Clinical Snapshot
Necrotizing Soft Tissue Infection Due to Vibrio vulnificus After Bathing in the Baltic Sea
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In late summer 2023, a male patient in his 80s presented with phlegmon of the right lower limb. He had recently returned from a trip to the Baltic Sea. Due to catecholamine-dependent hypotension, the patient received intensive medical care and calculated treatment with ampicillin/sulbactam. The gram-negative pathogen Vibrio vulnificus was cultivated in blood cultures after 9 h. Antimicrobial therapy was switched to ceftriaxone/ciprofloxacin and later deescalated to ceftriaxone monotherapy. Fluoroquinolones were avoided due to their high selection pressure as well as the risk of aortic and Achilles tendon rupture. A key component of treatment was complete debridement of the phlegmon (Figure). Histopathology revealed erosive-ulcerative, purulent-phlegmonous, and necrotizing inflammation of the dermis and subcutis without necrotizing fasciitis. Antimicrobial treatment was discontinued after 14 days and the patient was discharged to rehabilitation. Although infections of this kind are rare in Germany, they could increase if the Baltic Sea warms as a result of climate change. Risk factors include age, male sex, and immunosuppression. The patient we treated did not have immunosuppression. The mortality rate for septic shock in V. vulnificus bloodstream infection is up to 50%.
Dr. med Daniela Tominski M.sc, Klinik für Infektiologie – Innere Medizin, Vivantes Auguste Viktoria Klinikum, Berlin, daniela.tominski@vivantes.de
Dr. med. Dinah von Schöning, Labor Berlin Charité Vivantes GmbH, Abteilung für Mikrobiologie und Hygiene, Berlin
Dr. med. Martin Franz, Vivantes Klinikum Kaulsdorf, Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, Berlin
Conflict of interest statement: The authors declare that no conflict of interests exists.
Translated from the original German by Christine Rye.
Cite this as: Tominski D, von Schöning D, Franz M: Necrotizing soft tissue infection due to Vibrio vulnificus after bathing in the Baltic Sea. Dtsch Arztebl Int 2024; 121: 654b. DOI: 10.3238/arztebl.m2024.0058
