Vibrio Vulnificus

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
    • Necrotizing Cellulitis:
  • Gastrointestinal Illness: self-limited

Treatment

  • Treatment of Choice: Minocycline (100 mg PO q12 hours) + Cefotaxime (2 mg IV q8 hours)
    • Synergistic

Prognosis

  • Mortality Rate for Sepsis: >50%
  • Mortality Rate with Hypotension: almost 90%

References

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