Isolation of Vibrio vulnificus from blood of a fatal sepsis case, September 2000 - Niigata
(IASR 2000; 21: 243-243)

In the evening on September 21, 2000, a 60-year old male developed lower abdominal pain, loose stool, and fever, and was hospitalized on September 22. Upon admission his consciousness was clear, but he complained of lower abdominal pain. His abdomen was slightly distended, but muscle defense was not observed. Bowel sound was weak. Many small red eruptions were recognized on the whole body. Other physical findings included blood pressure, 104/80 mmHg; pulse rate, 110/minute, regular; body temperature, 38.6 C. Complete blood count revealed white blood cells, 5,000/µl; platelets, 35x10³/µl (thrombocytopenia). Abdominal radiography showed gas in the small intestine. Ultrasonography of the abdomen showed rough surface of the liver and a small amount of ascites. The patient was diagnosed as bowel hypomotility, sepsis, and disseminated intravascular coagulation. Infection and malignancy were suspected for underlying conditions. Stool and blood specimens for bacterial culture were collected before starting treatment with antibiotics. Despite frequent drip infusion he developed oliguria and hypotension. Pyrexia continued even after starting treatment with antibiotics (combination of cephalosporin and tetracycline). Eventually, he presented with dyspnea with blood gas; pH 7.299, PaO₂ 95.0 mmHg, PaCO₂ 21.9 mmHg, HCO₃^- 9.1 mmol/l. Complete blood count revealed white blood cells of 700/µl, platelets of 15x10³/µl. Metabolic acidosis was corrected and an adsorption therapy of bacterial toxin was prepared. However, the blood pressure could not be maintained despite high-dose catecholamines. He developed semicoma, and a mechanical ventilator was connected. The skin eruptions extended and blisters were observed. The circulatory collapse deteriorated and he died at 11 pm.

Vibrio vulnificus (Vv) was isolated from the blood specimen collected on September 22, but no other pathogen was found.

The patient, his wife, and daughter had an episode of eating raw oyster on September 20. However, his wife and daughter did not develop illness.

Vv can pass through the intestinal wall and invade into the bloodstream. The initial symptom of Vv infection is sudden chills and shaking 12-72 hours after eating raw or insufficiently cooked seafood. Clinical course of Vv infection is so fulminant that the patient soon falls into shock. Case fatality rate of Vv infection in the bloodstream infections increases to 50% or more. In case the patient develops hypotension due to septic shock, the fatality reaches 90% or more. Vv can cause severe illness especially in those having chronic liver disease, immunodeficiency, or alcoholism. We should remain alert to Vv as a life-threatening pathogen.

Reported by: Hidefumi Kishimoto, Seitaroh Iguchi, Toshiko Sekiya, Nobuko Shirota, and Yasuhiko Ohno, Niigata Prefecutral Muikamachi Hospital

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