View source for Vibrio vulnificus

==Background==
*Gram negative bacterium living in marine environments
*Leading cause of shellfish-associated death in US
**Patients with [[cirrhosis]] at high risk

{{Vibrio species}}



==Clinical Features==

*History of handling or ingestion of raw/undercooked seafood (most commonly oysters), exposure to marine/estuarine water
*Handling/skin exposure
**Rapid [[cellulitis]] that progresses to hemorrhagic bullae and [[purpura fulminans]]
**Wound infections can spread rapidly causing severe [[myositis]] and [[necrotizing fasciitis]]<ref>Choi HJ, Lee DK, Lee MW, Choi JH, Moon KC, Koh JK. Vibrio vulnificus septicemia presenting as purpura fulminans. J Dermatol. Jan 2005;32(1):48-51.</ref>
*Ingestion: 
**[[Vomiting]], [[diarrhea]], and/or [[abdominal pain]]
**+/- [[fever]], chills, or [[septic shock]]<ref>Choi HJ, Lee DK, Lee MW, Choi JH, Moon KC, Koh JK. Vibrio vulnificus septicemia presenting as purpura fulminans. J Dermatol. Jan 2005;32(1):48-51.</ref>
**Primary septicemia associated with highest case fatality rate among all foodborne infections (39%)<ref>Mead PS, Slutsker L, Dietz V, et al. Food-related illness and death in the United States. Emerg Infect Dis. 1999;5(5):607-625. doi:10.3201/eid0505.990502</ref>

==Differential Diagnosis==
{{SSTI DDX}}
{{Nausea and vomiting DDX}}

==Evaluation==
*Generally clinical diagnosis, though blood cultures may assist in ultimate diagnosis and vibrio PCR testing exists<ref>https://emedicine.medscape.com/article/1055523-workup</ref>
*CT and surgical consult if concern for nec fas
*CBC, BMP, LFTs if significant vomiting

==Management==
*Severe infections should be treated with immediate antibiotics and ICU admission
*May require aggressive surgical debridement
*[[Doxycycline]] 100 mg IV or PO BID + [[ceftazidime]] 2g IV q8h<ref>https://www.aafp.org/afp/2007/0815/p539.html</ref>

===[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>===
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Category'''
| align="center" style="background:#f0f0f0;"|'''Antibiotic'''
| align="center" style="background:#f0f0f0;"|'''Sensitivity'''
|-
| [[Penicillins]]||[[Penicillin G]]||X1
|-
| ||[[Penicillin V]]||X1
|-
| Anti-Staphylocccal [[Penicillins]]||[[Methicillin]]||X1
|-
| ||[[Nafcillin]]/[[Oxacillin]]||X1
|-
| ||[[Cloxacillin]]/[[Diclox.]]||X1
|-
| Amino-[[Penicillins]]||[[AMP]]/[[Amox]]||X1
|-
| ||[[Amox-Clav]]||X1
|-
| ||[[AMP-Sulb]]||X1
|-
| Anti-Pseudomonal [[Penicillins]]||[[Ticarcillin]]||X1
|-
| ||[[Ticar-Clav]]||X1
|-
| ||[[Pip-Tazo]]||X1
|-
| ||[[Piperacillin]]||X1
|-
| [[Carbapenems]]||[[Doripenem]]||X1
|-
| ||[[Ertapenem]]||X1
|-
| ||[[Imipenem]]||X1
|-
| ||[[Meropenem]]||X1
|-
| ||[[Aztreonam]]||X1
|-
| [[Fluroquinolones]]||[[Ciprofloxacin]]||X1
|-
| ||[[Ofloxacin]]||X1
|-
| ||[[Pefloxacin]]||X1
|-
| ||[[Levofloxacin]]||X1
|-
| ||[[Moxifloxacin]]||X1
|-
| ||[[Gemifloxacin]]||X1
|-
| ||[[Gatifloxacin]]||X1
|-
| 1st G [[Cephalo]]||[[Cefazolin]]||X1
|-
| 2nd G. [[Cephalo]]||[[Cefotetan]]||X1
|-
| ||[[Cefoxitin]]||X1
|-
| ||[[Cefuroxime]]||X1
|-
| 3rd/4th G. [[Cephalo]]||[[Cefotaxime]]||X1
|-
| ||[[Cefizoxime]]||X1
|-
| ||[[CefTRIAXone]]||X1
|-
| ||[[Ceftaroline]]||X1
|-
| ||[[CefTAZidime]]||X1
|-
| ||[[Cefepime]]||X1
|-
| Oral 1st G. [[Cephalo]]||[[Cefadroxil]]||X1
|-
| ||[[Cephalexin]]||X1
|-
| Oral 2nd G. [[Cephalo]]||[[Cefaclor]]/[[Loracarbef]]||X1
|-
| ||[[Cefproxil]]||X1
|-
| ||[[Cefuroxime axetil]]||X1
|-
| Oral 3rd G. [[Cephalo]]||[[Cefixime]]||X1
|-
| ||[[Ceftibuten]]||X1
|-
| ||[[Cefpodox]]/[[Cefdinir]]/[[Cefditoren]]||X1
|-
| [[Aminoglycosides]]||[[Gentamicin]]||I
|-
| ||[[Tobramycin]]||I
|-
| ||[[Amikacin]]||I
|-
| ||[[Chloramphenicol]]||X2
|-
| ||[[Clindamycin]]||X1
|-
| [[Macrolides]]||[[Erythromycin]]||X1
|-
| ||[[Azithromycin]]||X1
|-
| ||[[Clarithromycin]]||X1
|-
| Ketolide||[[Telithromycin]]||X1
|-
| Tetracyclines||[[Doxycycline]]||'''S+'''
|-
| ||[[Minocycline]]||'''S+'''
|-
| Glycylcycline||[[Tigecycline]]||X1
|-
| ||[[Daptomycin]]||R
|-
| Glyco/Lipoclycopeptides||[[Vancomycin]]||X1
|-
| ||[[Teicoplanin]]||X1
|-
| ||[[Telavancin]]||X1
|-
| ||[[Fusidic Acid]]||R
|-
| ||[[Trimethoprim]]||X1
|-
| ||[[TMP-SMX]]||X1
|-
| Urinary Agents||[[Nitrofurantoin]]||X1
|-
| ||[[Fosfomycin]]||X1
|-
| Other||[[Rifampin]]||X1
|-
| ||[[Metronidazole]]||R
|-
| ||[[Quinupristin dalfoppristin]]||X1
|-
| ||[[Linezolid]]||X1
|-
| ||[[Colistimethate]]||X1
|}

====Key====
{{Template:Antibacterial Spectra Key}}

==Table Overview==
{{Clinically Relevant Bacteria}}

==See Also==
*[[Microbiology (Main)]]

==References==
<references/>

[[Category:ID]]


==Disposition==
*Contingent on presentation, admit if severe or significant comorbidities

==See Also==

==External Links==

==References==
<references/>
[[Category:ID]]