Exam: Unresponsive male with fetor hepatis. Distended abdomen, + fluid wave, + caput medusa
Rash on lower extremities (next slide)
What’s the diagnosis?
How was it likely contracted?
What antibiotics if any?
Vibrio vulnificus Lactose-fermenting Gram negative rod Found in estuarine environments, associated with various marine species such as plankton, shellfish and finfish Cause soft tissue infections, gastroenteritis, or syndrome known as Primary Septicemia Septicemia can occur with doses of less than 100 total organisms
Vibrio vulnificus Sepsis From hematogenous spread or from direct innoculation Develop within 36 hrs after ingestion Bullous skin lesions -Gastroenteritis (anyone can get this): usually develops within 16 hours of eating the contaminated food -Sepsis: 60% case fatality Over 70 percent of infected individuals have distinctive bullous skin lesions. Transmitted to humans through open wounds in contact with seawater or through consumption of certain improperly cooked or raw shellfish. V. vulnificus is found in up to 10% of raw shellfish on the market in the United States) and is part of the normal flora of seawater from warmer climates. Dermatologic Manifestations Clinical Manifestations Mode of Transmission
Tender erythematous patches and plaques quickly progress to vesicles and hemorrhagic bullae, which may result in gangrene and necrotizing fasciitis
Vibrio vulnificus Primary Septicemia
High Risk Conditions Predisposing to Vibrio vulnificus sepsis:
Liver disease, either from excessive alcohol intake, viral hepatitis or other causes (95%)
Antacid use (high stomach pH)
Immune disorders, including HIV infection
Long-term steroid use
Culturing of the organism from wounds, diarrheic stools, or blood
Treatment: 3 rd generation cephalosporin and doxycycline (or antipseudomonal penicillin), supportive care, often debridement
Oliver JD. Wound infections caused by Vibrio vulnificus and other marine bacteria. Epidemiol Infect. 2005 Jun;133(3):383-91. Review. PMID: 15962544 [PubMed - indexed for MEDLINE]