Vibrio vulnificus infection: clinical manifestations, pathogenesis, and antimicrobial therapy

There has been a dramatic increase in the number of reported cases of infection due to Vibrio vulnificus in Taiwan. Although the organism has been etiologically implicated in a variety of clinical syndromes, most cases of V. vulnificus infection are categorized as primary bacteremia, skin and soft tissue infection. The mortality was up to 50% in septic patients, most of them dying within 48 h of admission. In most of the cases involving V. vulnificus infection have underlying disease, particularly liver cirrhosis. The pathogenesis may attribute to several virulent factors, such as lipopolysaccharide, capsular lipopolysaccharide, cytolysin, metalloprotease and siderophore. Tetracycline was suggested as the drug of choice based on an animal study. Our previous in vitro data showed that cefotaxime and minocycline acted synergistically in inhibiting V. vulnificus. Furthermore, another in vivo animal study indicated that therapy using combined with cefotaxime and minocycline was distinctly more advantageous than therapy with the single antibiotic regimen for the treatment of severe experimental murine V. vulnificus infection. Recently, we also demonstrated that the newer fluoroquinolones, as single agents were as effective as the combination therapy both in vitro and in vivo.