(1468) A Raw Deal: A Dangerous Dietary Indiscretion

Introduction: Vibrio Vulnificus (V. vulnificus) is an aquatic gram negative bacillus that can cause diarrhea, soft tissue infections, and septicemia. V. vulnificus' most prominent impact is seen in patients with chronic underlying illness, such as cirrhosis or hemochromatosis. Predominantly seen in summer and early fall, this aerobic bacteria is abundant in recessed, costal bodies of water. Foodborne illness is transmitted via filter-feeding organisms such as shellfish which concentrate V. vulnificus to levels higher than the surrounding water.

Description: We present a case of a 56-year-old male with metastatic stage IV gastroesophageal adenocarcinoma actively receiving chemotherapy. He presented with severe weakness and urticaria on the lower abdomen and thigh. He was febrile with clinical indicators of septic shock. Following ICU admission blood cultures were drawn, 30mL/Kg fluid bolus was given, empiric antibiotics with vanc/cefepime/micafungin and subsequent vasopressor therapy for septic shock was provided. Blood cultures initially showed gram negative rods, suspected to be line related. It soon speciated out to Vibrio vulnificus and at that point patient was further asked about travel and recent food ingestion. He admitted to having just one raw oyster a few days prior when out with family. The sensitivities showed good coverage with cefepime and other antibiotics were stopped. Following several days of treatment he was downgraded safely from the ICU.

Discussion: V. vulnificus is a pathogen which exerts its greatest effect on immunocompromised hosts. Found in marine environments this organism can have lethal consequences if not suspected and treated swiftly. Mortality approaches 35% in immunocompetent hosts and nearly twice that in immunocompromised individuals. Broad spectrum gram negative coverage with cefepime, often the empiric choice in the ICU, has good effect against this agent. Our case urges the importance of thorough history including recent diet. V. vulnificus is the leading cause of all seafood-related death in the United States; a large portion of patients with V. vulnificus septicemia report having consumed raw oysters. Oyster bars have warnings against ingestion by immunocompromised people for this reason.