Fatal Vibrio vulnificus Infection Associated with Eating Raw Oysters, New Caledonia

To the Editor: The bacterium Vi-brio vulnifi cus is a marine fl ora sap-rophyte that can cause necrotic skin infection and septicemia in humans who eat shellfi sh. Symptoms of sep-ticemia (mortality rate >50%) have been described mostly in Florida and Japan among persons who ate raw fi lter-feeding shellfi sh when seawater temperatures are >20°C (1). V. vulnifi cus–related septicemia introduced through the digestive system appears within 7 days after inges-tion (2). Clinical signs and symptoms include fever, collapse, and metastatic necrotic skin lesions. We report 3 patients from New Caledonia who died after V. vulnifi cus infection, which they probably acquired by eating contaminated oysters. These patients were hospitalized during February–May 2008 at Noumea Hospital (Noumea, New Caledonia). Patient 1 was a 51-year-old man with fever, muscle pains, bleeding gums, and a history of alcohol abuse; within 48 hours after symptom onset, he died of septic shock, with diffuse ecchymoses and purpura. Patient 2 was a 67-year-old woman with no known concurrent conditions who was admitted to the hospital with chills, diarrhea, and vomiting; septic shock developed, with painful erythematous plaques on the lower limbs becoming foamy, confl uent, and necrotic. Patient 3 was a 74-year-old woman with untreated lupus who was hospitalized with lower-limb edema, hypotension, hypothermia, and erythematous skin lesions. All 3 patients received cepha-losporins but died of multiple organ failure within 12 hours after hospital admission. Peripheral blood aerobic–anaer-obic samples were taken from all patients , stored in BacT/Alert FA vials (bioMérieux, Marcy-l'Etoile, France), and incubated in the BacT/Alert 3D system (bioMérieux). Curved mobile gram-negative bacilli were isolated from blood samples cultured on conventional media without additional salt within 24 h after incubation at 37°C in a 5% CO 2-enriched atmosphere. V. vulnifi cus was identifi ed through the Vitek2 system (bioMérieux) and con-fi rmed by using the Api 20E system (bioMérieux). Strains were sent to the Centre National de Reference des Vibrions et du Choléra, (Institut Pasteur, Paris, France), which by PCR confi rmed the gene encoding virulence-associated hemolysin, a species-specifi c marker (3). Molecular typing by pulsed-fi eld gel electrophoresis was performed to assess possible clonality of the strains. Several studies have shown the genomic diversity among environmental and clinical V. vulnifi cus isolates. The use of genotyping methods has identifi ed >100 V. vulnifi cus strains in a single oyster (4) and notable hetero-geneity among clinical isolates from multiple patients, even if …