Vibrio vulnificus septicemia in Thailand: A 12-year case series and report of two fatal massive rhabdomyolysis cases

Abstract

Background: Vibrio vulnificus infection is prevalent among tropical coastal regions and septicemia due to this bacterium is often rapidly fatal. Our review of V. vulnificus cases in Thailand included microbiological and clinical analyses which have rarely been documented. They included a rare complication of rhabdomyolysis which has never been reported in this country. Objective: We reported a case series of V. vulnificus septicemia at a university hospital in Thailand during a 12-year period including two fatal cases with rhabdomylysis due to V. vulnificus infection. Methods: Our case series of patients with V. vulnificus septicemia was retrospectively reviewed to determine clinical presentations, risk factors, microbiologic data, hospital courses, treatment, and outcomes. Results: Twenty-nine patients, predominantly male, were identified. Most patients had underlying cirrhosis or related chronic liver diseases and 20 cases (69%) died rapidly. Cellulitis and necrotizing fasciitis were common presenting symptoms. Consumption of undercooked shellfish may be a local risk factor. Inadequate surgical intervention may be related to a high mortality rate. Two fatal cases with autopsy-proven acute massive rhabdomyolysis were described, which emphasized urgent appropriate management. Conclusion: This 29-case series identified that V. vulnificus septicemia had a high mortality rate. Chronic liver diseases are known underlying factors. Acute massive rhabdomyolysis is very rare as a fatal complication of V. vulnificus infection. Keywords: Cellulitis, cirrhosis, necrotizing fasciitis, rhabdomyolysis, septicemia, Vibrio vulnificus