Background: Vibrio alginolyticus is a halophilic Gram-negative bacterium widely distributed in marine and estuarine environments. Although external ear infections are the predominant otologic manifestation, middle-ear infection has been reported, particularly when a chronic tympanic membrane perforation or a patent ventilation tube permits seawater to enter the middle ear.
Case presentation: In 2005, a 14-year-old girl with pre-existing chronic right otitis media and a central tympanic membrane perforation developed an acute suppurative exacerbation after repeated bathing in seawater near the waterfront of Puerto Padre Bay, Puerto Padre, Las Tunas, Cuba. She presented with profuse foul-smelling yellow-green mucopurulent otorrhea, pulsatile otalgia, and peripheral vertigo. Otoscopy showed a central perforation with active suppuration. Pure-tone audiometry demonstrated moderate mixed hearing loss in the right ear. Three-view mastoid radiographs showed no bone erosion or findings suggestive of cholesteatoma. Culture of the ear discharge yielded a halophilic Gram-negative bacillus subsequently identified as V. alginolyticus; species identification was confirmed at the Pedro Kourí Institute of Tropical Medicine in Havana. Initial amikacin therapy was followed by persistence of otorrhea, otalgia, and vertigo. Ceftriaxone was subsequently administered, after which the infection resolved and vertigo and hearing improved. The combination of peripheral vertigo and a sensorineural component of the hearing loss raised clinical suspicion of labyrinthine involvement. Because vestibular testing, advanced temporal-bone imaging, and serial audiograms are unavailable for retrospective review, labyrinthitis is considered probable rather than confirmed. After infection control, the patient was referred to pediatric otology in Holguín and later underwent tympanoplasty with a favorable audiologic outcome.
Conclusion: V. alginolyticus should be considered in unusual exacerbations of chronic otitis media when a tympanic membrane perforation and recent seawater exposure coexist. Concurrent vertigo and mixed hearing loss may indicate inner-ear involvement and warrant careful audiovestibular assessment.
Table of Contents
1. Introduction
2. Vibrio alginolyticus as a Human Pathogen
3. Otologic Infections Caused by Vibrio alginolyticus
4. Case Presentation
5. Audiologic and Radiologic Assessment
6. Microbiologic Investigation
7. Treatment and Clinical Course
8. Discussion
8.1 Pre-existing chronic otitis media as the underlying condition
8.2 Tympanic membrane perforation as a portal of entry
8.3 Seawater exposure in Puerto Padre Bay
8.4 Probable labyrinthitis and cochleovestibular involvement
8.5 Comparison with published cases
8.6 Historical antimicrobial susceptibility data
9. Limitations
10. Conclusions
11. Clinical Message
12. Ethics and Publication Considerations
Research Objectives and Core Themes
This medical case report and literature review investigates an unusual presentation of *Vibrio alginolyticus* middle-ear infection accompanied by probable labyrinthitis in an adolescent girl, aiming to highlight environmental exposure and anatomic vulnerability in atypical otologic presentations.
- Clinical documentation of a rare *Vibrio alginolyticus* middle-ear superinfection in a patient with a pre-existing chronic tympanic membrane perforation.
- Analysis of marine environmental exposure linked to bathing in seawater in Puerto Padre Bay, Cuba.
- Evaluation of associated audiovestibular symptoms, specifically peripheral vertigo and mixed hearing loss indicating probable labyrinthine involvement.
- Comprehensive microbiologic identification and review of historical antimicrobial susceptibility testing.
- Comparison with published cases of marine-acquired otologic infections and subsequent surgical management via tympanoplasty.
Excerpt from the Book
1. Introduction
Human infections caused by aquatic microorganisms occupy a distinctive position at the interface of infectious disease, environmental exposure, and anatomic susceptibility. Members of the genus Vibrio are Gram-negative organisms associated primarily with marine, coastal, and estuarine ecosystems. Vibrio alginolyticus is a strongly halophilic species that can act as an opportunistic human pathogen after contact with seawater.
Otologic infection is a recognized manifestation of V. alginolyticus disease. Surveillance data from the United States documented 1,331 infections between 1988 and 2012; ear infections were common, especially among children, but 422 of 437 ear infections (97%) were classified as otitis externa, emphasizing the relative rarity of middle-ear disease [1].
Middle-ear infection becomes biologically plausible when the tympanic membrane barrier is disrupted. Published pediatric experience specifically notes that V. alginolyticus otitis media usually occurs in the presence of a chronically perforated tympanic membrane or a patent pressure-equalizing tube and may follow even limited seawater exposure [2].
This report describes a clinical episode that occurred in 2005 in Puerto Padre, Las Tunas, Cuba, involving a 14-year-old girl with pre-existing chronic otitis media and a central tympanic membrane perforation who developed a suppurative exacerbation after repeated seawater exposure in Puerto Padre Bay. The episode was microbiologically linked to V. alginolyticus and was accompanied by peripheral vertigo and moderate mixed hearing loss, raising the possibility of associated labyrinthine involvement.
Summary of Chapters
1. Introduction: Introduces aquatic microbial infections and presents the clinical case of an adolescent girl with a marine-acquired middle-ear infection.
2. Vibrio alginolyticus as a Human Pathogen: Describes the biological and ecological characteristics of the halophilic bacterium and its association with saline environments and disrupted protective barriers.
3. Otologic Infections Caused by Vibrio alginolyticus: Reviews the published spectrum of ear infections, noting that middle-ear involvement primarily affects patients with chronic perforations or ventilation tubes.
4. Case Presentation: Details the clinical history of a 14-year-old patient from Cuba who developed acute suppuration following seawater bathing.
5. Audiologic and Radiologic Assessment: Analyzes pure-tone audiometry and mastoid imaging results, identifying moderate mixed hearing loss and potential inner-ear involvement.
6. Microbiologic Investigation: Outlines the biochemical identification process, reference laboratory confirmation, and historical antimicrobial susceptibility data.
7. Treatment and Clinical Course: Documents the initial antibiotic regimen, transition to ceftriaxone, resolution of symptoms, and subsequent referral for tympanoplasty.
8. Discussion: Examines causal interpretations, portals of entry, environmental exposure, probable labyrinthitis, and compares the findings with published literature.
9. Limitations: Addresses the constraints inherent to the retrospective reconstruction of a historical clinical case.
10. Conclusions: Summarizes clinical takeaways regarding atypical otologic exacerbations and the importance of exposure history.
11. Clinical Message: Highlights the diagnostic value of asking patients with unusual otorrhea whether they have recently swum in the sea.
12. Ethics and Publication Considerations: Discusses anonymization and consent requirements for publishing historical clinical data.
Keywords
Vibrio alginolyticus, chronic otitis media, tympanic membrane perforation, seawater, mixed hearing loss, vertigo, labyrinthitis, tympanoplasty, marine pathogen, otologic infection, Gram-negative bacillus, infectious exacerbation
Frequently Asked Questions
What is the primary subject of this publication?
The publication is a case report and literature review detailing a rare middle-ear infection caused by the marine bacterium Vibrio alginolyticus in an adolescent girl with pre-existing chronic otitis media.
What are the central thematic fields covered in the work?
The core themes include aquatic microbiology, environmental exposure pathways, otopathology associated with tympanic membrane perforations, audiovestibular assessments, and historical antimicrobial susceptibility.
What is the primary clinical objective or research question?
The work aims to document how seawater exposure can lead to acute suppurative exacerbations and probable labyrinthine involvement when the middle-ear barrier is compromised.
Which scientific methods and evaluations were utilized?
The report utilizes clinical evaluation, microbiologic culture, biochemical identification tests, pure-tone audiometry, mastoid radiography, and a comprehensive review of comparative medical literature.
What aspects are addressed in the main body of the work?
The main body covers the patient's case presentation, diagnostic imaging and audiologic findings, laboratory identification procedures, clinical treatment course, and an in-depth discussion on probable labyrinthitis and published case comparisons.
Which keywords best characterize the study?
Key terms include Vibrio alginolyticus, chronic otitis media, tympanic membrane perforation, seawater exposure, mixed hearing loss, vertigo, and probable labyrinthitis.
How did seawater exposure contribute to the patient's condition?
Repeated bathing in Puerto Padre Bay allowed marine water carrying halophilic bacteria to pass directly through a pre-existing central tympanic membrane perforation into the middle-ear cavity.
Why is labyrinthitis classified as probable rather than confirmed in this case?
Definitive confirmation was not possible because formal vestibular testing, advanced temporal-bone imaging, and serial audiograms were unavailable for retrospective review.
- Quote paper
- Manuel Suárez (Author), Xiomara Pérez Gisbert (Author), Yuneisy Hidalgo Vázquez (Author), 2026, From Seawater to the Middle Ear. Vibrio alginolyticus Infection in an Adolescent Girl With Chronic Otitis Media and Probable Labyrinthitis, Munich, GRIN Verlag, https://www.grin.com/document/1778740
