Vibrio Cellulitis

Aka: Vibrio Cellulitis, Vibrio vulnificus, Vibrio alginolyticus, Vibrio damsela

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II. Epidemiology

  1. Most common cause of shellfish related deaths in U.S.

III. Causes

  1. Vibrio vulnificus (most common)
  2. Vibrio alginolyticus
  3. Vibrio damsela

IV. Pathophysiology

  1. Vibrio vulnificus is halophilic (high salt concentration), brackish, warm water (esp. Gulf Coast states in U.S.)
  2. Laceration in salt water or brackish fresh water
    1. See Marine Trauma
    2. Warm water Temperature (>68 degrees F)
    3. Not associated with pollution or fecal waste
  3. Wound exposure (most common)
    1. Drippings from raw seafood
    2. Fish fin punctures
  4. Ingestion of contaminated seafood (raw oysters)
    1. Especially oysters harvested in Gulf of Mexico
    2. Infection does not alter food taste, odor, appearance
    3. Highest risk with Immunocompromised state (e.g. Diabetes Mellitus, Cirrhosis)

V. Risk Factors

  1. Immunocompromising conditions
    1. Diabetes Mellitus
    2. Lymphoma
    3. Cirrhosis
  2. Enhanced iron storage (high Transferrin Saturation)
    1. Alcoholic Cirrhosis
    2. Hemochromatosis
    3. Thalassemia major

VI. Symptoms and Signs: Ingestion

  1. Onset: 1-5 days
  2. Duration: 2-8 days
  3. Fever
  4. Diarrhea
  5. Nausea and Vomiting
  6. Mental status changes (50%)
  7. Septic Shock (33%)
  8. Abdominal Pain
  9. Skin lesions with Ecchymoses, ulcers and bullae
    1. See Cellulitis below
    2. Skin lesions develop within first 24 hours

VII. Signs: Cellulitis (Primary Wound Infections)

  1. Fever and chills (Bacteremia in 50%)
  2. Mental status changes (33%)
  3. Hypotension (10%)
  4. Painful Cellulitis onset at open wound sites
    1. Rapidly progressive infection
    2. Hemorrhagic bullous lesions (75% of cases)
    3. Marked local edema
    4. Necrotic ulcers
    5. Necrotizing Fasciitis

VIII. Labs

  1. Complete Blood Count with differential
  2. Blood Culture
  3. Gram Stain and Culture of skin lesions

IX. Course

  1. Cellulitis
    1. See Cellulitis or Marine Trauma
    2. Rapidly progressive Necrotizing Fasciitis and Septicemia
  2. Ingestion raw oysters
    1. Acute Gastroenteritis 24 hours after intake
    2. Hemorrhagic skin bullae
    3. See Foodborne Illness

X. Management

  1. Hospitalization
    1. Progresses rapidly with high mortality and morbidity
    2. Mortality rate rises with delayed treatment
  2. Surgical Debridement indications (Limb Amputation may be required)
    1. Embedded debris
    2. Necrotizing Fasciitis
  3. Antibiotics
    1. Recommended Protocol
      1. Doxycycline or Minocycline 100 mg PO or IV q12 hours AND
      2. Ceftazidime (Fortaz) 2 grams IV q8 hours or Ceftriaxone 2 g IV q24 hours
    2. Alternative protocol
      1. Ciprofloxacin 750 mg PO or 400 mg IV every 12 hours OR
      2. Levofloxacin 750 mg PO or IV every 24 hours

XI. Prognosis

  1. Very high case fatality rate: 30-40%
  2. Comorbid liver disease or Immunocompromised confers higher mortality
  3. Mortality increases with delay in treatment
    1. Prompt diagnosis: 33% mortality
    2. Delayed 24 hours: 53% mortality
    3. Delayed 72 hours: 100% mortality
    4. Klontz (1988) Ann Intern Med 109:318-23 [PubMed]

XII. Prevention

  1. See Prevention of Foodborne Illness
  2. Avoid seawater contact with open wounds
    1. Highest risk when water Temperature >68 F degrees
    2. Wash exposed wounds with soap and water immediately
    3. Seak immediate attention for signs of Cellulitis

XIII. References

  1. Habif (1996) Dermatology, p. 491
  2. Daniels (2011) Clin Infect Dis 52(6): 788-92 +PMID:21367733 [PubMed]
  3. Jain (2003) Emerg Med Clin North Am 21(4):1117-44 [PubMed]
  4. Perkins (2017) Am Fam Physician 95(9):554-60 [PubMed]
  5. Perkins (2004) Am Fam Physician 69(4): 885-90 [PubMed]
  6. Bross (2007) Am Fam Physician 76(4): 539-46 [PubMed]

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Related Studies

Ontology: Vibrio vulnificus (C0318256)

Definition (NCI) A species of facultatively anaerobic, Gram negative, curved rod shaped bacteria assigned to the phylum Proteobacteria. This species is motile, oxidase positive, hemolytic, halophilic, and can produce acid from arbutin but not from sucrose. V. vulnificus is a marine organism and a pathogen that causes wound infections and septicemia and has a higher rate of mortality than infections caused by other Vibrio species.
Definition (NCI_CDISC) Any bacterial organism that can be assigned to the species Vibrio vulnificus.
Definition (MSH) A species of halophilic bacteria in the genus VIBRIO, which lives in warm SEAWATER. It can cause infections in those who eat raw contaminated seafood or have open wounds exposed to seawater.
Concepts Bacterium (T007)
MSH D041261
SnomedCT 55905000
English Vibrio vulnificus, Vibrio vulnificus (Reichelt et al. 1979) Farmer 1980 emend. West et al. 1986, Beneckea vulnifica Reichelt et al. 1979 (Approved Lists 1980), vibrio vulnificus, VIBRIO VULNIFICUS, BENECKEA VULNIFICA, Beneckea vulnifica, Vibrio vulnificus (organism)
Swedish Vibrio vulnificus
Czech Vibrio vulnificus
Finnish Vibrio vulnificus
Polish Vibrio vulnificus
Norwegian Vibrio vulnificus
Spanish Vibrio vulnificus (organismo), Vibrio vulnificus
French Vibrio vulnificus
German Vibrio vulnificus
Italian Vibrio vulnificus
Russian VIBRIO VULNIFICUS
Dutch Vibrio vulnificus
Portuguese Vibrio vulnificus
Derived from the NIH UMLS (Unified Medical Language System)

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