Vibrio vulnificus Septicemia from Raw Shellfish

ISSUE: A 40-year-old male presented to the Emergency Department with fever, shortness of breath, bilateral leg ulcers, and history of Hepatitis C. After continued deterioration, blood cultures were drawn and an infectious disease consultation was called. The blood cultures grew gram-negative bacilli. After a thorough assessment by infectious disease, the patient admitted to ingesting raw oysters at a local restaurant. Preliminary diagnosis of Vibrio was determined. People with liver disease, low gastric acidity, and immunodeficiency are at an increased risk for septicemia. Infection in these individuals may result in death within 24–48 hours. Diagnosis and intervention are key elements in decreasing mortality. PROJECT: The preliminary diagnosis of Vibrio was submitted to public health officials. A complete seafood investigation was initiated by public health. The FDA was notified of the potential for a foodborne illness incident. Care of the critically ill patient included thoracentesis, hemodynamic support, dialysis, and antibiotics. RESULTS: The blood cultures were confirmed Vibrio vulnificus by the state lab. The oysters were traced by the FDA in conjunction with public health from the tags to the shipper, to the source of the seafood, and finally to the harvest site. There were no other cases identified during the timeframe in the city. The patient, when stabilized, was transferred to a rehabilitation hospital for care of his wounds. LESSONS LEARNED: Hepatitis C patients should be counseled concerning not eating raw shellfish. The restaurant added a notification to the menu cautioning immunosuppressed individuals to avoid ingesting raw shellfish.