Vibrio vulnificus: Difference between revisions

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==Background==
==Background==
*History of handling or ingestion of raw seafood (most commonly oysters)
*Gram negative bacterium living in marine environments
**Handling: rapid cellulitis that progresses to hemorrhagic bullae and purpura fulminans
*Leading cause of shellfish-associated death in US
**Ingestion: vomiting, diarrhea, or abdominal pain, and may present with fever, chills, or shock
**Patients with [[cirrhosis]] at high risk
*Severe Complications
**Necrotizing fasciitis and septicemia
**Immediate and intensive empirical antibiotic treatment
**Surgical debridement in suspected cases


==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
{{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>===
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===Key===
====Key====
{{Template:Antibacterial Spectra Key}}
{{Template:Antibacterial Spectra Key}}


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<references/>
<references/>


[[Category:ID]]
==Disposition==
*Contingent on presentation, admit if severe or significant comorbidities
==See Also==
==External Links==
==References==
<references/>
[[Category:ID]]
[[Category:ID]]

Latest revision as of 02:54, 15 January 2021

Background

  • Gram negative bacterium living in marine environments
  • Leading cause of shellfish-associated death in US

Vibrio species


Clinical Features

Differential Diagnosis

Skin and Soft Tissue Infection

Look-A-Likes

Nausea and vomiting

Critical

Emergent

Nonemergent

Evaluation

  • Generally clinical diagnosis, though blood cultures may assist in ultimate diagnosis and vibrio PCR testing exists[4]
  • 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[5]

Antibiotic Sensitivities[6]

Category Antibiotic 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

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

Table Overview

Gram Positives
Cocci
Clusters
Pairs/Chains
Other
Rods
Gram Negatives
Cocci
Rods
Lactose Fermenters
Lactose Non-Fermenters
Other
Rods/Cocci
Anaerobes

See Also

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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
  4. ↑ https://emedicine.medscape.com/article/1055523-workup
  5. ↑ https://www.aafp.org/afp/2007/0815/p539.html
  6. ↑ Sanford Guide to Antimicrobial Therapy 2014


Disposition

  • Contingent on presentation, admit if severe or significant comorbidities

See Also

External Links

References

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