Recurrent febrile illness as a presenting pattern of Vibrio albensis bacteremia in an immunocompetent adult: A case report and literature review

Abstract

Vibrio albensis is an extremely rare strain of the Non-O1/non-O139 Vibrio cholerae (NOVC) serogroup that can infect humans with only limited existing data in the literature regarding its pathogenicity, clinical presentation and treatment. We report a rare case of Vibrio albensis bacteremia in an otherwise immunocompetent adult without aquatic exposure or seafood ingestion, with full recovery on targeted antibiotics therapy. We also present a comprehensive literature review of all documented cases of V. albensis infections in humans. This case report enriches the limited literature about V. albensis bacteremia in humans. Clinicians should always suspect rare pathogens in cases where systemic symptoms are unexplained. Further case reporting and research regarding V. albensis infections are needed.

Highlights

• •Vibrio albensis bacteremia in an immunocompetent adult without aquatic exposure.
• •Recurrent monthly febrile episodes as the presenting pattern of bacteremia.
• •Altered biliary anatomy may predispose to V. albensis persistence and translocation.
• •Oral antibiotic therapy was sufficient for uncomplicated V. albensis bacteremia.
• •Comprehensive literature review identifying all reported human V. albensis infections.

Introduction

Vibrio genus is a Gram-negative, comma-shaped, marine bacteria that contains more than 100 species, including Vibrio cholerae which is the causative agent of epidemic cholera, Vibrio vulnificus and Vibrio parahaemolyticus which are well-known causes of wound infections, septicemia, and gastroenteritis [1], [2], [3], [4], [5]. They are usually contracted from marine animals and seafood in addition to fecal-oral transmission in environments with poor hygiene and sanitation [6]. Non-O1/non-O139 Vibrio cholerae (NOVC) strains are rarely pathogenic to humans [7].

V. albensis is a luminescent organism that belongs to the NOVC serogroup and has more than 70% of DNA sequences in common with V. cholerae [8]. Infections with V. albensis are extremely rare, with only a handful of documented case reports in the literature, making its pathogenesis, clinical presentation, and treatment poorly understood [9], [10], [11], [12], [13].

This case report highlights a rare presentation of bacteremia due to V. albensis in an immunocompetent patient with a remote history of biliary tract intervention, in addition to a comprehensive review of all V. albensis documented cases in humans in the literature.

Methods

Clinical data were collected from a patient admitted in August 2025 to Clemenceau Medical Center affiliated with Johns Hopkins International, Beirut, Lebanon. Written informed consent was obtained from the patient for anonymous publication of this case report. Laboratory and Imaging results were retrieved from the hospital’s Laboratory Information System (LIS). In the clinical microbiology laboratory, bacterial identification was done using MALDI-TOF, and antimicrobial susceptibility testing was performed using the Kirby–Bauer disk diffusion method in accordance with EUCAST breakpoints. A comprehensive literature review was conducted in order to identify all the previously reported cases of V. albensis infections in humans. The search was performed via PubMed, Google Scholar, and checking reference review of relevant articles without a duration limit. The terms used in this search were “Vibrio albensis,” “V. albensis,” “non-O1/non−139 Vibrio cholerae,” and “NOVC infections.”

Only reported cases of infections with Vibrio albensis in humans were included in this review. Articles describing infections related to non-humans and infections caused by other Vibrio species along with articles discussing environmental and in vitro data were otherwise excluded.

Extracted data from the reports included the patients’ demographics and comorbidities, clinical presentation, microbiological findings, in addition to clinical manifestations and treatment outcomes.

Results

Case presentation

A 54-year-old male patient, previously healthy, non-smoker, non-alcoholic, and with no known drug or food allergies, presented to the emergency department with a two-day history of fatigue, myalgia, vomiting, and right upper quadrant pain with pruritus.

He reported having fever reaching 39°C with chills and noted having similar monthly self-limiting febrile episodes lasting for two days, occurring over the past three months.

The patient denied any urinary, respiratory or any other gastrointestinal symptoms. He also denied any suspicious meal intake or any sick contacts with similar symptoms.

Of notable relevance, the patient explained that the current symptoms were very similar to those he experienced more than ten years ago when he was diagnosed with choledocholithiasis where he underwent cholecystectomy and Endoscopic Retrograde Cholangiopancreatography (ERCP) without stent placement. The patient had a recent visit to Romania 3 months earlier, where he had previously lived before residing in Lebanon 7 years ago.

Ceftriaxone and Metronidazole were initiated empirically after securing cultures.

Physical exam

The patient was conscious, cooperative and oriented, pale but with no jaundice or icteric sclera. Cardiopulmonary exam was unremarkable. Abdominal examination revealed mild right upper quadrant tenderness with negative Murphy’s sign. No lower limbs edema was observed.

Vital signs

on presentation were significant for fever of 39.1°C.

Laboratory findings

were pertinent for mild thrombocytopenia (100,000/μL), elevated inflammatory marker (CRP 10.3 mg/dL and peaked at 13.8 mg/dL) and mild hepatic enzymes elevation. Renal function and electrolytes remained within normal range. COVID−19 PCR, Influenza Rapid Antigen Test, and urine analysis turned out negative.

Imaging

Chest X-ray was within normal limits. CT abdomen pelvis without contrast showed mild enteritis, normal appendix and mild diffuse colonic diverticulosis. Magnetic Resonance Cholangiopancreatography (MRCP) showed post-cholecystectomy changes with mild intrahepatic biliary duct dilation in the right lobe with pneumobilia but no common bile duct (CBD) calculi or masses were detected.

Microbiological findings

Urine culture turned negative. Blood culture grew Vibrio albensis that demonstrated multisensitivity, including fluoroquinolones susceptibility.

Management and outcome

Ceftriaxone and Metronidazole were initiated upon presentation and the patient was later discharged on Cefixime 400 mg orally once daily for 2 weeks. On follow-up, he had normalization of his inflammatory markers along with clinical improvement and resolution of his febrile episodes without recurrence.

Literature review

In our literature review, we were able to identify 5 cases of reported V. albensis infections in humans (Table 1).

Table 1.

Summary of previously reported cases of V. albensis infections in humans.

Case	Patient	Presentation/Culture	Exposure	Treatment	Outcome
Tendolkar and Deodhar (India, 1990) [9]	60-year-old female patient, immunocompetent	Endophthalmitis post intracapsular cataract extraction V. albensis detected in vitreous culture	None reported	Subconjunctival and intramuscular Chloramphenicol	No improvement in visual acuity one month later
Engel et al. (Netherlands, 2013, published in 2016) [10]	50-year-old male patient with history of COPD and tuberculosis	Septic shock due to deep skin infection V. albensis detected in blood culture C. albicans detected in blood culture	None reported	Empirical treatment with Ciprofloxacin, Cefotaxime along with selective digestive decontamination with Polymyxin E, tobramycin and amphotericin B	Multi-organ failure and death
Aaraj et al. (Lebanon, 2019) [11]	27-year-old previously healthy Lebanese male	UTI V. albensis detected in urine culture	Contaminated tap water from the patient’s home	Ciprofloxacin	Complete recovery upon follow-up
Ahmad OE et al. (Doha, 2022) [12]	64-year-old female patient with decompensated liver cirrhosis	Decompensated liver disease and pneumonia V. albensis ESBL detected in blood culture	None reported	Ertapenem	Complete recovery upon follow-up
Stolaj et al. (Italy, 2023) [13]	47-year-old Romanian female living in Italy, with ovarian seromucinous tumor and obesity	Febrile gastroenteritis V. cholerae biovar albensis detected in stools culture	None reported	Ceftriaxone	Clinical improvement

Case 1: A 60-year-old female who developed endophthalmitis following intracapsular cataract extraction where V. albensis was detected in the vitreous culture (reported by Tendolkar and Deodhar in 1990) [9].

Case 2: A 50-year-old male with chronic obstructive pulmonary disease (COPD) and tuberculosis who presented with septic shock due to deep skin infection and blood culture showed V. albensis (reported in a literature review by Engel et al. in 2016) [10].

Case 3: A 27-year-old previously healthy Lebanese male who presented with urinary tract infection (UTI) due to V. albensis, that was also isolated from the patient’s home tap water (reported by Aaraj et al. in 2019) [11].

Case 4: A 64-year-old female with a history of endometrial cancer in remission and decompensated liver cirrhosis due to chronic hepatitis B infection who presented with decompensated liver disease and pneumonia and blood culture revealed ESBL producing V. albensis isolate (reported by Ahmad OE et al. in 2022) [12].

Case 5: A 47-year-old Romanian female living in Italy, who presented with febrile gastroenteritis where stools culture showed V. cholerae biovar albensis (reported by Stolaj et al. in 2023) [13].

Discussion

Vibrio albensis is considered one of the rarest human-causing pathogens in the Vibrio genus [7], [11]. Although no well-known pathogenicity is established, few reports have documented its role in localized infections (urinary tract infections, febrile gastroenteritis, and postoperative endophthalmitis) and systemic infections (bacteremia) [9], [10], [11], [12], [13].

Our case report illustrates a rare presentation of Vibrio albensis bacteremia in an otherwise immunocompetent male with a history of biliary tract intervention. At first biliary pathology was suggested, given the presentation with recurrent febrile episodes and right upper quadrant pain. However, no obstructive lesions were detected by imaging but rather mild intrahepatic dilation with pneumobilia which may have predisposed an ascending infection in the patient. During retrospective investigations, the patient denied having any water-related activities during his visit to Romania or having consumed any seafood. He also denied having any open wounds during his stay there or any exposure to coastal waters.

The recurrent monthly febrile episodes might be explained by either periodic symptomatic episodes in a chronic carriage state. This could also suggest that the microorganism might have resided intracellularly or might have formed a biofilm. However, further investigations are warranted to elucidate these mechanisms.

The fact that our patient is immunocompetent, unlike the previously reported patient with COPD and tuberculosis and the patient with liver cirrhosis where both presented with bacteremia [10], [12], may suggest that V. albensis has the potential to affect healthy individuals and cause disease.

Despite the fact that our patient had a travel history to Romania 3 months earlier, the patient confirmed, retrospectively, that there is no identifiable aquatic exposure or even consumption of seafood. This could be explained by the possibility of V. albensis transmission via food contamination by infected water or even via personal hygiene practices involving contaminated water as with the case reported in Lebanon where the patient presented with UTI and tap water culture showed V. albensis [11].

The fact that our patient was successfully treated with Cefixime orally implies that oral therapy may represent a viable option for treatment of selected cases of uncomplicated V. albensis bacteremia in immunocompetent patients, given the antimicrobial susceptibility. Though this observation is limited to a single case and cannot be generalized.

Our case highlights several points. First, rare pathogens like V. albensis could be the cause of bacteremia in otherwise immunocompetent patients, and therefore should be considered in the differential diagnosis. Second, the absence of known routes of transmission like marine exposure does not rule out the infection with non-O1/non-O139 Vibrio cholerae (NOVC). Third, antimicrobial susceptibility testing is crucial to enable targeted therapy given the limited clinical experience with this organism. Fourth, oral antibiotic therapy may represent a viable step-down option for certain V. albensis bacteremia cases that are uncomplicated, if susceptibility pattern allows; though this is based on a single case and warrants further validation.

In our case, we hypothesize that a niche for bacterial persistence or translocation might have been created by the altered biliary anatomy resulting from the prior ERCP and cholecystectomy. However, this remains speculative, as no biliary source cultures were obtained and imaging did not reveal definitive evidence of cholangitis or biliary infection.

The exact source of infection could not be identified in the patient, which represents a limitation of this case report.

This case report enriches the limited literature about V. albensis bacteremia in humans.

Conclusion

We report a rare case of Vibrio albensis bacteremia in an otherwise immunocompetent adult without aquatic exposure or seafood ingestion. The successful oral step-down antimicrobial therapy suggests that oral antibiotics may represent a potential treatment option in certain uncomplicated cases, though further case reports are needed to validate this observation. Clinicians should always suspect rare pathogens in cases where systemic symptoms are unexplained. Further case reporting and research are needed to better understand the epidemiology, transmission routes and pathogenesis, and optimal therapeutic management for the rare V. albensis infections.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.