PRIMARY VIBRIO-VULNIFICUS SEPTICEMIA - FI RST DOCUMENTED CASE IN FRENCH-WEST-INDIES

BACKGROUND: Vibrio vulnificus is a non-choleric halophilic vibrion wid ely distributed in marine environments. Contamination in humans is unc ommon except in coastal areas of the United States and Asia. We report the first documented case in the French West Indies. CASE REPORT: A 5 7-year-old native with alcoholic cirrhosis was hospitalized for septic shock The infectious syndrome began suddenly a few hours earlier with fever, diarrhea, and intense pain in the calf muscles. In the absence of a suspected agent, a wide spectrum antibiotic was prescribed. On d ay 3, bullae developed over the legs and progressed, despite early sur gical debridement, to bilateral rapidly extensive necrosing cellulitis . An above the knee amputation was required but did not prevent death on day 9 due to irreversible multiple organ failure. Blood cultures we re positive for V. vulnificus. DISCUSSION:: Primary septice mia due to V. vulnificus is mainly observed in subjects with an underlying liver disease and usually occurs after ingestion of contamined raw halieuti c products such as oysters. The clinical presentation is characteristi c with secondary necrotic ulcerations on the lower limbs. Improvement in the extremely poor prognosis of these infections depends on early i nitiation of an effective antibiotic with wide exe resis of necrotic t issue. Physicians should be aware of this severe infection despite its low frequency.