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

• Published in: BMC infectious diseases 2020-02, Vol.20 (1), p.104-7, Article 104
• Main Authors: Brehm, Thomas Theo, Berneking, Laura, Rohde, Holger, Chistner, Martin, Schlickewei, Carsten, Sena Martins, Meike, Schmiedel, Stefan
• Format: Article
• Language: English
• Subjects: Adult; Ampicillin; Amputation; Amputation injury; Amputation stump; Amputation, Traumatic - complications; Anti-Bacterial Agents - therapeutic use; Antibiotics; Aquatic bacteria; Bacteria; Blood; Brackish water; Case Report; Case reports; Ceftriaxone; Cholera; Ciprofloxacin; Climate; Climate change; Coastal waters; Diseases; Estuaries; Femur; Fractures; Fractures (Injuries); Genomes; Global temperature changes; Global warming; Health aspects; Humans; Infection; Infections; Infectious diseases; Inflammation; Leg; Leg Injuries - surgery; Literature reviews; Male; Marine environment; Meropenem; Microbial Sensitivity Tests; Minimum inhibitory concentration; Motor boats; Motorboat propeller injury; Muscles; Necrosis; Non-cholera Vibrio; Pathogens; Patients; Penicillins; Physicians; Pleasure boats; Seafood; Ships - instrumentation; Skin diving; Snorkeling; Spain; Sports injuries; Sulbactam; Surgical Wound Infection - drug therapy; Surgical Wound Infection - etiology; Surgical Wound Infection - microbiology; Trauma; Vibrio; Vibrio - drug effects; Vibrio - genetics; Vibrio - isolation & purification; Vibrio carchariae; Vibrio harveyi; Vibrio infections; Vibrio Infections - microbiology; Water temperature; Waterborne diseases; Wound infection
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-020-4789-2

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. 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. 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.