Fulminant sepsis related to Vibrio vulnificus. Series of cases

Background. Vibrio vulnificus is a marine bacteria associated with the inge stion of raw shellfish or contact with seawater. It can produce wound infec tion, diarrhea and sepsis. The main risk factor for infection is the presen ce of chronic liver disease. Prior studies have shown mortality from 40% to 63%. Objective. Report of 8 cases of disseminated infection with V. vulnif icus causing fulminant sepsis. Design. Series of cases. Methods. We reviewe d the database of the laboratory of clinical microbiology from 1990 to 1999 . A computer-based review of the worldwide medical literature was also acco mplished. Results. There were 8 cases of V. vulnificus infection. All patie nts had chronic liver disease, 3 also had diabetes mellitus and 1 received immunosuppressive agents. Five patients were known to have ingested raw she llfish. 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 agent s used, the mortality was of 87.5%. Disk-diffusion test showed 100% suscept ibility to imipenem, ceftazidime and tetracycline; 83% to cefepime, ticarci llin and cotrimoxazole and 50% to quinolones. Conclusion. The V. vulnificus infection appears in patients with chronic liver disease and it is associa ted with high mortality. This infection has to be suspected in high-risk pa tients who have eaten raw shellfish and therapy must be initiated as soon a s possible.