Non-O1, non-O139 Vibrio cholerae bacteremic skin and soft tissue infections.
BACKGROUND
Non-O1, non-O139 Vibrio cholerae can cause sporadic cases of gastroenteritis and extra-intestinal invasive infections, following exposure to contaminated seawater or freshwater or after consumption of raw seafood. Bacteremic infections with skin and soft tissue manifestations are uncommon and in most cases are associated with liver cirrhosis, haematologic malignancies, diabetes mellitus and other immunosuppressed conditions.


METHODS
The medical literature was reviewed and we found 47 published cases of non-O1, non-O139 Vibrio cholerae bacteremic skin and soft tissue infections. A fatal case of bacteremia with bullous cellulitis in a 43-year-old patient with liver cirrhosis is described, which is the first reported in Greece.


RESULTS
From January 1974 to May 2015, a total of 48 patients with non-O1, non-O139 Vibrio cholerae bacteremia with skin and soft tissue infections were reported. Males predominated. Liver cirrhosis, chronic liver disease and alcohol abuse were common comorbidities. The soft tissue lesions most commonly described were localised cellulitis, with or without bullous and haemorrhagic lesions (66.7%), while necrotising fasciitis was more rare (29.2%). Of the 48 patients with non-O1, non-O139 V. cholerae bacteremic skin and soft tissue infections, 20 (41.7%) died despite treatment.


CONCLUSIONS
Although rarely encountered, non-O1, non-O139 Vibrio cholerae should be included in the differential diagnosis of bacteremic skin and soft tissue infections in patients with underlying illnesses and epidemiologic risk factors. Timely and appropriate antibiotic and surgical treatments are important in the management of the infection.
a Department of Clinical Microbiology , Parasitology, Zoonoses and Geographical Medicine.
Sofia
S
Maraki
a Department of Clinical Microbiology , Parasitology, Zoonoses and Geographical Medicine.
Athanasia
A
Christidou
b Intensive Care Medicine Department , University Hospital of Heraklion , Crete , Greece.
Maria
M
Anastasaki
c Laboratory of Clinical Bacteriology and Molecular Microbiology , School of Medicine, University of Crete , Heraklion , Crete , Greece.
Efstathia
E
Scoulica
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D002481:Cellulitis / Q000175:diagnosis / Q000382:microbiology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D017809:Fatal Outcome; D005260:Female; D019337:Hematologic Neoplasms / Q000453:epidemiology; D006801:Humans; D007108:Immune Tolerance; D008103:Liver Cirrhosis / Q000453:epidemiology; D008297:Male; D009102:Multiple Organ Failure / Q000453:epidemiology; D012307:Risk Factors; D017192:Skin Diseases, Bacterial / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D018461:Soft Tissue Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D014735:Vibrio Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D044163:Vibrio cholerae non-O1 / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity*
D000900:Anti-Bacterial Agents
Greece; Non-O1; bacteremia; cellulitis; necrotising fasciitis; non-O139 Vibrio cholerae; skin and soft tissue infections