Vibrio vulnificus: Difference between revisions
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Vibrio vulnificus
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*Presents as [[Causes::gastroenteritis]], skin infection, and [[Causes::bacteremia]] in an immunocompromised patient (usually cirrhosis) |
*Presents as [[Causes::gastroenteritis]], skin infection, and [[Causes::bacteremia]] in an immunocompromised patient (usually cirrhosis) |
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| − | *1 to 3 days following ingestion of |
+ | *1 to 3 days following ingestion of oysters |
*Severe, rapidly-progressing soft tissue infection |
*Severe, rapidly-progressing soft tissue infection |
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**Erythematous lesions that develop into [[Causes::hemorrhagic bullae]] then necrotic ulcers |
**Erythematous lesions that develop into [[Causes::hemorrhagic bullae]] then necrotic ulcers |
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Latest revision as of 12:13, 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
