Fatal Vibrio vulnificus Sepsis in Vertically Acquired Hepatitis C

Abstract

P ostoperative management of esophageal atresia (EA) frequently mandates serial dilations and application of local antifibrotic agents to control recalcitrant anastomotic strictures. Recently, temporary esophageal stenting has been described to maintain patency (1-4). Indwelling foreign material has an associated risk of erosion, and this must be considered when managing patients with anastomotic strictures after long-gap EA repair. We report 2 cases of arterioesophageal fistula formation and massive upper gastrointestinal bleeding (UGIB) related to stent placement after EA repair, each with unrecognized aberrancy of the right subclavian artery (ARSA). Based on these events, the authors advise that esophageal stents be placed only after detailed imaging studies rule out vascular aberrancy.

Vibrio vulnificus quorum-sensing molecule cyclo(Phe-Pro) inhibits RIG-I-mediated antiviral innate immunity

“…Regarding the severe liver dysfunction observed in chronic HCV patients co-infected with V. vulnificus 7 – 10 , several possible interpretations other than cFP-mediated inhibition of RIG-I activation may also explain such fulminant liver disease with high mortality. Iron-overloaded mice were shown to be more susceptible to V. vulnificus infection 50 .…”

“…Because increased hepatic iron content is a common finding among patients with chronic HCV infection 51 , homing of Vibrio to the liver may aggravate chronic HCV infection. V. vulnificus PAMPs 7 – 10 , which can stimulate multiple TLRs in the liver, may also lead to liver failure 52 , 53 . For instance, production of proinflammatory cytokines induced by V. vulnificus virulence factors such as capsular polysaccharide, lipopolysaccharide, cytotoxins, pili, and flagellum may explain the vulnerability of patients affected by HCV related-chronic liver disease 9 , 54 .…”

“…Previous clinical studies and public health customs warn against raw oyster/shellfish consumption by patients with chronic liver diseases, since V. vulnificus contamination in such uncooked seafood can aggravate symptoms 6 . Particularly in immune-compromised people or those with liver diseases, such as cirrhosis or hepatitis, infection by this opportunistic pathogen is often associated with high lethality 7 – 10 . However, there is insufficient data regarding the molecular mechanisms of disease severity caused by co-infection of V. vulnificus and liver-specific viruses such as hepatitis C virus (HCV).…”

“…HCV, which has a positive-sense, uncapped RNA genome ~9.6-kb in length, is a leading cause of chronic liver disease, contributing to the development of liver cirrhosis and hepatocellular carcinoma 11 . Clinical case reports call for differential medical care of chronic HCV patients who are co-infected with V. vulnificus 8 – 10 . The severe disease outcomes caused by co-infection by these two pathogens prompted us to test the hypothesis that V. vulnificus might blunt antiviral innate immunity to HCV.…”

Visual LAMP Method for Detection of Vibrio vulnificus in Aquatic Products and Environmental Water

“…vulni cus infection can be caused by eating raw or uncooked oysters [10]. V. vulni cus infections are characterized by acute onset, severe disease and high mortality, with 50% of patients dying as a result of multiple organ failure within 48 h after onset [11], increasing to 100% if patients are not treated within 72 h [12]. V. vulni cus infections tend to increase with the increase with climate warming and offshore activities.…”