Updated: 11/27/2018

Vibrio parahaemolyticus / vulnificus

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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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