Lower extremity manifestations of Vibrio vulnificus infection.

Vibrio vulnificus is a potentially lethal marine bacterium that has not been previously described in podiatric literature. A review of the microorganism's characteristics, susceptible patient population, and lower extremity manifestations of infection is presented. V. vulnificus is found as part of the normal flora of the Gulf of Mexico, Atlantic, and Pacific coastal waters and is often isolated from the filter feeding shellfish of these regions. Its pathogenicity is generally reserved for the immunocompromised host, and is specifically related to disease states which exhibit high serum iron levels. V. vulnificus infections present in two distinct clinical syndromes: primary sepsis secondary to raw oyster ingestion, or localized infection from wound exposure to V. vulnificus-inhabited salt water. Both syndromes demonstrate characteristic skin lesions of the trunk and extremities that present as hemorrhagic bullae and progress to necrotic ulcerations. Although V. vulnificus infection is rare, its extreme virulence in patients suffering from a chronic disease process and its manifestation of characteristic lower-extremity lesions require the podiatric physician to be able to recognize and treat such a condition.