Vibrio vulnificus
Background
- Gram negative bacterium living in marine environments
- Leading cause of shellfish-associated death in US
- Patients with cirrhosis at high risk
Vibrio species
Clinical Features
- History of handling or ingestion of raw/undercooked seafood (most commonly oysters), exposure to marine/estuarine water
- Handling/skin exposure
- Rapid cellulitis that progresses to hemorrhagic bullae and purpura fulminans
- Wound infections can spread rapidly causing severe myositis and necrotizing fasciitis[1]
- Ingestion:
- Vomiting, diarrhea, and/or abdominal pain
- +/- fever, chills, or septic shock[2]
- Primary septicemia associated with highest case fatality rate among all foodborne infections (39%)[3]
Differential Diagnosis
Skin and Soft Tissue Infection
- Cellulitis
- Erysipelas
- Lymphangitis
- Folliculitis
- Hidradenitis suppurativa
- Skin abscess
- Necrotizing soft tissue infections
- Mycobacterium marinum
Look-A-Likes
- Sporotrichosis
- Osteomyelitis
- Deep venous thrombosis
- Pyomyositis
- Purple glove syndrome
- Tuberculosis (tuberculous inflammation of the skin)
Nausea and vomiting
Critical
Emergent
- Acute radiation syndrome
- Acute gastric dilation
- Adrenal insufficiency
- Appendicitis
- Bowel obstruction/ileus
- Carbon monoxide poisoning
- Cholecystitis
- CNS tumor
- Electrolyte abnormalities
- Elevated ICP
- Gastric outlet obstruction, gastric volvulus
- Hyperemesis gravidarum
- Medication related
- Pancreatitis
- Peritonitis
- Ruptured viscus
- Testicular torsion/ovarian torsion
Nonemergent
- Acute gastroenteritis
- Biliary colic
- Cannabinoid hyperemesis syndrome
- Chemotherapy
- Cyclic vomiting syndrome
- ETOH
- Gastritis
- Gastroenteritis
- Gastroparesis
- Hepatitis
- Labyrinthitis
- Migraine
- Medication related
- Motion sickness
- Narcotic withdrawal
- Thyroid
- Pregnancy
- Peptic ulcer disease
- Renal colic
- UTI
Evaluation
- Generally clinical diagnosis, though blood cultures may assist in ultimate diagnosis and vibrio PCR testing exists[4]
- CT and surgical consult if concern for nec fas
- CBC, BMP, LFTs if significant vomiting
Management
- Severe infections should be treated with immediate antibiotics and ICU admission
- May require aggressive surgical debridement
- Doxycycline 100 mg IV or PO BID + ceftazidime 2g IV q8h[5]
Antibiotic Sensitivities[6]
Key
- S susceptible/sensitive (usually)
- I intermediate (variably susceptible/resistant)
- R resistant (or not effective clinically)
- S+ synergistic with cell wall antibiotics
- U sensitive for UTI only (non systemic infection)
- X1 no data
- X2 active in vitro, but not used clinically
- X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
- X4 active in vitro, but not clinically effective for strep pneumonia
Table Overview
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See Also
References
- ↑ Choi HJ, Lee DK, Lee MW, Choi JH, Moon KC, Koh JK. Vibrio vulnificus septicemia presenting as purpura fulminans. J Dermatol. Jan 2005;32(1):48-51.
- ↑ Choi HJ, Lee DK, Lee MW, Choi JH, Moon KC, Koh JK. Vibrio vulnificus septicemia presenting as purpura fulminans. J Dermatol. Jan 2005;32(1):48-51.
- ↑ Mead PS, Slutsker L, Dietz V, et al. Food-related illness and death in the United States. Emerg Infect Dis. 1999;5(5):607-625. doi:10.3201/eid0505.990502
- ↑ https://emedicine.medscape.com/article/1055523-workup
- ↑ https://www.aafp.org/afp/2007/0815/p539.html
- ↑ Sanford Guide to Antimicrobial Therapy 2014
Disposition
- Contingent on presentation, admit if severe or significant comorbidities