Instituto de Medicina Tropical “Pedro Kour풒
Instituto Politécnico Nacional de México
Universidad de los Andes, Mérida-Venezuela

Severe otitisdue to Vibriofluvialisin a patient with AIDS: First report in the world

Dr. Luis Enrique Cabrera Rodríguez,¹ Dra. Sara Palma Monroy,² Lic. Luis Morier,³ Dra. María Margarita Ramírez Álvarez,⁴Téc. Anabel Fernández Abreu,⁵ Dra. GracielaCastro Escarpulli,⁶ Dra. Aurora Longa Briceño⁷ y Lic. Laura Bravo Fariñas⁸

Vibrio species are natural inhabitants of brackish and salty water worldwide. Human disease is associated with the ingestion of contaminated water or consumption of contaminated shellfish or seafood. Vibrio fluvialis is one of halophic vibrio is distinct from non –cholera vibrios and have been recognized increasing as potentially pathogenic bacteria in extraintestinal infections.¹ We describe a case of sharp diffuse external otitis associated which was caused by Vibrio fluvialis in patient with AIDS.

Case report

A 34-year old man with a history of AIDS (CD4 cell count =123 /mm³). Five days after swimming in a pool of sea water the patient had fever of 38.5 °C, purulent exudate through the auditive duct; intense pain in the right ear region, which intensified during mastication, the patient was referred to the “Pedro Kouri” Instituteof Tropical Medicinein the Havana City, Cuba. Physical examination revealed a remarkable edematous and erythematous external auditive duct, with a purulent exudate, and adenopathies in the auricular and retroauricular regions. Examination of the cardiovascular system as well as of other system was normal. On his admission to the hospital an ear swab was done and treatment with 500 mg of tetracycline, taken orally every 6 h, was started. Treatment was discontinued after 10 days and the patient’s condition improved clinically.

 Laboratory tests revealed: Hemoglobin, 11.6 g/L; hematocrits, 37.0 %; eritrosedimentation, 74mm/h; leukocyte count, 13.000 x 10⁹; neutrophils, 79 %; platelet count, 210 000. Blood chemistry values were as follows: glucose, 5.5 mm/L; creatinine 130 mg/dL. The purulent exudate collected from the lesion before starting treatment was directly plated on Mac Conkey agar and incubated at 37 °C for 18h. The isolate, presumably identified as Vibrio fluvialis by API (Analytical Profile Index /Identification) 20E biochemical testing series (bioMérieux, France), was definitely identified according to the standard procedures: it was oxidase positive, esculine negative and string test positive. It grew on thiosulfate-citrate-bilesalts-sucrose agar (TCBS>,Oxoid) with yellow colonies due to the sucrose fermentation. The isolate was susceptible to 10 mg and 150 mg disks of the O/129 compound (2>, 4-diamino-6, 7-diisoprropylperidine phosphate). It also grew in 6.5 % NaCl and was L-lysine >Möller (1 % NaCl) and L-ornithine decarboxylase negative and arginine dihydrolase positive. No other bacterial pathogens were isolated.² The antimicrobial susceptibility test, performed with the Kirby-Bauer method>,³ showed that the strain was susceptible to tetracycline, ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, nalidixic acid, ciprofloxacin, streptomycin, erythromycin, gentamicin, cefuroxime, polymixin B. The prevalence of Vibrio fluvialis intestinal infection in patients with AIDS has been reported in the literature.^4-6> >The species most often associated with soft-tissue infections are V. vulnificus, V. alginolyticus, and V. dansela.⁷ The isolation of V. fluvialis without other >bacteria suggests that this species had a contributing role in the development of this patient^¢s otitis. The patient^¢s history would suggest that sea water constituted infection source in this case.This is the first case reported in Cuba and as far as we know in the world. As a conclusion, clinicians should consider V. fluvialis infection in the differential diagnosis when assessing immunocompromised patients.

References

1. Other pathogenic vibrios. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas and Bennett¢s. Principles and practice of infectious diseases. 4^th ed. New York: Churchill Livingstone; 1995. p. 1945-8.

2. Farmer JJ III, Janda M, Birkhead K. Vibrio. In:Murray PR, Baron EJ, Pfaller MA, Jorgensen JH, Yolken , eds. Manual of Clinical Microbiology 8 ^th ed. Washington, DC: American Society for Microbiology; 2003.p.706-17.

3. National Committee for Clinical Laboratory Standards Performance Standards for Antimicrobial Susceptibility Testing 2001. Eleventh Informational Supplement. NCCLS Document M100-S11.Wayne, 2001.

4. ChinKP, Lowe MA, Tong MJ, Koehleer AL. Vibrio fluvialis infection after raw oyster ingestion in a patient with liver disease and acquired immune deficiency syndrome related complex. Gastroenterology 1987;92:796-9.

5. Laughon BE, Druckman DA, Vernon A. Prevalence of enteric pathogens in homosexual men with and without acquired immunodeficiency syndrome. Gastroenterology 1988;94:984-93.

6. Varghese RM, Farr RW, Wax MK, Chafin BJ, Owens RM. Vibrio fluvialis wound infection associated with medical leech therapy. Clin Infect Dis 1996;22:709-10.

7. Mukherji A, Schroeder S, Deyling C, Procop GW. An unusual soured of Vibrio alginolyticus associated otitis: prolonged colonization of freshwater exposure. Arch Oto HN Surg 2000;126:790-1.

 

Recibido: 8 de octubre de 2004. Aprobado: 4 de febrero de 2005.
Lic. Laura Bravo Fariñas. Instituto de Medicina Tropical “Pedro Kour풒. Autopista Novia del Mediodía Km 6 1/>2 , AP 601, Marianao 13, Ciudad de La Habana. Teléf: 202-04-36 al 45. Correo electrónico: >[e-mail]

¹ Especialista de I Grado en Microbiología. Instituto de Medicina Tropical “Pedro >Kourí>’’(IPK).
² Doctora en Medicina. IPK.
³ Licenciado en Ciencias Biológicas. Investigador Auxiliar. IPK.
⁴ Especialista de II grado en Microbiología. Investigadora Agregada. IPK.
⁵ Técnica en Farmacia. IPK.
⁶ Doctora en Ciencias. Laboratorio de Bacteriología Médica Escuela Nacional de Ciencias Biológicas. Instituto Politécnico Nacional. México. Becario COFAA>,EDD.
⁷ Máster en Ciencias. Laboratorio de Bacteriología Médica Escuela Nacional de Ciencias Biológicas. Universidad de los Andes. Mérida-Venezuela.
⁸ Doctora en Ciencias. Licenciada en Ciencias Biológicas. IPK.

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