A 31-year-old Texas man was examined by doctors at Parkland Memorial Hospital in Dallas after complaining of severe pain in both legs and feet, along with fever, chills, and redness surrounding a recent tattoo on his left calf. Based on the severity of his symptoms, he was admitted to the hospital, where, over the next few hours, the area surrounding the tattoo became increasingly swollen and discolored. The patient’s breathing soon became rapid and shallow, while his heartrate increased to compensate for his inefficient respiration. His blood pressure dropped dramatically and remained low despite the administration of intravenous fluids. His kidneys began to fail. The patient’s collection of signs and symptoms indicated septic shock, an often fatal complication of bacterial infection. He was placed on a ventilator and given antibiotics to fight the infection.

Upon admission to the hospital, the patient related that he had gotten the tattoo just over a week ago and had gone swimming in the ocean 5 days later, while it was still healing. He started to feel ill the following morning. He had previously been diagnosed with chronic liver disease, due to excessive alcohol consumption.

The combination of the recent tattoo, the ocean visit, and the patient’s liver disease pointed towards infection with Vibrio vulnificus, a small, Gram-negative bacterium occasionally referred to as a comma bacterium because of its curved appearance. People are often more familiar with Vibrio cholera, the agent of diarrhea, but in the United States, V. vulnificus is far more prevalent. Infection occurs either via consumption of undercooked shellfish or through contact with open wounds. Most cases of vibriosis are mild and include watery diarrhea accompanied by abdominal cramping, nausea, vomiting, fever, and chills. Persons who are immunosuppressed, or who have underlying conditions, including cancer, diabetes, HIV, or liver disease, are at risk for more severe infection.

The patient initially showed progress and was removed from the ventilator after 18 days. Unfortunately, he soon deteriorated and, despite the best efforts of doctors, died 2 months after his initial admission to the hospital. In this case, the patient’s recent tattoo served as a near-perfect portal of entry for the bacterium. Tattoo aftercare instructions routinely include warnings against bathing or swimming until the tattoo has completely healed. Furthermore, the patient’s chronic liver disease put him at risk for serious infection, an unfortunate confluence of events.

Vibrio vulnificus is a Gram-negative bacterium which, in this case, led to a septic infection. Explain the sequence of events in which exposure to this bacteria lead to death via septic shock.