Adult epiglottitis due to Vibrio vulnificus

New atypical manifestations and prognostic factors of Vibrio vulnificus infection: A 10-year retrospective study

Vibrio vulnificus (V. vulnificus) infection is rare but potentially fatal. This study explored the new atypical manifestations and prognostic factors of V. vulnificus-infected patients throughout hospitalization. we retrospectively reviewed 33 patients diagnosed as having V. vulnificus infection in Guangdong Province, China between 2010 and 2020. Medical records were analyzed. Multiple logistic regression and receiver operating characteristic (ROC) curve analyses were performed. New atypical manifestations were found, including cholangitis, urinary tract infection, and suppurative otitis media. Eleven of thirty-three (33.3%) V. vulnificus-infected patients died eventually. By univariate analysis, patients with cardio-cerebro-vascular diseases, lower platelet counts, higher levels of C-reactive protein and procalcitonin (PCT) had a statistically higher mortality. However, multivariate analysis showed that only PCT (P = 0.036) reached statistical significance. Also, the area under the ROC value estimate for PCT was 0.8816 (95% CI, 0.759-1.000; P = 0.0009). More than half of patients with V. vulnificus infection would die when PCT ＞20 ng/ml, while no patient dies when PCT ≤ 20 ng/ml. This study found new atypical manifestations of V. vulnificus infection. Also, PCT is an effective and independent predictor of mortality of V. vulnificus infection, and is suitable for clinicians to make early risk stratification and best therapeutic strategies.

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.

Infections with Vibrio vulnificus

V. vulnificus is an uncommon cause of soft tissue infection and primary septicemia, especially in patients with hepatic disease or who patients who are immunocompromised. The mortality of infection in these patients is extremely high despite timely antibiotic therapy. It is important to consider the possibility of infection with V. vulnificus in patients who present with high fever and rapidly progressive sepsis and have a history of consumption of raw seafood (especially oysters) or exposure of open wounds in a marine environment. Public education regarding the risk of raw seafood consumption is essential to preventing infection with this virulent pathogen.

Clinical infections of Vibrio vulnificus: a case report and review of the literature

Vibrio vulnificus is a marine Gram-negative bacillus that is recognized as a cause of fulminant primary septicemia and wound infections. One of the most common bacteria in seawater, V. vulnificus is concentrated in ocean filter feeders (e.g., oysters and clams). Primary septicemia can occur in patients, typically with underlying liver disease, who have acquired the organism through the gastrointestinal tract after recent consumption of raw shellfish. Characterized by fevers, chills, and bullous skin lesions, V. vulnificus septicemia is associated with a mortality greater than 50%. With septic shock, mortality approaches 100%. Wound infections are seen after injury to the skin in a marine environment or from exposure of preexisting wounds to seawater. Because of the high morbidity and mortality associated with V. vulnificus infections, effective treatment includes preventive measures to educate high-risk individuals, early search for and recognition of the disease, aggressive antibiotic therapy, supportive care, and, in the case of wound infections, aggressive debridement. Review of this subject was prompted by a case of V. vulnificus primary septicemia and fulminant septic shock in a patient with the unusual presentation of pain in the lower extremities.

Epiglottitis in adults

Acute epiglottitis has become a disease of adults, probably as a result of immunization of children against Haemophilus influenzae. This article is a review of the literature on epiglottitis, including signs and symptoms, investigation, differential diagnosis, and treatment in the emergency department. The microbiology is discussed and the importance of prophylaxis in exposed persons is stressed.

First documented case of bacteremia with Vibrio vulnificus in Sweden

A few days after a mild trauma to a toe, a 90-year-old woman presented with fever, malaise and cellulitis. On suspicion of erysipelas the patient was initially treated with benzylpenicillin and cefuroxime. Her general condition improved rapidly, but there was local progression with numerous necrotic areas with surrounding bullae. Vibrio vulnificus was isolated from the blood. After susceptibility testing, the patient was finally treated with ciprofloxacin and pivampicillin, and recovered slowly. To our knowledge, this is the first reported case of bacteremia with V. vulnificus in Sweden.

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.