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Vibrio vulnificus is a Gram-negative, motile, curved bacillus of the family Vibrionaceae that is a rare cause of gastroenteritis, septicemia, and wound infections in humans. V. vulnificus is halophilic, flourishes in warm temperatures, and is part of the bacterial flora of the marine environment. The location of our health care setting, on the Gulf of Mexico, has given us the opportunity to observe a wide variety of clinical presentations of infections caused by this organism. In the first case, a 27-year-old man struck by lightning while windsurfing was found pulseless in the water and was resuscitated. The patient subsequently developed cardiac arrhythmias, respiratory failure, and necrotizing fasciitis, blood cultures yielded V. vulnificus. After antibiotic therapy and several fasciotomies, the patient recovered. The second case was that of a 43-year-old Asian man employed as an oyster shucker who presented with complaints of redness, tearing, and photophobia of the right eye. The diagnosis of corneal ulcer secondary to V. vulnificus was made after culture of the right eye revealed the organism. The third case involved a 46-year-old man who presented with complaints of abdominal pain, nausea, chills, and bullous lesions on the lower extremities. He developed disseminated intravascular coagulation, and cultures of the lesions on his lower extremities showed V. vulnificus. Initially, the patient denied any exposure to raw seafood or seawater, but he eventually remembered eating raw oysters 3 days before his illness. The fourth case is that of a 32-year-old, human immunodeficiency virus-positive, hepatitis C-positive woman with cirrhosis who presented with productive cough, chills, fever, and red spots on her extremities and buttocks. Blood cultures revealed V. vulnificus and the patient was treated with antibiotics and improved clinically. These four cases illustrate the wide range of clinical presentations associated with this organism.
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PMID:Varied clinical presentations of Vibrio vulnificus infections: a report of four unusual cases and review of the literature. 1498 56

Bacteremic necrotizing fasciitis caused by non-O1 Vibrio cholerae has rarely been reported. We describe a case of necrotizing fasciitis of the bilateral lower extremities in a 68-year-old man with liver cirrhosis and diabetes mellitus. Cultures of blood and the debrided tissue all yielded V. cholerae serogroup non-O1 (O56). Despite extensive radical debridement and antibiotic treatment with ceftazidime and doxycycline, the patient died on the 12th hospital day due to multiple organ failure. The present case is the first report of necrotizing fasciitis and bacteremia caused by V. cholerae serogroup O56.
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PMID:Bacteremic necrotizing fasciitis caused by Vibrio cholerae serogroup O56 in a patient with liver cirrhosis. 1562 44

A 76-year-old man with liver cirrhosis and diabetes mellitus was admitted to our hospital because of bacterial meningoencephalitis. He had eaten raw fish 2 days before onset. He also developed septic shock, disseminated intravascular coagulation, adult respiratory distress syndrome and panophthalmitis of the right eye. Vibrio vulnificus was isolated from the blood culture. Extensive therapy including antibiotics and nafamostat methylate, resulted in full recovery except for right blindness. The necrotizing fasciitis, which is common with Vibrio vulnificus infection, had not been complicated in this patient.
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PMID:[A patient with Vibrio vulnificus meningoencephalitis]. 1571 95

Infections caused by Vibrio vulnificus were first reported in 1979 by Blake et al. of the US Centers for Disease Control. At that time described as a 'rare, unnamed halophilic lactose-fermenting Vibrio species', V. vulnificus has emerged as the most virulent foodborne pathogen in the United States with a hospitalization rate of 0.910 and a case-fatality rate of 0.390. It is in addition a significant cause of potentially life-threatening wound infections. Infections following ingestion of raw or undercooked seafood, commonly raw oysters, can lead to a primary septicaemia with a fatality rate of 50-60%. An unusual symptom, occurring in 69% of 274 cases reviewed by Oliver, is the development of secondary lesions, typically on the extremities, which are generally severe (often a necrotizing fasciitis) and require tissue debridement or amputation. These cases occur almost exclusively in males over the age of 50 years. Interestingly, this gender specificity has been found to be due to the female hormone oestrogen, which in some manner provides protection against the lethal V. vulnificus endotoxin. Further, most cases occur in persons with certain underlying diseases which are either immunocompromising or which lead to elevated serum iron levels (e.g. liver cirrhosis, chronic hepatitis, haemochromatosis). V. vulnificus infections resulting in primary septicaemia have been extensively studied, and the subject of several reviews. This review concentrates on the wound infections caused by this marine bacterial pathogen, including the more recently described biotypes 2 and 3, with brief discussions of those caused by other marine vibrios, and the increasingly reported wound/skin infections caused by Mycobacterium marinum, Erysipelothrix rhusiopathiae, and Aeromnonas hydrophila.
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PMID:Wound infections caused by Vibrio vulnificus and other marine bacteria. 1596 44

Necrotising fasciitis is a fulminant and life-threatening infection. It is associated with a high mortality rate and is often seen in the aged and immunocompromised patients. Liver cirrhosis is regarded as a risk factor of necrotising fasciitis. From January 1995 to December 2003, 17 cirrhotic patients who had been admitted to our hospital for necrotising fasciitis were identified. The infection all developed in the lower extremities. Only six patients survived, and the overall case fatality rate was 64.7%. The cases were divided into two groups: survivors and nonsurvivors. Comparisons were made on age, gender, presenting symptoms, underlying medical diseases, laboratory data and clinical course. Underlying diabetes mellitus and grade C liver cirrhosis were the only statistically significant factors that led to poor prognosis (p< 0.05).
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PMID:Necrotising fasciitis: clinical features in patients with liver cirrhosis. 1599 30

Non-O1 Vibrio cholerae are gram-negative rods that can cause sporadic gastroenteritis, bacteraemia, and extraintestinal infections, primarily following the consumption of raw seafood or exposure of damaged skin to contaminated saltwater during the summer months. Bacteraemic necrotizing fasciitis caused by non-O1 V. cholerae has rarely been reported. Liver cirrhosis, haemochromatosis, and immunosuppression are important factors contributing to the severity of the infections and outcome. This report describes a case of liver cirrhosis in which right lower leg compartment syndrome and acute renal failure presented as the initial symptoms of bacteraemic necrotizing fasciitis. The organisms growing in the wound and blood cultures were identified as non-O1 V. cholerae. After antibiotic therapy, fasciotomy, right above-knee amputation, repeat debridement of the left lower leg and split-thickness skin grafts, the patient was eventually discharged in a stable condition.
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PMID:Bacteraemic necrotizing fasciitis with compartment syndrome caused by non-O1 Vibrio cholerae. 1711 24

Necrotizing fasciitis due to Vibrio vulnificus may result in overwhelming sepsis, leading to death in some patients. Significant risk factors for severe disease include preexisting liver disease. We report a case of Vibrio vulnificus necrotizing fasciitis in a patient with previously undiagnosed chronic hepatitis and cirrhosis.
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PMID:Necrotizing fasciitis from Vibrio vulnificus in a patient with undiagnosed hepatitis and cirrhosis. 1725 4

Necrotizing fasciitis is a life-threatening soft-tissue infection. It is useful to know the etiology of this disease in each community and region because this information can facilitate early diagnosis and treatment. We reviewed medical records of 217 consecutive patients with necrotizing fasciitis in South Korea. Etiologic organisms were documented in 171 (78.8%) patients. Gram-negative marine bacteria were the most common organisms (68.4%). Seasonal variation in incidence occurred during warmer periods. Liver cirrhosis and alcoholism were common underlying illnesses. Gastrointestinal symptoms were more common in persons infected with gram-negative marine bacteria (56.4% versus 29.6%). Gram-negative bacteria were the predominant pathogens in multiple site involvement. Acute Physiology and Chronic Health Evaluation II scores, marine bacteria, and medical treatment without surgery affected mortality. When necrotic areas included less than three extremities, fasciotomy improved the survival rate. In coastal areas, gram-negative marine bacteria are the most common pathogens associated with necrotizing fasciitis. Fasciotomy can improve survival of patients with necrotic areas that involve less than three sites in necrotizing fasciitis.
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PMID:Marine bacteria as a leading cause of necrotizing fasciitis in coastal areas of South Korea. 1934 93

We report a case of spontaneous bacterial peritonitis and necrotizing fasciitis caused by Bacillus cereus in a cirrhotic patient without preceding disruption of skin or symptoms of gastroenteritis. This rapidly fatal infection due to B. cereus adds to the long list of aetiologies of infectious complications among patients with cirrhosis of the liver.
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PMID:Fatal spontaneous bacterial peritonitis and necrotizing fasciitis with bacteraemia caused by Bacillus cereus in a patient with cirrhosis. 1985 Jul 8

Shewanella algae infections are rare in humans. Previously reported cases of S. algae have mainly been associated with direct contact with seawater. We report a case of primary S. algae bacteremia occurring after the ingestion of raw seafood in a patient with liver cirrhosis that presented a fulminent course of necrotizing fasciitis.
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PMID:Primary Shewanella algae bacteremia mimicking Vibrio septicemia. 1994 81


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