Epidemiology
- Risk Factors
- Ingestion of Raw Shellfish: oysters, etc.
- Vibrio vulnificus can be isolated from almost all oysters harvested in the Chesapeake Bay and the Gulf of Mexico when water temperature is >80°F (27.6°C)
- High-Risk Groups
- Cirrhosis: due to impaired bacterial clearance by hepatic macrophages -> dissemination within 36 hrs of ingestion
- ETOH Abuse Without Liver Disease:
- Chronic Hepatitis:
- Hereditary Hemochromatosis:
- Transplants:
- Diabetes:
- RA:
- CRF:
- Lymphoma:
- Immunodeficiency Syndromes:
Etiology
- Vibrio vulnificus
- Halophilic, curved, capsulated GNR found in warm salt water
Diagnosis
- CXR/Chest Pattern
- Blood Cult+Sens: diagnostic
- Wound Cult+Sens: may be diagnostic
Clinical Presentations
- Sepsis Pattern (see Sepsis): brupt onset of disease
- Fever
- Hypotension
- Hemorrhagic and Necrotic Bullous Skin Lesions:
- Coalescing Areas of Cellulitis:
- Altered Mental Status:
- Disseminated Intravascular Coagulation (DIC)
- GI Disturbances:
- Respiratory Failure:
- Absence of Neurologic Symptoms: in contrast to similar food-borne illnesses (like Scomboid, Cigua Toxin Intoxication, Botulism), which have both GI AND neurologic symptoms
- Wound Infection: due to contact with contaminated water
- Gastrointestinal Illness: self-limited
Treatment
- Treatment of Choice: Minocycline (100 mg PO q12 hours) + Cefotaxime (2 mg IV q8 hours)
Prognosis
- Mortality Rate for Sepsis: >50%
- Mortality Rate with Hypotension: almost 90%
References