II. Epidemiology
- Most common cause of shellfish related deaths in U.S.
III. Causes
- Vibrio vulnificus (most common)
- Vibrio alginolyticus
- Vibrio damsela
IV. Pathophysiology
- Vibrio vulnificus is halophilic (high salt concentration), brackish, warm water (esp. Gulf Coast states in U.S.)
-
Laceration in salt water or brackish fresh water
- See Marine Trauma
- Warm water Temperature (>68 degrees F)
- Not associated with pollution or fecal waste
-
Wound exposure (most common)
- Drippings from raw seafood
- Fish fin punctures
- Ingestion of contaminated seafood (raw oysters)
- Especially oysters harvested in Gulf of Mexico
- Infection does not alter food taste, odor, appearance
- Highest risk with Immunocompromised state (e.g. Diabetes Mellitus, Cirrhosis)
V. Risk Factors
- Immunocompromising conditions
- Enhanced iron storage (high Transferrin Saturation)
VI. Symptoms and Signs: Ingestion
- Onset: 1-5 days
- Duration: 2-8 days
- Fever
- Diarrhea
- Nausea and Vomiting
- Mental status changes (50%)
- Septic Shock (33%)
- Abdominal Pain
- Skin lesions with Ecchymoses, ulcers and bullae
- See Cellulitis below
- Skin lesions develop within first 24 hours
VII. Signs: Cellulitis (Primary Wound Infections)
- Fever and chills (Bacteremia in 50%)
- Mental status changes (33%)
- Hypotension (10%)
- Painful Cellulitis onset at open wound sites
- Rapidly progressive infection
- Hemorrhagic bullous lesions (75% of cases)
- Marked local edema
- Necrotic ulcers
- Necrotizing Fasciitis
VIII. Labs
- Complete Blood Count with differential
- Blood Culture
- Gram Stain and Culture of skin lesions
IX. Course
-
Cellulitis
- See Cellulitis or Marine Trauma
- Rapidly progressive Necrotizing Fasciitis and Septicemia
- Ingestion raw oysters
- Acute Gastroenteritis 24 hours after intake
- Hemorrhagic skin bullae
- See Foodborne Illness
X. Management
- Hospitalization
- Progresses rapidly with high mortality and morbidity
- Mortality rate rises with delayed treatment
- Surgical Debridement indications (Limb Amputation may be required)
- Embedded debris
- Necrotizing Fasciitis
-
Antibiotics
- Recommended Protocol
- Doxycycline or Minocycline 100 mg PO or IV q12 hours AND
- Ceftazidime (Fortaz) 2 grams IV q8 hours or Ceftriaxone 2 g IV q24 hours
- Alternative protocol
- Ciprofloxacin 750 mg PO or 400 mg IV every 12 hours OR
- Levofloxacin 750 mg PO or IV every 24 hours
- Recommended Protocol
XI. Prognosis
- Very high case fatality rate: 30-40%
- Comorbid liver disease or Immunocompromised confers higher mortality
- Mortality increases with delay in treatment
- Prompt diagnosis: 33% mortality
- Delayed 24 hours: 53% mortality
- Delayed 72 hours: 100% mortality
- Klontz (1988) Ann Intern Med 109:318-23 [PubMed]
XII. Prevention
- See Prevention of Foodborne Illness
- Avoid seawater contact with open wounds
- Highest risk when water Temperature >68 F degrees
- Wash exposed wounds with soap and water immediately
- Seak immediate attention for signs of Cellulitis
XIII. References
- Habif (1996) Dermatology, p. 491
- Daniels (2011) Clin Infect Dis 52(6): 788-92 +PMID:21367733 [PubMed]
- Jain (2003) Emerg Med Clin North Am 21(4):1117-44 [PubMed]
- Perkins (2017) Am Fam Physician 95(9):554-60 [PubMed]
- Perkins (2004) Am Fam Physician 69(4): 885-90 [PubMed]
- Bross (2007) Am Fam Physician 76(4): 539-46 [PubMed]