Digestive Diseases and Sciences

, Volume 40, Issue 6, pp 1257–1260 | Cite as

FatalVibrio parahemolyticus septicemia in a patient with cirrhosis

A case report and review of the literature
  • Robert J. Hally
  • Raymond A. Rubin
  • Henry S. Fraimow
  • Margaret L. Hoffman-Terry
Case Report

Summary

Vibrio parahemolyticus has been well documented to cause outbreaks of infectious diarrhea, usually related to poor food handling; only rarely has it been reported to cause fatal septicemia. In contrast,Vibrio vulnificus is a well-known cause of septicemia, especially in patients with cirrhosis. A 31-year-old woman with cirrhosis who developed fatalV. parahemolyticus sepsis after ingesting raw seafood is described. We review the clinical syndromes associated with sepsis caused by these two organisms. Leg pain and bullous skin lesions may be a clue to the diagnosis. Febrile patients with cirrhosis should be questioned regarding recent seafood ingestion, and appropriate antibiotics chosen if this history is obtained. Physicians should inform patients at risk to avoid raw seafood in an attempt to prevent this potentially lethal syndrome.

Key words

cirrhosis Vibrio parahemolyticus Vibrio vulnificus septicemia 

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References

  1. 1.
    Morris JG Jr, Black RE: Cholera and Other Vibrioses in the United States. N Engl J Med 312:343–501, 1985PubMedGoogle Scholar
  2. 2.
    Blake PA, Merson MH, Weaver RE: Disease caused by a marineVibrio: Clinical characteristics and epidemiology. N Engl J Med 300:1–5, 1979PubMedGoogle Scholar
  3. 3.
    Hughes JM, Hollis DG, Gangarosa EJ, Weaver RE: NoncholeraVibrio infections in the United States: Clinical, epidemiologic, and laboratory features. Ann Intern Med 88:602–606, 1978PubMedGoogle Scholar
  4. 4.
    Barker WH:Vibrio parahemolyticus outbreaks in the United States. Lancet 1:551–554, 1974PubMedGoogle Scholar
  5. 5.
    Plotkin BJ, Kilgore SG, McFarland L: Polyvibrio infections:Vibrio vulnificus andVibrio parahemolyticus dual wound and multiple site infections. J Infect Dis 161:364–365, 1990PubMedGoogle Scholar
  6. 6.
    Howard RJ, Pessa ME, Brennaman BH, Ramphal R: Necrotizing soft tissue infections by marine vibrios. Surgery 98:126–130, 1985PubMedGoogle Scholar
  7. 7.
    Roland FP: Leg gangrene and endotoxin shock due toVibrio parahemolyticus—an infection acquired in New England coastal waters. N Engl J Med 282:1306, 1970Google Scholar
  8. 8.
    Armstrong CW, Lake JL, Miller GB Jr: Extraintestinal infections due to halophilic vibrios. South Med J 76:571–574, 1983PubMedGoogle Scholar
  9. 9.
    Klontz KC, Lieb S, Schreiber M, Janowski HT, Baldy LM, Gunn RA: Syndromes ofVibrio vulnificus infections: Clinical and epidemiologic features in Florida cases, 1981–1987. Ann Intern Med 109:318–323, 1988PubMedGoogle Scholar
  10. 10.
    Tay L, Yu M:Vibrio parahemolyticus isolated from blood cultures. Singapore Med J 19:89–92, 1978PubMedGoogle Scholar
  11. 11.
    Bonner JR, Coker AS, Berryman CR, Pollock HM: Spectrum ofVibrio infections in a Gulf Coast community. Ann Intern Med 99:464–469, 1983PubMedGoogle Scholar
  12. 12.
    Hlady WG, Mullen RC, Hopkins RS:Vibrio vulnificus infections associated with raw oyster consumption—Florida, 1981–1992. MMWR 42:405–407, 1993Google Scholar
  13. 13.
    Kelly MT: Effect of temperature and salinity onVibrio (Beneckea) vulnificus occurrence in a Gulf Coast environment. Appl Environ Microbiol 44:820–824, 1992Google Scholar
  14. 14.
    Gorbach SL: Infectious diarrhea and bacterial food poisoning.In Gastrointestinal Disease: Pathophysiology/Diagnosis/Management. MH Sleisenger, JS Fordtran (eds). Philadelphia, WB Saunders, 1993, pp 1128–1173Google Scholar
  15. 15.
    Morris JG Jr:Vibrio vulnificus—a new monster of the deep? Ann Intern Med 109:261–262, 1988PubMedGoogle Scholar
  16. 16.
    Scully RE, Mark EJ, McNeely WF, McNeely BU, Craven DE, Trucksis M: Case records of the Massachusetts General Hospital: Weekly Clinicopathological Exercises. N Engl J Med 321:1029–1038, 1989PubMedGoogle Scholar
  17. 17.
    Rajkovic IA, Williams R: Abnormalities of neutrophil phagocytosis, intracellular killing and metabolic activity in alcoholic cirrhosis and hepatitis. Hepatology 6:252–262, 1986PubMedGoogle Scholar
  18. 18.
    Garcia-Tsao G: Spontaneous bacterial peritonitis. Gastroenterol Clin North Am 21:257–275, 1992PubMedGoogle Scholar
  19. 19.
    Hoff G, Giedinghagen DH, Thomas MC:Vibrio infections in Kansas City. Mo Med 87:881–883, 1990PubMedGoogle Scholar
  20. 20.
    Wright AC, Simpson LM, Oliver JD: Role of iron in the pathogenesis ofVibrio vulnificus infections. Infect Immun 34:503–507, 1981PubMedGoogle Scholar
  21. 21.
    Bullen JJ, Spalding PB, Ward CG, Gutteridge JMC: Hemochromatosis, iron, and septicemia caused byVibrio vulnificus. Arch Intern Med 151:1606–1609, 1991PubMedGoogle Scholar
  22. 22.
    Blake PA, Weaver RE, Hollis DG: Diseases of humans (other than cholera) caused by vibrios. Annu Rev Microbiol 34:341–367, 1980PubMedGoogle Scholar
  23. 23.
    Doyle MP: PathogenicEscherichia coli, Yersinia enterocolitica, andVibrio parahemolyticus. Lancet 336:1111–1115, 1990PubMedGoogle Scholar
  24. 24.
    Spriggs DR, Sack RB: Summary of the 25th United States-Japan Joint Conference on cholera and related diarrheal diseases. J Infect Dis 162:584–590, 1990PubMedGoogle Scholar
  25. 25.
    Hughes JM, Boyce JM, Aleem AR, Wells JG, Rahman AS, Curlin GT:Vibrio parahemolyticus enterocolitis in Bangladesh: Report of an outbreak. Am J Trop Med Hyg 27:106–112, 1978PubMedGoogle Scholar
  26. 26.
    Zide N, Davis J, Ehrenkranz J: FulminatingVibrio parahemolyticus septicemia: A syndrome of erythemia multiforme, hemolytic anemia, and hypotension. Arch Intern Med 133:479–481, 1974PubMedGoogle Scholar
  27. 27.
    Weaver RE, Ehrenkranz NJ:Vibrio parahemolyticus septicemia. Arch Intern Med 135:197, 1975PubMedGoogle Scholar
  28. 28.
    Hayashi S, Nakamura T, Kurita Y, Kanoh J, Yoshii S: An autopsy case ofVibrio parahemolyticus sepsis. J Jpn Soc Intern Med 78:949–952, 1989Google Scholar
  29. 29.
    Klontz KC: Fatalities associated withVibrio parahemolyticus andVibrio cholerae non-O1 infections in Florida (1981–1988). South Med J 83:500–502, 1990PubMedGoogle Scholar
  30. 30.
    Hollis DG, Weaver RE, Baker CN, Thornsberry C: HalophilicVibrio species isolated from blood cultures. J Clin Microbiol 3:425–423, 1976PubMedGoogle Scholar
  31. 31.
    Kelly MT, Hickman-Brenner FW, Farmer JJ III:Vibrio Manual of Clinical Microbiology, 5th ed. A Balows (ed). Washington, American Society for Microbiology, 1991, pp 384–395Google Scholar
  32. 32.
    Joseph SW, Debell RM, Brown WP:In vitro response to chloramphenicol, tetracycline, ampicillin, getamicin, and betalactamase production by halophilic vibrios from human and environmental sources. Antimicrob Agents Chemother 13:244–248, 1978PubMedGoogle Scholar
  33. 33.
    Auerbach PS, Yajko DM, Nassos PS, Kizer KW, McCosker JE, Geehr EC, Hadley WK,: Bacteriology of the marine environment: Implications for clinical therapy. Ann Emerg Med 16:643–649, 1987PubMedGoogle Scholar
  34. 34.
    Carson JL, Strom BL, Duff A, Gupta A, Shaw M, Lundin FE, Das K: Acute liver disease associated with erythromycins, sulfonamides, and tetracyclines. Ann Intern Med 119:576–583, 1993PubMedGoogle Scholar
  35. 35.
    Tacket CO, Brenner F, Blake PA: Clinical features and an epidemiological study ofVibrio vulnificus infections. J Infect Dis 149:558–561, 1984PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • Robert J. Hally
    • 1
    • 2
  • Raymond A. Rubin
    • 1
    • 2
  • Henry S. Fraimow
    • 1
    • 2
  • Margaret L. Hoffman-Terry
    • 1
    • 2
  1. 1.From the Division of Gastroenterology, Department of MedicineThomas Jefferson University HospitalPhiladelphia
  2. 2.Division of Infectious Diseases, Department of MedicineThomas Jefferson University HospitalPhiladelphia

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