for that hospital. In 1996, hospital-acquired pressure ulcers were 90 percent of the predicted prevalence rate; in 1997, the rate dropped to 59 percent of the predicted prevalence and in 1998, to 53 percent of the predicted prevalence. The severity index decreased markedly from 291 (1996) to 98 (1997) then to 62 (1998). These improvements are attributed to the purposeful addition of multidimensional interventions, including best practices and research-based protocols, to prevent and treat nosocomial pressure ulcers.

De novo 46,XX,t(6;7)(q27;q11;23) associated with severe cardiovascular manifestations characteristic of supravalvular aortic stenosis and Williams syndrome

Supravalvular aortic stenosis may present as an isolated finding or as part of Williams syndrome. Williams syndrome is a contiguous gene syndrome associated with neurodevelopmental and multisystemic manifestations caused by hemizygous deletion at 7q11.23. We report on the prenatal and histopathological findings in a patient with a chromosome translocation involving the Williams syndrome critical region. The initial abnormality on fetal ultrasound was hydrops fetalis detected at 30 weeks and echocardiography showed narrowing of the aorta and the pulmonary arteries. The baby died shortly after delivery and an autopsy revealed diffuse tubular thickening with luminal narrowing of the aorta, aortic branches, and the pulmonary arteries. Histopathology showed dysplasia of the media with reduced elastic content and "cartwheel" arrangement of collagen, elastic, and muscle fascicles. The karyotype was 46,XX,t(6;7)(q27;q11.23). Three signals were detected using the Oncor fluorescent in situ hybridization probe for elastin-Williams syndrome (WSCR) suggesting that the break in chromosome 7 is within the elastin-Williams gene. This patient is of special interest because of the prenatal presentation and the chromosomal translocation involving the elastin-Williams syndrome locus.

Structure and dynamics of the pore of inwardly rectifying K(ATP) channels

Inwardly rectifying K(+) currents are generated by a complex of four Kir (Kir1-6) subunits. Pore properties are conferred by the second transmembrane domain (M2) of each subunit. Using cadmium ions as a cysteine-interacting probe, we examined the accessibility of substituted cysteines in M2 of the Kir6.2 subunit of inwardly rectifying K(ATP) channels. The ability of Cd(2+) ions to inhibit channels was used as the estimate of accessibility. The distribution of Cd(2+) accessibility is consistent with an alpha-helical structure of M2. The apparent surface of reactivity is broad, and the most reactive residues correspond to the solvent-accessible residues in the bacterial KcsA channel crystal structure. In several mutants, single channel measurements indicated that inhibition occurred by a single transition from the open state to a zero-conductance state. Analysis of currents expressed from mixtures of control and L164C mutant subunits indicated that at least three cysteines are required for coordination of the Cd(2+) ion. Application of phosphatidylinositol 4,5-diphosphate to inside-out membrane patches stabilized the open state of all mutants and also reduced cadmium sensitivity. Moreover, the Cd(2+) sensitivity of several mutants was greatly reduced in the presence of inhibitory ATP concentrations. Taken together, these results are consistent with state-dependent accessibility of single Cd(2+) ions to coordination sites within a relatively narrow inner vestibule.

The C-terminal Sequence Encodes Function in Serine Proteases

Serine proteases of the chymotrypsin family have maintained a common fold over an evolutionary span of more than one billion years. Notwithstanding modest changes in sequence, this class of enzymes has developed a wide variety of substrate specificities and important biological functions. Remarkably, the C-terminal portion of the sequence in the protease domain accounts fully for this functional diversity. This portion is often encoded by a single exon and contains most of the residues forming the contact surface in the active site for the P1-P3 residues of the substrate, as well as domains responsible for the modulation of catalytic activity. The evolution of serine proteases was therefore driven by optimization of contacts made with the unprimed subsites of the substrate and targeted a relatively short portion of the sequence toward the C-terminal end. The dominant role of the C-terminal sequence should facilitate the identification of function in newly discovered genes belonging to this class of enzymes.

[Acute and chronic osteochondral lesions of the talus]

Osteochondral lesions of the talus are often not or delayed diagnosticated. They mostly are related to traumatic lesions of the upper ankle joint, where by traumatic distorsion are most common among. The degenerative change classified as osteochondrosis dissecans tali shows in the most cases also an originally traumatic generic. The classification by osteochondrosis dissecans tali in four stages by Berndt and Harty is nowadays accepted. These can be distinguished by means of several diagnostic methods. They are regarded as state-of-the-art of therapy and prognosis. Basically for diagnostic purposis the conventional X-ray in two planes with the right feet-allignement is sufficient. Despite the fact, that Szintigraphy and Computertomography for particular questions are the right tools, the MRI gives the highest amount of information. In the case of low levels of defects (Stage I and II) the conservative therapy is appropriate. In more serious cases (Stage III and IV) the surgical intervention has to be used. Beside the open surgical approach the arthroscopy has a growing importancy. In 60% of cases good long term results can be achieved. Beside some advantage there are some limits compared to the arthrotomy. The efficiency of new therapeutic methods like bone-cartilage-transplantation and chondrocyte-transplantation compared to the conventional wound toilet, microfractures and fragmentrefixation has to be proved by long term studies. The results depend on the stage and the localisation of the osteochondral lesion. In the developed stages III and IV surgical actions as wound toilet, removement of dissecate with microfragmentation respectivaly refixation are indicated, since conservative therapy methods lead undoubtedly to worse results. Generally mostly good and very good results connected with painless and weight bearing could be achieved.

Acute and chronic osteochondral talus lesions

Osteochondral lesions of the talus are often not or delayed diagnosticated. They mostly are related to traumatic lesions of the upper ankle joint, where by traumatic distorsion are most common among. The degenerative change classified as osteochondrosis dissecans tali shows in the most cases also an originally traumatic generic. The classification by osteochondrosis dissecans tali in four stages by Berndt and Harty is nowadays accepted. These can be distinguished by means of several diagnostic methods. They are regarded as state-of-the-art of therapy and prognosis. Basically for diagnostic purposis the conventional X-ray in two planes with the right feet-allignement is sufficient. Despite the fact, that Szintigraphy and Computertomography for particullar questions are the right tools, the MRI gives the highest amount of information. In the case of low levels of defects (Stage I and II) the conservative therapy is appropriate. In more seriouse cases (Stage III and IV) the surgical intervention has to be used. Beside the open surgical approach the arthroscopy has a growing importancy. In 60 % of cases good long term results can be achieved. Beside some advantage there are some limits compared to the arthrotomy. The efficiency of new therapeutic methods like bone-cartilage-transplantation and chondrocyte-transplantation compared to the conventional wound toilet, microfractures and fragmentrefixation has to be proved by long term studies. The results depend on the stage and the localisation of the osteochondral lesion. In the developed stages III and IV surgical actions as wound toilet, removement of dissecate with microfragmentation respectivally refixation are indicated, since conservative therapy methods lead undoubtely to worse results. Generally mostly good and very good results connected with painless and weight bearing could be achieved.

Unexpected crucial role of residue 225 in serine proteases

Residue 225 in serine proteases of the chymotrypsin family is Pro or Tyr in more than 95% of nearly 300 available sequences. Proteases with Y225 (like some blood coagulation and complement factors) are almost exclusively found in vertebrates, whereas proteases with P225 (like degradative enzymes) are present from bacteria to human. Saturation mutagenesis of Y225 in thrombin shows that residue 225 affects ligand recognition up to 60,000-fold. With the exception of Tyr and Phe, all residues are associated with comparable or greatly reduced catalytic activity relative to Pro. The crystal structures of three mutants that differ widely in catalytic activity (Y225F, Y225P, and Y225I) show that although residue 225 makes no contact with substrate, it drastically influences the shape of the water channel around the primary specificity site. The activity profiles obtained for thrombin also suggest that the conversion of Pro to Tyr or Phe documented in the vertebrates occurred through Ser and was driven by a significant gain (up to 50-fold) in catalytic activity. In fact, Ser and Phe are documented in 4% of serine proteases, which together with Pro and Tyr account for almost the entire distribution of residues at position 225. The unexpected crucial role of residue 225 in serine proteases explains the evolutionary selection of residues at this position and shows that the structural determinants of protease activity and specificity are more complex than currently believed. These findings have broad implications in the rational design of enzymes with enhanced catalytic properties.

Telematics in research planning processes: an example from global health

It is increasingly recognized that the appropriate application of information and communication technology can substantially improve communication and cooperative work processes in terms of quantity, quality and cost-effectiveness. Within large organizations, strategic decision making is one of the key cooperative processes which have to be faced. In this paper the authors discuss one example of this class of cooperative processes: research planning within the World Health Organization (WHO). The paper presents conceptual details of a process designed to assist in creating global networks of scientists, planners and field workers interested in cooperating to promote health development activities of WHO. The implementation of this process was realized in an Internet-based system to support global research planning. In particular, this application shows that the utilization of information and communication technology can not only quantitatively change existing processes, but can create new ones--and on a qualitatively improved level.

Non-isotopic competitive reverse transcription polymerase chain reaction coupled with high performance liquid chromatography to measure beta 2-receptor messenger RNA in the human heart

We describe an application of competitive reverse transcription-polymerase chain reaction (PCR) coupled with HPLC for quantification of beta 2-adrenergic receptor messenger RNA (mRNA) in human atrial tissues removed during cannulation for cardiopulmonary bypass operations. We constructed an internal standard which was reverse transcribed in different concentrations together with constant levels of cellular RNA and subsequently PCR amplified. The competitor RNA shows the same beta 2-adrenergic receptor primer sequences as the cellular mRNA but yields a different-sized product. This allows resolution of the amplified copy DNA (complementary DNA, cDNA) fragments with a specific HPLC column. The concentration of beta 2-adrenergic receptor mRNA is derived from the ratio between the peak intensities corresponding to the amplified competitor and target products. We assessed the imprecision, accuracy and sensitivity of the method. Concentrations of beta 2-adrenergic receptor mRNA of 22.7 +/- 15.2 x 10(6) molecules per micrograms total RNA in patients treated with beta 2-antagonists were not significantly different from control patients showing 16.8 +/- 9.9 x 10(6) beta 2-adrenergic receptor mRNA molecules per microgram total RNA (Mean +/- SD). Competitive reverse transcription PCR is a highly specific, non-radioactive procedure for quantification of beta 2-adrenergic receptor mRNA and simultaneously other gene expression levels of interest in atrial tissue specimens and may therefore be used to advance our understanding of heart muscle disease.

Hydrops fetalis and neonatal leukemia in Down syndrome

Four newborn infants with Down syndrome and manifestations of neonatal leukemia are described. One of the four was stillborn, two died shortly after birth, and a fourth survived and all evidence of leukemia disappeared in the first month of life. Three of the four cases had hydrops fetalis, and a fourth was a macerated stillborn. Nine other similar reported cases are reviewed. We conclude that neonatal leukemia in Down syndrome is a form of leukemia that is usually transient, with spontaneous recovery, but may be fatal at or around the time of birth with manifestations of hydrops fetalis, hepatosplenomegaly, and/or progressive liver disease.

Interaction of calcium with Bordetella pertussis adenylate cyclase toxin. Characterization of multiple calcium-binding sites and calcium-induced conformational changes

The adenylate cyclase (CyaA) secreted by Bordetella pertussis is a toxin that is able to enter eukaryotic cells and cause a dramatic increase in cAMP level. In addition, the toxin also exhibits an intrinsic hemolytic activity that is independent from the ATP cycling catalytic activity of the toxin. Both the cytotoxic and hemolytic activities are calcium-dependent. In this work, we have analyzed the calcium interacting properties of CyaA. We have shown that CyaA exposed to CaCl2 could retain membrane binding capability and hemolytic activity when it was further assayed in the presence of an excess of EGTA. Determination of the calcium content of CyaA exposed first to calcium and subsequently to EGTA indicated that some (3-5) calcium ions remained bound to the protein, suggesting the existence of Ca2+ binding sites of high affinity. Binding of Ca2+ to these sites might be necessary for both the membrane binding capability and the hemolytic activity of the toxin. In addition, CyaA possesses a large number (about 45) of low affinity (KD = 0.5-0.8 mM) Ca2+ binding sites that are located in the C terminus of the toxin, between amino acids 1007 and 1706. This region mainly consists of about 45 repeated sequences of the type GGXGXDXLX (where X represents any amino acid) that are characteristic of the RTX (Repeat in ToXin) bacterial protein family. Our data suggest that each one can bind one calcium ion. Circular dichroism spectroscopy analysis showed that calcium binding to the low affinity sites induces a large conformational change of CyaA, as revealed by an important increase in the content of alpha-helical structures. This conformational change might be directly involved in the Ca(2+)-dependent translocation of the catalytic domain of CyaA through the plasma membrane of target cells.

Restriction of self-antigen presentation to cytolytic T lymphocytes by mouse peptide pumps

Transport of an immunogenic self-peptide from the second domain of the mouse major histocompatibility complex (MHC) H-2Kd class I molecule is blocked at the TAP1-TAP2 peptide pump level due to its amino acid sequence and is not presented to cytolytic T lymphocytes (CTL). We demonstrate that first, TAP1-TAP2 pumps can restrict antigen presentation by selecting against internal peptide motifs which are not involved in peptide binding to MHC class I molecules. Second, some molecules targeted to the endoplasmic reticulum are processed for MHC class I presentation in the cytosol. Third, some abundantly expressed immunogenic self-peptides are cytosolically sequestered. The advantage for the host, in terms of the peripheral T cell repertoire is that the spared CTL can be used to recognize foreign antigens. It is, however, anticipated that this advantage will be exploited by pathogens to evade immune surveillance by similar strategies.

Conformational behaviour of a synthetic peptide of the C-terminus of villin that interacts with actin: an NMR, CD and stimulated annealing study

The solution structure of a synthetic 22-amino acid peptide (P1) corresponding to the extreme C-terminal end and one of the F-actin binding sites of villin has been determined by 1H NMR and CD spectroscopy. The structure of this peptide was compared to that of a peptide in which lysine to glutamic acid substitutions were introduced at positions 17 and 19 (P11), abolishing F-actin binding. Both peptides are largely unstructured in aqueous solution. Changes observed in the NMR and CD spectra of both peptides are consistent with alpha-helix formation in trifluoroethanol/water mixtures. A set of 189 interproton distances derived from nuclear Overhauser enhancement (NOE) measurements, 17 phi-angle constraints obtained from 3JNH alpha coupling constants, as well as about 10 N ... O distance restraints deduced from amide proton exchange kinetics with deuterium, were used for the structure determination. The three-dimensional structure of P1 and P11 is characterized by two helical regions, one extending from residues 2 to 5 and a second covering residues 7 to 17. The central fragment, ranging from Leu-7 to Leu-15, is more stable. The C-terminal residues are less structured, particularly within peptide P11. The significance of these structural results is discussed in relation to the biological activity of villin.

Solution structure of a homopyrimidine: homopurine dodecamer encoded by the HIV-1 envelope gene: NMR and molecular simulation studies

The solution structure of the nonpalindromic dodecanucleotide homopyrimidine:homopurine, d(5'-TTTCTCCTTTCT):d(5'-AGAAAGGAGAAA), was determined by two-dimensional nuclear magnetic resonance spectroscopy combined with molecular simulation. The dodecamer sequence studied was found within the HIV-1 envelope sequence and had all four Gs substituted by A in two hypermutants. A set of low-energy B-DNA conformations satisfying the quantitative NOE data were obtained. These highly related structure had neither peculiar helical parameters for the base pairs nor axis curvature. Analysis of the dihedral angles (epsilon-zeta) suggests that the A stretches flanking the GpA dinucleotides were more flexible.

Prenatal diagnosis and fetopathological findings in five fetuses with trisomy 9

Five male fetuses with trisomy 9 are discussed. Three were detected prenatally and terminated, 1 aborted spontaneously, and the fifth delivered prematurely and died soon after. Multiple congenital abnormalities characteristic of trisomy 9 were detected in all 5 cases and are compared to those of previous reports.

Treatment of psoriasis at a Dead Sea dermatology clinic

BACKGROUND

The Dead Sea, with its unique optical, chemical, and atmospheric properties, provides an effective alternative treatment for psoriasis.

METHODS

The records of 1448 consecutive psoriasis patients treated at a Dead Sea psoriasis clinic were retrospectively evaluated concerning their treatment response and demographic characteristics.

RESULTS

Clearing of 80-100% was observed in 88% of the patients treated, including almost 58%, who had complete clearing. The demographic data studied that included gender, previous treatment at the Dead Sea, prior history of hospitalization for psoriasis, prior PUVA treatment, or a history of arthritis did not reveal any significant relationships, although overseas patients responded considerably better than Israelis.

CONCLUSIONS

The overall response in a large cohort of psoriasis patients treated at the Dead Sea was excellent. Further prospective studies and basic investigations are essential to understand the mechanism(s) involved and the relationships between other demographic data and the treatment response.

Quantification of attention-related behaviors in individuals with traumatic brain injury. A pilot study

Clinical disorders of attention are common after traumatic brain injury but objective measures of their nature and severity are lacking. We developed a standardized independent work task to be performed by patients in a controlled, distracting environment. Videotaped records of patient behavior were made and coded in 15-s intervals for on-task behavior, presence of distractors and presence of extraneous motor behavior. Interrater reliability was good to excellent across eleven testing sessions involving four patients. This evaluation system revealed clinically important differences in on-task behavior among the four patients, as well as different levels of distraction in response to external stimuli. It also showed effects of different tasks and repeated sessions. These data indicate that this evaluation system and accompanying coding process are reliable and provide preliminary evidence that they produce clinically valid results.

Listeria-associated pericarditis in an AIDS patient

Listeria monocytogenes is a pathogenic, facultative intracellular gram-positive rod, generally seen in cell-mediated immunocompromised states. In acquired immunodeficiency syndrome (AIDS), it most commonly presents as bacteremia or meningitis. An association with pericarditis has not been described previously in this group of patients. This article describes a case of pericarditis secondary to listeriosis involving a focal pancarditis and necrosis of the A-V node with subsequent refractory ventricular tachyarrhythmias in an immunodeficient patient presenting with altered mental status. Infectious etiologies should be considered for "benign" appearing pericardial effusions in AIDS patients and the diagnosis of listeriosis excluded in the presence of "diphtheroid-like" organisms.

Prenatal ultrasonic prediction of autopsy-proven pulmonary hypoplasia

The sensitivity, specificity, and positive and negative predictive values for ultrasound estimation of fetal chest circumference in relation to autopsy-proven pulmonary hypoplasia are described in 58 singleton pregnancies at risk (39 with associated preterm premature rupture of the membranes at 30 weeks' gestation or less and of 12 or more days' duration, and 19 with associated anomalies). The ultrasonographic diagnosis of pulmonary hypoplasia was based on values at or below the lower limit of the 95% confidence intervals (for predicting a future observation) for normal pregnancies for each of the following tests; chest circumference in relation to gestational age and to femur length, for the chest circumference to abdominal circumference ratio and for a combination of the three measurements. At necropsy, the diagnosis of pulmonary hypoplasia was based on lung weight to birthweight ratio or radial alveolar counts. Pulmonary hypoplasia was diagnosed in 16 cases at autopsy. The clinicians and the pathologist were blinded to the ultrasonographic measurements. All tests performed well with a sensitivity of 0.55 to 0.80, specificity of 0.90 to 1.00, positive predictive value of 0.80 to 1.00, negative predictive value of 0.87 to 0.91, and an overall accuracy of 0.87 to 0.91. We conclude that ultrasound measurement of fetal chest circumference is of value with regard to the management of pregnancies at risk for lethal pulmonary hypoplasia.

Structural and functional consequences of amino acid substitutions in the second conserved loop of Escherichia coli adenylate kinase

All known nucleoside monophosphate kinases contain an invariant sequence Asp-Gly-Phe(Tyr)-Pro-Arg. In order to understand better the structural and functional role of individual amino acid residues belonging to the above sequence, three mutants of Escherichia coli adenylate kinase (D84H, G85V, and F86L) were produced by site-directed mutagenesis. Circular dichroism spectra revealed that the secondary structure dichroism spectra revealed that the secondary structure of all three mutant proteins is very similar to that of the wild-type enzyme. However, each of the substitutions resulted in a decreased thermodynamic stability of the protein, as indicated by differential scanning calorimetry measurements and equilibrium unfolding experiments in guanidine HCl. The destabilizing effect was most pronounced for the G85V mutant, in which case the denaturation temperature was decreased by as much as 11 degrees C. The catalytic activity of the three mutants represented less than 1% of that of the wild-type enzyme. Furthermore, for the D84H-modified form of adenylate kinase, the impaired binding of nucleotide substrates was accompanied by a markedly decreased affinity for magnesium ion. These observations support the notion that Asp84 is directly involved in binding of nucleotide substrates and that this binding is mediated by interaction of the aspartic acid residue with divalent cation. The two remaining residues probed in this study, Gly85 and Phe86, belong to a beta-turn which appears to play a major role in stabilizing the three-dimensional structure of adenylate kinase.

Vibrio vulnificus. Hazard on the half shell

Vibrio vulnificus is an extremely invasive gram-negative bacillus that causes bacteremia and shock. It should be suspected in any patient who is immunocompromised or has liver disease or hemochromatosis. Reduced gastric acidity may also increase the risk of infection if a patient presents with a history of ingesting raw shellfish (especially oysters) or trauma in brackish waters and skin lesions. Patients most commonly present with one of three clinical syndromes: primary septicemia, wound infection, or gastroenteritis. Treatment includes aggressive wound debridement, antibiotic therapy, and supportive care. Rapidly diagnosing and promptly initiating therapy are critical because V vulnificus infection is rapidly progressive and mortality approaches 100% if septic shock occurs.