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Updated: Nov 27 2018

Vibrio parahaemolyticus / vulnificus

  • Snapshot
    • A 45-year-old woman presents to a local hospital in Mexico with a swollen, erythematous left ankle. She reports that she recently obtained a tattoo on her left ankle 5 days ago. Since then, she went to Mexico on vacation, swam in seawater, and ate copious amounts of seafood, including raw oysters and ceviche. On physical exam, she has a warm and erythematous plaque over her left ankle where her tattoo is located and has 2 red bullae. Wound cultures are sent to the laboratory and she is started on the appropriate antibiotics. (Vibrio vulnificus infection)
  • Introduction
    • Classification
      • a facultative anaerobe, gram-negative bacillus
      • found in raw shellfish, sediment, and seawater
      • Vibrio vulnificus
        • gastroenteritis
        • necrotizing fasciitis
        • cellulitis
      • Vibrio parahaemolyticus
        • gastroenteritis
    • Epidemiology
      • incidence
        • more common in warm weather
        • V. vulnificus is the most common cause of death from seafood consumption in the US
        • V. parahaemolyticus is the most common cause of diarrhea in Japan
      • risk factors
        • eating undercooked seafood
        • chronic liver disease
          • in particular, cirrhosis
        • disorders of iron metabolism
        • immunocompromised status
        • shucking oysters
        • tsunami
          • organism can infect current wounds
    • Pathogenesis
      • infects via contaminated seafood or direct contact in the case of wound infections
    • Prevention
      • ensure properly cooked seafood
    • Prognosis
      • typically resolves with treatment
      • mortality is high in those who develop septic shock
  • Presentation
    • Symptoms
      • vomiting
      • diarrhea
      • abdominal pain
    • Physical exam
      • may have bullae on skin that progress to necrotic ulcers
  • Studies
    • Labs
      • stool studies
      • wound culture
      • blood culture
    • Making the diagnosis
      • based on clinical presentation and laboratory studies
  • Differential
    • Viral gastroenteritis
      • distinguishing factor
        • typically does not present with skin lesions such as bullae
        • not associated with seawater or seafood
  • Treatment
    • Conservative
      • supportive care
        • indication
          • all patients
        • modalities
          • intravenous hydration
    • Medical
      • doxycycline
        • indication
          • all patients
    • Operative
      • surgical debridement
        • indication
          • necrotizing fasciitis
  • Complications
    • Septic shock
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