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.
- What is the most likely causative organism?
- What is the specific treatment required in this case?
College Answer
a)
- Vibrio vulnificus or V parahaemolyticus
b)
- Surgical debridement of necrotic tissue including amputation if indicated.
- Antibiotic therapy – 3rd generation cephalosporin + a tetracycline OR Ciprofloxacin OR Meropenem OR any reasonable antibiotic choice
Discussion
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.
References
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.