Presentation Title

Vibrio Vulnificus Bacteremia Secondary to Pool Water Aspiration

Speaker Credentials

Medical Education

Speaker Credentials

MD

Format

Poster

Start Date

6-11-2020 10:30 AM

End Date

6-11-2020 10:45 AM

Abstract

Vibrio Vulnificus Bacteremia Secondary to Pool Water Aspiration Daniel High,MD¹, Nicole Cohen,MD², Arian Bethencourt,MD³, Hector Vazquez,MD⁴, Paola R. Solari,MD⁵ ¹Internal Medicine Resident, Aventura Hospital and Medical Center ²Infectious Disease Fellow, Aventura Hospital and Medical Center ³Pulmonary Disease and Critical Care Fellow, Aventura Hospital and Medical Center ⁴Pulmonary Disease and Critical Care Faculty, Aventura Hospital and Medical Center ⁵Infectious Disease Faculty, Aventura Hospital and Medical Center Introduction. Vibrio vulnificus is a halophilic, gram-negative bacteria. Inoculation is typically from seafood ingestion or saltwater contamination of wounds that imposes a high mortality rate. Predisposing factors include diabetes mellitus, liver disease, end-stage renal disease, rheumatoid arthritis, and hemochromatosis. Case Description. An 80-year-old female with a 50 pack-year smoking history, Atrial Fibrillation on rivaroxaban, Chronic Obstructive Pulmonary Disease, and Chronic Lymphocytic Leukemia not requiring treatment, presents to the emergency department 3 days after a near-drowning event at a chlorinated pool, complaining of "stabbing" substernal chest pain radiating to the back, chills, nausea/vomiting, and productive cough for several hours. She denied dyspnea, hemoptysis, or sick contacts. White blood cell count on admission was 88 x 1011 / L. Examination revealed tachycardia and clear lungs. Chest CTA scan demonstrated faint diffuse ground glass opacification consistent with possible aspiration pneumonitis, mediastinal and bilateral axillary adenopathy, hepatosplenomegaly, and no aortic dissection or pulmonary embolism. EKG showed Afib with rapid ventricular response. Empiric cefepime and azithromycin were started. Both admission blood cultures grew V. vulnificus and antibiotics were changed to ceftriaxone and doxycycline. Repeat blood cultures were negative; she was discharged home to complete 14 days of IV antibiotics and short course of steroids. Discussion. This patient acquired V. vulnificus bacteremia by near drowning, leading to aspiration pneumonitis and ingestion. There is at least one previous case report of V. vulnificus gastroenteritis and pneumonia following near drowning though this may be the first reported case from a chlorinated pool.

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Nov 6th, 10:30 AM Nov 6th, 10:45 AM

Vibrio Vulnificus Bacteremia Secondary to Pool Water Aspiration

Vibrio Vulnificus Bacteremia Secondary to Pool Water Aspiration Daniel High,MD¹, Nicole Cohen,MD², Arian Bethencourt,MD³, Hector Vazquez,MD⁴, Paola R. Solari,MD⁵ ¹Internal Medicine Resident, Aventura Hospital and Medical Center ²Infectious Disease Fellow, Aventura Hospital and Medical Center ³Pulmonary Disease and Critical Care Fellow, Aventura Hospital and Medical Center ⁴Pulmonary Disease and Critical Care Faculty, Aventura Hospital and Medical Center ⁵Infectious Disease Faculty, Aventura Hospital and Medical Center Introduction. Vibrio vulnificus is a halophilic, gram-negative bacteria. Inoculation is typically from seafood ingestion or saltwater contamination of wounds that imposes a high mortality rate. Predisposing factors include diabetes mellitus, liver disease, end-stage renal disease, rheumatoid arthritis, and hemochromatosis. Case Description. An 80-year-old female with a 50 pack-year smoking history, Atrial Fibrillation on rivaroxaban, Chronic Obstructive Pulmonary Disease, and Chronic Lymphocytic Leukemia not requiring treatment, presents to the emergency department 3 days after a near-drowning event at a chlorinated pool, complaining of "stabbing" substernal chest pain radiating to the back, chills, nausea/vomiting, and productive cough for several hours. She denied dyspnea, hemoptysis, or sick contacts. White blood cell count on admission was 88 x 1011 / L. Examination revealed tachycardia and clear lungs. Chest CTA scan demonstrated faint diffuse ground glass opacification consistent with possible aspiration pneumonitis, mediastinal and bilateral axillary adenopathy, hepatosplenomegaly, and no aortic dissection or pulmonary embolism. EKG showed Afib with rapid ventricular response. Empiric cefepime and azithromycin were started. Both admission blood cultures grew V. vulnificus and antibiotics were changed to ceftriaxone and doxycycline. Repeat blood cultures were negative; she was discharged home to complete 14 days of IV antibiotics and short course of steroids. Discussion. This patient acquired V. vulnificus bacteremia by near drowning, leading to aspiration pneumonitis and ingestion. There is at least one previous case report of V. vulnificus gastroenteritis and pneumonia following near drowning though this may be the first reported case from a chlorinated pool.