Necrotizing fasciitis may be caused by a variety of organism . The progression of the disease may be gradual or have a fulminant course. We report a case of septicaemia, gangrene and fulminant necrotizing fasciitis caused by Vibrio Vulnificus with fatal outcome. The patient expired inspite of I.V antibiotics and amputation of the affected limb. Transmission to men is through contact with skin, mucosa or wounds exposed to sea water, and/or consumption of certain undercooked fish or raw shell , specially during the summer months. Significant risk factors for fulminant course of the disease include preexisting liver disease and immune compromised states. This infection should be clinically suspected and recognized from its typical history of exposure to sea water and fulminant clinical progress as a delay in diagnosis and treatment may result in considerable mortality.

Necrotizing fascitits is a necrotizing soft tissue infection (NSTI) spreading along fascial planes, with or without overlying cellulitis; also called Meleney’s ulcer. Necrotizing fascitits is severe manifestation of lymphangitis that progresses in a frightening manner within a short period. Tissue necrosis develops rapidly behind advancing wall of inflammation that limits penetration by antibiotics.

Necrotizing fasciitis due to Vibrio Vulnificus, the awareness of which has evolved during the last 30 years, can produce an overwhelming toxic shock-like syndrome that results in rapid deterioration and death. It is especially fatal in subjects who have chronic liver disease such as cirrhosis caused by chronic hepatitis B or C infection. Other high-risk conditions that predispose to severity of infection with Vibrio Vulnificus include iron overload states (hemochromatosis), concurrent malignancy, human immunodeficiency virus infection (AIDS) and other immunocompromised states, chronic renal failure, thalassemia and diabetes. A recent study showed that people with these pre-existing medical conditions were 80 times more likely to develop Vibrio Vulnificus septicemia with grave consequences than were healthy people.

Vibrio Vulnificus infection is diagnosed by routine stool and wound culture. The laboratory should be notified Zakaria when this infection is suspected by the physician, since a special growth medium can be used to increase the diagnostic yield. The treating clinician should have a high suspicion for this organism when patients present with gastrointestinal illness, fever, or shock following the ingestion of raw seafood, especially oysters, or with a wound infection after exposure to seawater.

Vibrio Vulnificus can be the cause of necrotizing fasciitis in the arabian gulf region especially in immunocompromised patients with chronic liver disease. These patients, who ingest undercooked or raw seafood or come in contact with the sea water, must be advised to seek medical care as soon as possible if they have skin lesions with fever and pain.

It should be a standard practice for physicians to advise patients with underlying medical illnesses, particularly cirrhosis or immunosuppression, against the ingestion of uncooked or undercooked seafood or exposure of wounds to seawater.

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