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[Fulminant sepsis caused by Vibrio vulnificus. A case series]
P Cornejo-Juárez1, A L Rolón-Montes de Oca, J C Tinoco-Favila
1Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubiran.
Background:
Vibrio vulnificus is a marine bacteria associated with the ingestion of raw shellfish or contact with seawater. It can produce wound infection, diarrhea and sepsis. The main risk factor for infection is the presence of chronic liver disease. Prior studies have shown mortality from 40% to 63%.
Objective:
Report of 8 cases of disseminated infection with V. vulnificus causing fulminant sepsis.
Design:
Series of cases.
Methods:
We reviewed the database of the laboratory of clinical microbiology from 1990 to 1999. A computer-based review of the worldwide medical literature was also accomplished.
Results:
There were 8 cases of V. vulnificus infection. All patients had chronic liver disease, 3 also had diabetes mellitus and 1 received immunosuppressive agents. Five patients were known to have ingested raw shellfish. The mean duration of illness before death was 4 days. All patients presented with sepsis, seven had cutaneous lesions. Five patients received early antimicrobial treatment during the first 24 hours and all of them in the first 48 hours. Regardless of susceptibility to the antimicrobial agents used, the mortality was of 87.5%. Disk-diffusion test showed 100% susceptibility to imipenem, ceftazidime and tetracycline; 83% to cefepime, ticarcillin and cotrimoxazole and 50% to quinolones.
Conclusion:
The V. vulnificus infection appears in patients with chronic liver disease and it is associated with high mortality. This infection has to be suspected in high-risk patients who have eaten raw shellfish and therapy must be initiated as soon as possible.