Vibrio vulnificus infection in Southern Brazil - Case report / Infecção por Vibrio vulnificus no sul do Brasil - Relato de caso

The genus Vibrio is a member of the family Vibrionaceae, and among their disease-causing species, Vibrio vulnificus, a lactose-positive gram-negative bacillus, is one of the most virulent pathogen of the noncholerae vibrios. We describe the case of a 39-year-old male patient, who was using immunosuppressive therapy, admitted to the hospital for liver transplantation. Twelve hours later, the patient presented high fever, myalgia, anuria and erythematous plaques on lower limbs, of rapid growth and proximal progression. The patient was treated with ceftriaxone, meropenem and oxacillin, however he expired within 30 hours. Blood cultures showed growth of a gram-negative bacillus, which was later identified as Vibrio vulnificus.

O gênero Vibrio é membro da família Vibrionaceae, e entre as espécies patogênicas, Vibrio vulnificus, bacilo gram negativo lactose positivo, tem sido frequentemente citado. Descrevemos o caso de um paciente masculino de 39 anos, em uso de medicação imunossupressora, admitido no hospital para transplante hepático. Doze horas após a internação, o paciente evoluiu com febre, mialgias, anúria e placas eritematosas em membros inferiores, com rápido crescimento e evolução proximal. O paciente foi tratado com ceftriaxona, meropenem e oxacilina sem melhora, evoluindo para óbito em 30 horas. Hemocultura mostrou crescimento de bacilo gram negativo posteriormente identificado como Vibrio vulnificus.

Accurate diagnosis and treatment of Vibrio vulnificus infection: a retrospective study of 12 cases

BACKGROUND AND AIMS: Vibrio vulnificus causes an infectious disease that has extremely poor convalescence and leads to necrotic fasciitis. In this study, we sought to define the characteristic epidemiology of V. vulnificus infection and clarify its diagnosis at the global level. METHODS: Over a period of 10 years, we investigated the appearance of symptoms, underlying conditions, treatment, and mortality in 12 patients (eight men, four women; >50 years old; average age, 66 years,) infected with V. vulnificus. RESULTS: The development of symptoms occurred primarily between June and September, a period during which seawater temperature rises and the prevalence of V. vulnificus increases. All patients had underlying diseases, and seven patients reported a history of consuming fresh fish and uncooked shellfish. The patients developed sepsis and fever with sharp pain in the limbs. Limb abnormalities were observed on visual examination. All patients underwent debridement; however, in the survival group, the involved limb was amputated early in 80% patients. The mortality rate was 58.3%. CONCLUSION: Recognition of the characteristic epidemiology and clinical features of this disease is important, and positive debridement should be performed on suspicion. When the illness reaches an advanced stage, however, amputation should be the immediate treatment of choice.

Peritonitis bacteriana espontánea asociada a bacteriemia por Vibrio cholerae no O1, no O139 / Spontaneous bacterial peritonitis associated with Vibrio cholerae non-O1, non-139 bacteremia

Vibrio cholerae is a Gram-negative bacilli with curved, comma shape that belongs to the family Vibrionaceae. The antigenic structure consists of a flagellar H antigen and a somatic O antigen (used to classify V cholerae in various serogroups). Serogroups 01 and 0139 have caused epidemics of cholera. Vibrio cholerae non-01 non-139 has been isolated from patients with bacteremia, acute secretory diarrhea, dysentery, abdominal pain, nausea, vomiting, fever and cellulitis. Invasive forms such as meningitis, spontaneous bacterial peritonitis (SBP) and encephalitis are uncommon. Immunosuppression and cirrhosis are risk factors for developing invasive disease. This case report describes a cirrhotic patient from Salta, Argentina, consulting for abdominal pain and fever. He was diagnosed with SBP and Vibrio cholerae non-01 non-139 bacteremia. He received antibiotic treatment with third generation cephalosporins for fourteen days with favorable clinical outcome.

Vibrio cholerae es un bacilo gramnegativo, curvo y móvil, perteneciente a la familia Vibrionaceae, que presenta antígenos flagelares H y somático O; este último permite clasificarlo en numerosos serogrupos. Los serogrupos O1 y O139 han causado epidemias de cólera. Vibrio cholerae serogrupo no O1, no O139 es no aglutinable con el antisuero específico y se manifiesta clínicamente como bacteriemias, diarrea acuosa, disentería, dolor abdominal, náuseas, vómitos, fiebre y celulitis. Raramente se describen formas invasoras tales como meningitis, peritonitis bacteriana espontánea (PBE) y cerebritis, entre otras. Dentro de los factores de riesgo para desarrollar enfermedad invasora se encuentran la inmunodepresión y la cirrosis hepática. Comunicamos el caso de un paciente procedente de la provincia de Salta, Argentina, con antecedentes de cirrosis hepática, que consulta por dolor abdominal y fiebre, en el que se diagnóstica PBE asociada a bacteriemia por Vibrio cholerae no 01, no 0139. Recibió tratamiento con cefalosporinas de tercera generación iv, por catorce días con una evolución clínica favorable.

Gastroenteritis aguda causada por Vibrio cholerae no-O1, no-O139 que porta una región homologa a la isla de patogenicidad VpaI-7 / Acute gastroenteritis caused by a Vibrio cholerae non-O1, non-O139 strain harboring a genetic region homologous to the VpaI-7 pathogenicity island

Pathogenic Vibrio cholerae isolates, the etiologic agents of cholera, generally express one of two O antigens (O1 or O139). Most environmental isolates are nonpathogenic and are referred to as "non-O1, non-O139". However some V. cholerae non-O1, non-O139 strains are clearly pathogenic and have caused outbreaks or sporadic cases of gastroenteritis and extraintestinal infections in humans. We report a case of acute gastroenteritis by a V. cholerae non-O1, non-O139 harboring a genetic region homologous to a segment of the VpaI-7 V. parahaemolyticus pathogenicity island.

Cepas patogénicas de Vibrio cholerae, el agente causal del cólera, expresan generalmente uno de dos antígenos O (denominados O1 u O139). La mayoría de las cepas ambientales son no patogénicas y corresponden al tipo denominado "no-O1, no-O139". Sin embargo, algunas cepas de este tipo son claramente patogénas y han causado brotes de gastroenteritis e infecciones extra-intestinales en humanos. Se reporta un caso clínico de gastroenteritis aguda causado por una cepa de V. cholerae no-O1, no-O139 que contiene en su genoma una región homóloga a un segmento de la isla de patogenicidad VpaI-7 descrita previamente en V. parahaemolyticus.

Bullae and Sweat Gland Necrosis in the Differential Diagnosis for Vibrio vulnificus Infection in an Alcoholic Patient

Bullae and sweat gland necrosis remain rare cutaneous manifestation, and these conditions can be misdiagnosed as Vibrio vulnificus infections or other soft tissue infections because of their low index of suspicion. A 46-yr-old man with a history of continued alcohol consumption presented with erythematous and hemorrhagic bullous lesions on his left arm. The patient reported that after the ingestion of clams, he slept for 12 hr in a heavily intoxicated state. Then the skin lesions started as a reddish patch that subsequently became hemorrhagic bullae. V. vulnificus infection, cellulitis, and necrotizing fasciitis were considered in initial differential diagnosis. However, on the basis of sweat gland necrosis on histopathologic examinations and negative results on bacterial cultures, we made the diagnosis of bullae and sweat gland necrosis. Therefore, bullae and sweat gland necrosis should also be considered in chronic alcoholic patients who present with bullae and a previous history of unconsciousness.

Bacteriemia por Vibrio parahaemolyticus: reporte de caso y revisión de la literatura / Vibrio parahaemolyticus bacteremia: case report and literature review

Vibrio parahaemolyticus is a facultative anaerobio gram negative rod responsible of sea food-associated diarr-hoea. Although less common, it also causes wound infections and bacteraemia. We present a case of bacteraemia by this agent and a review of the literature.

Vibrio parahaemolyticus es un bacilo gram negativo, anaerobio facultativo, responsable de brotes de síndrome diarreico agudo por ingestión de mariscos crudos o mal cocidos contaminados. Ocasionalmente. se ha reportado asociado a infección de heridas y sepsis. Se reporta un caso clínico de bacteriemia por este microorganismo y se realiza una revisión de la literatura.

Avaliação de bacterina e Lactobacillus plantarum frente à infecção experimental por Vibrio harveyi em pós-larvas de Litopenaeus vannamei / Evaluation of bacterin and Lactobacillus plantarum front an experimental infection of Vibrio harveyi in pos-larvae of Litoenaeus vannamei

Objetivou-se averiguar o efeito da bactéria Lactobacillus plantarum e células inativas das bactérias Vibrio alginolyticus, Aeromonas salmonicida e Pasteurella multocida na sobrevivência larval de Litoenaeus vannamei, no teste de estresse e infecção experimental com Vibrio harveyi. Foram utilizados tanques cônicos de 30 L, povoados com 400 larvas cada, no estádio de pós-larva cinco. Tratamentos em triplicatas foram consistidos de: 1: ração comercial (controle), 2: ração comercial + bacterina via oral na artemia, 3: ração comercial + bacterina via imersãoe 4: ração comercial com inóculo de Lactobacillus plantarum. A aplicação da bacterina ocorreu seis horas antes da infecção e do teste de estresse; enquanto o Lactobacillus plantarum foi administrado por 15 dias antes dos desafios. As pós-larvas do tratamento 4 (ração suplementada com L. plantarum) obtiveram maior índice de sobrevivência no teste de estresse (87,86 ± 2,35%), seguido dos tratamentos 2 e 3 (bacterina via imersão e oral) com 81,54±1,50% e 80,16 ± 2,15% respectivamente, superiores ao índice do controle (72,63 ± 3,34%).Já no desafio com V. harveyi, os animais do grupo tratado com a adição de bacterina via imersão apresentaram maior sobrevivência(79,60 ± 7,12%). As pós-larvas dos tratamentos com bacterina via oral na artêmia e alimentadas com o probiótico L. plantarum,apresentaram sobrevivências de 65,60 ± 5,18% e 69,60 ± 10,43 %,respectivamente, sendo superiores ao controle (56,4 ± 5,58%), quando desafiados com V. harveyi. Os resultados demonstram que ouso de ração com L. plantarum e bacterina aumentam a sobrevivência das pós-larvas de L. vannamei frente aos testes de estresse e infecções experimentais com V. harveyi.

This study aimed to verify the effect of probiotics and inactivated cells of bacterias such as Vibrio alginolyticus, Aeromonas salmonicida and Pasteurella multocida in larvae survival of Litopenaeus vannamei, in stress test and experimental infection with Vibrio harveyi. Conic tanks of 30L, were stocked with 400 post-larvae stage five. Four experimental treatments with triplicates consisted of: 1: commercial feed (control),2: commercial feed plus bacterin by oral administration in artemia, 3:commercial feed plus bacterin by immersion administration, 4:commercial feed with Lactobacillus plantarum inoculation. Bacterin application was conducted 6h before the infection and stress test, while probiotic administration was for 15 days before challenges. In stress test, post-larvae of treatment 4 (commercial feed supplemented with Lactobacillus plantarum) with reached the highest survival rate(87,86 ± 2,35%) followed by the ones of treatment 3 and 2 (bacterimby immersion and bacterim by oral administration in artemia) with 81,54±1, 50% and 80,16 ± 2,15%, respectively, which were superior to the control treatment (72,63 ± 3,34%). Next to V. harveyi challenge, animals from treatment 3 presented the highest survival rate (79,60 ±7,12%) followed by treatments 4 (69,60 ± 10,43%), 2 (65,60 ± 5,18%)and control (56,4 ± 5,58%). All treatments were different from control. The present results demonstrate the possible use of L. plantarum and bacterin as promoters in survival rates of L. vannamei post-larvae in the stress tests and challenges with Vibrio harveyi.

Vibrio vulnificus infection in São Paulo, Brazil: case report and literature review

Non cholera Vibrio may cause conjunctivitis, wound infection, gastroenteritis and serious sepsis. Transmission to men is through contact with skin, mucosa or wounds exposed to marine water, and consumption of certain barely cooked or raw seafood, more frequently in the summer. This is one of the first cases of severe infection related to Vibrio vulnificus described in Brazil. The patient was an old man, who ingested seafood in Guarujá, a seashore city near São Paulo, 3 days before hospitalization. He was admitted to the emergency room in an ill state with septic shock. On 2 sets of blood culture a highly virulent microorganism was isolated, Vibrio vulnificus, which leads to sepsis and frequently to death in susceptible patients. The objective of this report was to use this case to discuss clinical aspects, microbiological diagnosis and treatment of the infection caused by this agent, besides the review of epidemiology, associated risk factors and prevention before consuming or getting in contact with seafood, especially in patients with greater susceptibility to this kind of infection.

Septicemia caused by Vibrio cholerae O1 biotype El Tor, in São Paulo, Brazil

We reported a case of septicemia by Vibrio cholerae O1, in São Paulo, Brazil. A 70-year-old male patient, living in an urban area, entered the emergency service having sepsis, dying 12 hours later. Blood culture was positive for Vibrio cholerae O1. This is the first case of bacteremia by Vibrio cholerae O1 reported in South America.

Revisión y recomendaciones para el manejo de diarrea por Vibrio parahaemolyticus / Review and guidelines for treatment of diarrhea caused by Vibrio parahaemolyticus

A contar del año 1998 se han presentado en Chile tres brotes epidémicos por Vibrio parahaemolyticus, el último de ellos durante el verano del 2005, que afectó a más de 10.000 personas. Los afectados presentaron un cuadro clínico caracterizado por diarrea, náuseas, vómitos, dolor abdominal y fiebre; 6 por ciento de los casos tuvo leucocitos fecales positivos y un paciente falleció. La cepa predominante en los tres brotes ha sido la pandémica O3: K6. El diagnóstico de V. parahaemolyticus se realizó con la confirmación microbiológica de las cepas y tipificación o por asociación epidemiológica. Las cepas fueron susceptibles in vitro a tetraciclina, cefalosporinas de tercera generación, quinolonas y cloranfenicol no observándose susceptibilidad a ampicilina. Todos los casos se asociaron al consumo de mariscos crudos o insuficientemente cocidos. Por la repercusión de este brote, el Ministerio de Salud impulsó la formación de una comisión multidisciplinaria para actualizar los aspectos epidemiológicos, clínicos y microbiológicos, y elaborar una guía de recomendaciones en el manejo de esta infección.

Food poisoning outbreak from contaminated fish-balls.

On February 9th, 1998, a food poisoning outbreak occurred at a boarding school for underprivileged students. An unmatched case-control study was done. An environmental survey, laboratory study of rectal swab culture, fish-balls, water and the cooking utensils were also performed. There were 132 suspect cases, of which the attack rate in teachers was 9.8 per cent (4/41), 16.7 per cent (1/6) in the food handlers and 15.7 per cent (127/810) in the students. The median incubation period was 18 hours. Analysis of food consumption revealed those who ate lunch noodles had the highest risk (OR 3.8, 95% CI 0.6-5.9). In details of food components, those who ate fish-balls in curry had the only significant risk (OR 3.5, 95% CI 1.2-0.8) of becoming ill when compared to those who did not. Fish-balls in noodles and curry had a dose response relationship. Bacterial culture from 25 grams of fish-balls was positive for Vibrio parahaemolyticus. The fish-balls in noodles and curry were identified as the implicated food. The modes of contamination were uncooked food, cooking utensils and the food handlers. The manufacturer, which had no license to operate and had poor standards of sanitation, was closed by the Food and Drug Administration.

Halophilic vibrio infections: a review

Los vibrios halofílicos son bacterías gram-negativas en forma de bacilos curvos que requieren altas concentraciones de sal para sobrevivir. Usualmente se encuentran en el medio ambiente marino a través del mundo. Las infeccioens causadas por estos organismos están usualmente asociados con la ingesta de marisco o la exposición de alguna herida a agua de mar. La presentación clínica y severidad de estas infecciones es muy variada. La presentación más común son síntomas no muy severos de gastroenteritis, pero puden ocurrir infecciones de tejido blando y septicemias presentando mortalidad elevada especialmente en pacientes con condiciones hepáticas pre-existentes. La detección temprana e inicio de tratamiento adequado con tetraciclina es de suma importancia debido a la rápida progresión de esta infección

Vibrio vulnificus Septicemia: Report of Four Cases

Vibrio vulnificus causes very severe infections. The organism is isolated, for the most part, from the blood, and skin lesions. Isolation from other sources, including the urine, is very rate. Four cases of V. vulnificus septicemia were bacteriologically diagnosed in 1984 and 1985 at Severance Hospital. All of the patients were men, 42 years and older, with preexisting liver disease. All of them showed hypotension and secondary skin lesions, and all expired. The organism was isolated from the blood in all patients, from the peritoneal fluid in one, and from skin lesions in two. From one patient, isolation from a urine speAmen was also accomplished. All of the isolates were typical in their characteristics such as in their forming green colonies on Thiosulfate citrate bile sucrose (TCBS) agar, delayed acid production from lactose, and growth in broth with 6% NaCl.