Vibrio vulnificus meningoencephalitis in a patient with thalassemia and a splenectomy

J Neurovirol. 2019 Feb;25(1):127-132. doi: 10.1007/s13365-018-0675-8. Epub 2018 Nov 5.

Abstract

Vibrio vulnificus usually causes wound infection, gastroenteritis, and septicemia. However, it is a rare conditional pathogen causing meningoencephalitis. We report a case of a young, immunocompromised man presenting with severe sepsis after exposure to sea water and consumption of seafood. The patient subsequently developed meningoencephalitis, and Vibrio vulnificus was isolated from his blood culture. The sequence was confirmed by Next-generation sequencing of a sample of cerebrospinal fluid, as well as from a bacteria culture. After the pathogen was detected, the patient was treated with ceftriaxone, doxycycline, and moxifloxacin for 6 weeks, which controlled his infection. In this case, we acquired his clinical and dynamic MRI presentations, which were never reported. Physicians should consider Vibrio vulnificus infections when they see a similar clinical course, brain CT and MRI findings, susceptibility factors and recent seafood ingestion or exposure to seawater. Due to high mortality, the early diagnosis and treatment of Vibrio vulnificus infections are crucial. Next-generation sequencing was found to be useful for diagnosis.

Keywords: Clinical manifestations; MRI presentations; Next-generation sequencing; Vibrio vulnificus meningoencephalitis.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-Bacterial Agents / therapeutic use*
  • Ceftriaxone / therapeutic use
  • Doxycycline / therapeutic use
  • Humans
  • Immunocompromised Host*
  • Magnetic Resonance Imaging
  • Male
  • Meningoencephalitis / diagnostic imaging
  • Meningoencephalitis / drug therapy
  • Meningoencephalitis / immunology*
  • Meningoencephalitis / microbiology
  • Moxifloxacin / therapeutic use
  • Seafood / microbiology
  • Seawater / microbiology
  • Sepsis / diagnostic imaging
  • Sepsis / drug therapy
  • Sepsis / immunology*
  • Sepsis / microbiology
  • Splenectomy
  • Thalassemia / immunology
  • Thalassemia / pathology
  • Thalassemia / surgery
  • Treatment Outcome
  • Vibrio vulnificus / drug effects
  • Vibrio vulnificus / growth & development
  • Vibrio vulnificus / isolation & purification
  • Vibrio vulnificus / pathogenicity*

Substances

  • Anti-Bacterial Agents
  • Ceftriaxone
  • Doxycycline
  • Moxifloxacin