Clinical Study of Vibrio vulnificus Sepsis

Park, Seok Don; Lee, Jae Young; Kim, Hyun Dai; Yoon, Nyung Hoon

Abstract

BACKGROUND
Vibrio (V.) vulnificus is a pathogenic marine bacterium that can cause rapid progression of a life-threatening infection. Although V. vulnificus sepsis is well-known to Koreans and was designated as a legal communicable disease in August 2000, many people still become infected each year.
OBJECTIVE
The purpose of this study was to investigate the clinical features of V. vulnificus sepsis, in order to offer basic data for the treatment and prevention of this disease.
METHODS
We reviewed the available data of 141 patients with V. vulnificus sepsis, which were obtained from 105 patients admitted to hospital and 36 case reports published in the Korean medical journals between 1982 and 2004.
RESULTS
Eighty-five percent of patients were 40 to 60 years old. Men were affected 10.5 times more often than women. Patients with underlying chronic diseases (94%) such as alcohol abuse and liver diseases displayed primary sepsis starting with fever, chills, and/or diarrhea, often within 2.3 days of consumption of various kinds of raw seafood. Skin lesions appeared initially as a painful, localized swelling like a bee-sting, followed by edema, blisters, purpura, necrosis and, less commonly, maculopatch, cyanosis, papules, wheals, pustules or erythema multiforme-like lesions. The cutaneous lesions that were present in 91.5% of patients on admission, appeared on the lower extremities in 88.9% of the cases. Of the 141 patients, 88 patients (62.4%) died. The mortality rate increased as initiation of treatment was delayed. Laboratory findings revealed thrombocytopenia and elevated levels of liver enzymes in many tested cases. V. vulnificus was cultivated more easily from the skin lesion (95%) than blood (69%). There were significant differences in systolic blood pressure, leukocyte count and creatinine between survivors and nonsurvivors (p<0.05). V. vulnificus was highly susceptible to several kinds of antibiotics such as ampicillin, ciprofloxacin, and 3rd generation cephalosporins. Mortality rate increased as the delay from the onset of illness to the initiation of treatment was prolonged.
CONCLUSION
Clinicians should promptly initiate appropriate therapy for patients with underlying chronic disease if they exhibit unexplained fever and diarrhea after ingesting raw seafood.