Vibrio vulnificus
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Epidemiology
- routinely isolated from seawater, zooplankton & shellfish on the Gulf coast & east & west coasts of the US, especially during summer months
- ingestion of contaminated saltwater seafood
- patients with cirrhosis
- 13 deaths from Vibrio vulnificus on th U.S, East coast in 2023[10]
Pathology
- wound infection, cellulitis, necrotizing fasciitis or myositis after exposure to seawater or cleaning shellfish
- puncture wound in seawater (fishhook or other sharp object)
- erythematous lesions evolving into hemorrhagic bullae & then into necrotic ulcers
- gastroenteritis & septicemia after ingesting raw shellfish (oysters)
- risk factors: liver disease, congestive heart failure, diabetes mellitus, renal failure, immunosuppressive therapy, hemochromatosis
- vomiting, diarrhea & severe abdominal cramps
- incubation period is 18 hours
- 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
More general terms
References
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 297, 536
- ↑ 2.0 2.1 2.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 18, 19. American College of Physicians, Philadelphia 1998, 2012, 2018, 2021.
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 94
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/17853628
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/21177133 Free Article
- ↑ 6.0 6.1 6.2 Scully EP, Earp BE, Miller AL, Loscalzo J Just a Cut. N Engl J Med 2016; 375:1780-1786. November 3, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27806242 <Internet> 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/ - ↑ 7.0 7.1 Park J, Lee CS (image) Vibrio vulnificus Infection. N Engl J Med 2018; 379:375. July 26, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30044934 https://www.nejm.org/doi/full/10.1056/NEJMicm1716464
- ↑ Baker-Austin C, Oliver JD. Vibrio vulnificus: new insights into a deadly opportunistic pathogen. Environ Microbiol. 2018;20(2):423-430. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29027375 https://ami-journals.onlinelibrary.wiley.com/doi/10.1111/1462-2920.13955
- ↑ Coerdt KM, Khachemoune A. Vibrio vulnificus: review of mild to life-threatening skin infections. Cutis. 2021;107(2):E12-E17. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33891847 https://www.mdedge.com/dermatology/article/236136/infectious-diseases/vibrio-vulnificus-review-mild-life-threatening-skin
- ↑ 10.0 10.1 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