A 61-year-old male fisherman presented to the Emergency Department with hypotension, three days after falling on a coastal slipway and suffering extensive abrasions to both lower limbs. These abrasions are now progressing and transforming into haemorrhagic bullae. The patient is now admitted to the ICU for organ support.
This question requires the candidate to be familiar with a fairly rare pathogen.
a) Vibrio vulnificus is strongly suggested by the keywords "fisherman" and "coastal slipway".
b) A tetracycline, ciprofloxacin or meropenem are all good choices.
The Sanford Guide recommends doxycycline together with ceftriaxone, with ciprofloxacin as an alternative sole agent.
Strom, Mark S., and Rohinee N. Paranjpye. "Epidemiology and pathogenesis of Vibrio vulnificus." Microbes and infection 2.2 (2000): 177-188.
Bross, Michael H., et al. "Vibrio vulnificus infection: diagnosis and treatment."American family physician volume 76, number 4 (2007): 539-544.