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Vibrio vulnificus

Epidemiology: 1) routinely isolated from seawater, zooplankton & shellfish on the Gulf coast & east & west coasts of the US, especially during summer months 2) ingestion of contaminated saltwater seafood 3) patients with cirrhosis 4) 13 deaths from Vibrio vulnificus on th U.S, East coast in 2023 [10] Pathology: 1) wound infection, cellulitis, necrotizing fasciitis or myositis after exposure to seawater or cleaning shellfish - puncture wound in seawater (fishhook or other sharp object) 2) erythematous lesions evolving into hemorrhagic bullae & then into necrotic ulcers 3) gastroenteritis & septicemia after ingesting raw shellfish (oysters) a) risk factors: liver disease, congestive heart failure, diabetes mellitus, renal failure, immunosuppressive therapy, hemochromatosis b) vomiting, diarrhea & severe abdominal cramps c) incubation period is 18 hours 4) the organism is extremely invasive, producing necrotizing fasciitis, vasculitis, gangrene & shock, apparently from ingestion or wound contamination [2] Clinical manifestations: - excruciating pain - hemorrhagic bullae - necrotizing fasciitis - gastroenteritis & septicemia * images [7] Laboratory: - comma-like appearance on gram stain or culture - Vibrio cholerae+parahaemolyticus+vulnificus DNA Complications: - mortality rate is high - > 50% with septicemia - ~15% with wound infection Management: 1) antibiotic therapy a) cephalosporin + doxycycline - cefepime, ceftazidime, ceftriaxone, cefotaxime [6] - ceftazidime [2] b) chloramphenicol c) fluoroquinolone - ciprofloxacin, levofloxacin d) gentamicin [6] 2) debridement

General

Vibrio

Properties

KINGDOM: monera DIVISION: SCHIZOMYCETES

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 297, 536
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 18, 19. American College of Physicians, Philadelphia 1998, 2012, 2018, 2021.
  3. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 94
  4. Bross MH, Soch K, Morales R, Mitchell RB. Vibrio vulnificus infection: diagnosis and treatment. Am Fam Physician. 2007 Aug 15;76(4):539-44. PMID: 17853628
  5. Horseman MA, Surani S. A comprehensive review of Vibrio vulnificus: an important cause of severe sepsis and skin and soft-tissue infection. Int J Infect Dis. 2011 Mar;15(3):e157-66. Review. PMID: 21177133 Free Article
  6. Scully EP, Earp BE, Miller AL, Loscalzo J Just a Cut. N Engl J Med 2016; 375:1780-1786. November 3, 2016 PMID: 27806242 http://www.nejm.org/doi/full/10.1056/NEJMcps1512793 - Rothaus C (images) Just a Cut. Now@NEJM. Nov 3, 2016 http://blogs.nejm.org/now/index.php/just-a-cut/2016/11/03/
  7. Park J, Lee CS (image) Vibrio vulnificus Infection. N Engl J Med 2018; 379:375. July 26, 2018 PMID: 30044934 https://www.nejm.org/doi/full/10.1056/NEJMicm1716464
  8. Baker-Austin C, Oliver JD. Vibrio vulnificus: new insights into a deadly opportunistic pathogen. Environ Microbiol. 2018;20(2):423-430. PMID: 29027375 https://ami-journals.onlinelibrary.wiley.com/doi/10.1111/1462-2920.13955
  9. Coerdt KM, Khachemoune A. Vibrio vulnificus: review of mild to life-threatening skin infections. Cutis. 2021;107(2):E12-E17. PMID: 33891847 https://www.mdedge.com/dermatology/article/236136/infectious-diseases/vibrio-vulnificus-review-mild-life-threatening-skin
  10. AMA Morning Rounds, Sept 5, 2023 American Medical Association - Christensen J CDC warns doctors to be on alert for cases of flesh-eating bacteria Vibrio vulnificus. CNN. Sept 1, 2023 https://us.cnn.com/2023/09/01/health/cdc-warning-flesh-eating-bacteria/index.html