Sinister seafood: bacteraemia secondary to non-O1/O139 Vibrio cholerae infection

Introduction. Vibrio species are curved, motile Gram-negative bacilli found in estuarine and marine environments, and are known to cause to gastroenteritis, skin and soft tissue infections, and septicaemia. While not responsible for cholera epidemics, non-O1/O139 Vibrio cholerae (NOVC) is increasingly reported as a cause of gastroenteritis.

Case presentation. A 66-year-old man presented to an emergency department with a 1 week history of epigastric pain, emesis and fever. Blood cultures drawn on admission initially demonstrated Gram-negative bacilli, and ultimately grew NOVC, which was later confirmed by matrix-assisted laser desorption ionization-time of flight MS. Subsequent history revealed that the patient had eaten fish and seafood prior to falling ill. He was treated with intravenous ceftriaxone and oral doxycycline while admitted, and oral ciprofloxacin and doxycycline upon discharge. His bacteraemia was believed to be secondary to altered gut anatomy from prior surgery and proton-pump inhibitor use.

Conclusion. Risk factors for NOVC bacteraemia include cirrhosis, immunosuppression and other forms of liver disease. Cases are often linked to a history of seafood ingestion when water temperatures rise, enabling Vibrio species to proliferate. While the optimal management of NOVC bacteraemia is unclear, a combination of a third-generation cephalosporin with a tetracycline has been suggested. Physicians should maintain a high index of suspicion for this pathogen when evaluating ill patients with a history of liver disease and seafood ingestion.