Vibrio vulnificus: Difference between revisions

Latest revision as of 16:13, 27 September 2022

Halophilic (salt-loving) marine pleomorphic Gram-negative rod that causes severe rapidly-progressing soft tissue infections

Background

Pathophysiology

Polysaccharide capsule is resistant to phagocytosis and triggers cytokine release including TNF-alpha
It can sequester iron from hemoglobin and highly-saturated transferrin

Epidemiology

Mostly found in saltwater estuaries, associated with springtime plankton blooms
Normal microbiotia of molluscs, including oysters and crabs

Risk Factors

Cirrhosis
Other liver disease
Iron-overload states including hemochromatosis, hemolytic anemia, chronic renal failure
Malignancy
HIV
Immunosuppressing medications

Clinical Presentation

Presents as gastroenteritis, skin infection, and bacteremia in an immunocompromised patient (usually cirrhosis)
1 to 3 days following ingestion of oysters
Severe, rapidly-progressing soft tissue infection
- Erythematous lesions that develop into hemorrhagic bullae then necrotic ulcers
- Metastatic cutaneous lesions develop at 36 hours
- Often related to a wound contaminated with salt water, often in the Golf Coast
Bacteremia is common
- Associated with oyster consumption in 90% of cases
25% case-fatality rate, up to 50% in cases of bacteremia

Management

Needs antibiotics, ideally early, as well as surgical debridement of the nectrotizing soft tissue infection
Fluoroquinolones, third-generation cephalosporins, and doxycycline all work
Should typically start with combination of third-generation cephalosporin and either ciprofloxacin or doxycycline

Prevention

Patients with cirrhosis should avoid eating raw oysters

@@ Line 1: / Line 1: @@
-* Halophilic (salt-loving) marine pleomorphic Gram-negative rod that causes severe rapidly-progressing soft tissue infections
+*Halophilic (salt-loving) marine pleomorphic Gram-negative rod that causes severe rapidly-progressing soft tissue infections
 ==Background==
 ===Pathophysiology===
-* Polysaccharide capsule is resistant to phagocytosis and triggers cytokine release including TNF-alpha
+*Polysaccharide capsule is resistant to phagocytosis and triggers cytokine release including TNF-alpha
-* It can sequester iron from hemoglobin and highly-saturated transferrin
+*It can sequester iron from hemoglobin and highly-saturated transferrin
 ===Epidemiology===
-* Mostly found in saltwater estuaries, associated with springtime plankton blooms
+*Mostly found in saltwater estuaries, associated with springtime plankton blooms
-* Normal microbiotia of molluscs, including oysters and crabs
+*Normal microbiotia of molluscs, including oysters and crabs
 ===Risk Factors===
-* Cirrhosis
+*[[Cirrhosis]]
-* Other liver disease
+*Other liver disease
-* Iron-overload states including hemochromatosis, hemolytic anemia, chronic renal failure
+*Iron-overload states including [[hemochromatosis]], [[hemolytic anemia]], [[chronic renal failure]]
-* Malignancy
+*[[Malignancy]]
-* HIV
+*[[HIV]]
-* Immunosuppressing medications
+*Immunosuppressing medications
 ==Clinical Presentation==
-* Presents as sepsis and skin infection in an immunocompromised patient (usually cirrhosis) 1 to 3 days following ingestion of ulcers
+*Presents as [[Causes::gastroenteritis]], skin infection, and [[Causes::bacteremia]] in an immunocompromised patient (usually cirrhosis)
-* Severe, rapidly-progressing soft tissue infection
+*1 to 3 days following ingestion of oysters
-** Erythematous lesions that develop into hemorrhagic bullae then necrotic ulcers
+*Severe, rapidly-progressing soft tissue infection
-** Metastatic cutaneous lesions develop at 36 hours
+**Erythematous lesions that develop into [[Causes::hemorrhagic bullae]] then necrotic ulcers
-** Often related to a wound contaminated with salt water, often in the Golf Coast
+**Metastatic cutaneous lesions develop at 36 hours
-* Bacteremia is common
+**Often related to a wound contaminated with salt water, often in the Golf Coast
-** Associated with oyster consumption in 90% of cases
+*Bacteremia is common
-* 25% case-fatality rate, up to 50% in cases of bacteremia
+**Associated with oyster consumption in 90% of cases
+*25% case-fatality rate, up to 50% in cases of bacteremia
 ==Management==
-* Needs antibiotics, ideally early, as well as surgical debridement of the nectrotizing soft tissue infection
+*Needs antibiotics, ideally early, as well as surgical debridement of the nectrotizing soft tissue infection
-* Fluoroquinolones, third-gen cephalosporins, and doxycycline all work
+*[[Fluoroquinolones]], third-generation [[cephalosporins]], and [[doxycycline]] all work
+*Should typically start with combination of third-generation [[Cephalosporins|cephalosporin]] and either [[ciprofloxacin]] or [[doxycycline]]
 ==Prevention==
-* Patients with cirrhosis should avoid eating raw oysters
+*Patients with cirrhosis should avoid eating raw oysters
 {{DISPLAYTITLE:''Vibrio vulnificus''}}