Wound infection with Vibrio harveyi following a traumatic leg amputation after a motorboat propeller injury in Mallorca, Spain: a case report and review of literature

Abstract

Background: Vibrio spp. are aquatic bacteria that are ubiquitous in warm estuarine and marine environments, of which 12 species are currently known to cause infections in humans. So far, only five human infections with V. harveyi have been reported. Case presentation: A 26-year old patient was transferred to our center by inter-hospital air transfer from Mallorca, Spain. Seven days before, he had suffered a complete amputation injury of his left lower leg combined with an open, multi-fragment, distal femur fracture after he had been struck by the propeller of a passing motorboat while snorkeling in the Mediterranean Sea. On admission he was febrile; laboratory studies showed markedly elevated inflammatory parameters and antibiotic treatment with ampicillin/sulbactam was initiated. Physical examination showed a tender and erythematous amputation stump, so surgical revision was performed and confirmed a putrid infection with necrosis of the subcutaneous tissue and the muscles. Tissue cultures subsequently grew V. harveyi with a minimal inhibitory concentration (MIC) of 16 mg/L for ampicillin, and antibiotic treatment was switched to ceftriaxone and ciprofloxacin. Throughout the following days, the patient repeatedly had to undergo surgical debridement but eventually the infection could be controlled, and he was discharged. Conclusions: We report the first human infection with V. harveyi acquired in Spain and the second infection acquired in the Mediterranean Sea. This case suggests that physicians and microbiologists should be aware of the possibility of wound infections caused by Vibrio spp. acquired in the ocean environment, especially during hot summer months. Since Vibrio spp. preferentially grow at water temperatures above 18°C, global warming is responsible for an abundance of these bacteria in coastal waters. This will likely lead to a worldwide increase in reports of Vibrio-associated diseases in the future.

Heatwave-associated Vibrio infections in Germany, 2018 and 2019

“…As in other studies, this finding demonstrates that most infections with Vibrio spp. involve either exposure of previously contracted wounds to seawater or injuries acquired during water-based activities [ 9 , 37 ]. The vast majority of Vibrio infections (n = 54; 86%) occurred between June and September: when water-associated recreational activities increase, high SSTs are responsible for an elevated abundance of Vibrio spp.…”

“…can manifest as wound infections, ear infections, gastroenteritis, and primary septicaemia and have been predominantly reported in tropical and subtropical regions [ 6 ]. In Europe, cases are rare, and infections associated with the Mediterranean Sea [ 7 - 9 ], the Atlantic Ocean [ 10 - 12 ], or the Baltic Sea [ 13 , 14 ] have only been sporadically reported. However, a rapidly warming marine environment accompanied by an increase in extreme weather events such as heatwaves has resulted in unprecedented peak SSTs favouring the spread of Vibrio spp.…”

Molecular Detection and Distribution of Six Medically Important Vibrio spp. in Selected Freshwater and Brackish Water Resources in Eastern Cape Province, South Africa

“…In some studies from other provinces of South Africa, the isolation of Vibrio harveyi , V. parahaemolyticus , V. cholerae , V. mimicus , and V. vulnificus from tap, borehole, and dam in North West province ( Maje et al, 2020 ) and V. cholerae from four WWTPs located in Gauteng Province ( Dungeni et al, 2010 ) has also been reported. Health risks that an individual using these water resources could be exposed to include gastrointestinal infections caused by V. parahaemolyticus , V. mimicus , and V. fluvialis ; wound infections caused by V. vulnificus and V. harveyi ; cholera caused by V. cholerae ; and cholera-like bloody diarrhea caused by V. fluvialis ( Ramamurthy et al, 1994 ; Igbinosa and Okoh, 2010 ; Jones, 2017 ; Brehm et al, 2020 ).…”

Nicht-Cholera-Vibrionen – derzeit noch seltene, aber wachsende Infektionsgefahr in Nord- und Ostsee

“…Aber auch bei einem entsprechendem Krankheitsbild von Reiserückkehrern muss an Infektionen mit Nicht-Cholera-Vibrionen gedacht werden. Dies verdeutlicht der Fall eines 2018 im Universitätsklinikum Hamburg-Eppendorf behandelten Patienten, der sich auf Mallorca im Rahmen einer Schiffsschraubenverletzung mit Amputation des Unterschenkels eine Wundinfektion mit V. harveyi zugezogen hatte [ 8 ]. Um in Zukunft tiefergehende Erkenntnisse über Epidemiologie, Mikrobiologie und klinische Zeichen von Infektionen mit Nicht-Cholera-Vibrionen zu gewinnen, ist neben einer zuverlässigen Surveillance dringend auch weitere Forschung zu diesen neu aufkommenden Pathogenen erforderlich.…”