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Unknown #102






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    Unknown #102 Unknown #102 Presentation Transcript

    • Unknown #102
    • Galveston, TX
      • 48 yo male with a history of HTN, remote pancreatitis and ETOH abuse, has been lost to follow-up
      • Brought in by his landlord as he was found unresponsive in the hallway with a “rash”
      • His landlord noticed his belly has been swelling over the last few months
      • VS: Temp: 101.2 BP 88/40, Pulse 110, 02Sat 99% 2L, RR 22
      • 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%)
        • Hemochromatosis
        • Diabetes
        • Antacid use (high stomach pH)
        • Cancer
        • Immune disorders, including HIV infection
        • Long-term steroid use
    • Diagnosis,Treatment
      • Culturing of the organism from wounds, diarrheic stools, or blood
      • Treatment: 3 rd generation cephalosporin and doxycycline (or antipseudomonal penicillin), supportive care, often debridement
    • References
      • 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]
      • Chiang SR, Chuang YC. Vibrio vulnificus infection: clinical manifestations, pathogenesis, and antimicrobial therapy. J Microbiol Immunol Infect. 2003 Jun;36(2):81-8. Review. PMID: 12886957 [PubMed - indexed for MEDLINE]
      • Borenstein M, Kerdel F. Infections with Vibrio vulnificus. Dermatol Clin. 2003 Apr;21(2):245-8. Review. PMID: 12757246 [PubMed - indexed for MEDLINE]