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Key Features

  • Vibrios other than Vibrio cholerae that cause human disease are V parahaemolyticus, V vulnificus, and V alginolyticus

  • Infection is acquired by exposure to organisms in raw or undercooked crustaceans or shellfish and warm (> 20°C) ocean waters and estuaries

  • Oysters are implicated in up to 90% of food-related cases

Clinical Findings

  • V cholerae

    • Causes voluminous diarrhea, rapid development of marked dehydration, and death if untreated

    • Rehydration and antimicrobial therapy are life-saving

  • V parahaemolyticus

    • Causes acute watery diarrhea with fever, typically within 24 h after ingestion of contaminated shellfish

    • Disease is self-limited

    • Antimicrobial therapy usually not necessary

  • V vulnificus and V alginolyticus

    • Neither cause diarrhea

    • They do, however, cause cellulitis and primary bacteremia after ingestion of contaminated shellfish or exposure to seawater

    • Cellulitis with or without sepsis may occur with

      • Bulla formation

      • Necrosis

      • Extensive soft tissue destruction, at times requiring débridement and amputation

    • Infection can progress rapidly and be severe in immunocompromised individuals, especially those with cirrhosis, with death rates of 50%

Diagnosis

  • Culture

Treatment

  • Tetracycline, 500 mg orally four times a day for 7–10 days, is the drug of choice for suspected or documented primary bacteremia or cellulitis caused by Vibrio species

  • Vibrio cholerae is also susceptible to

    • Doxycycline, 100 mg twice daily orally for 7–10 days

    • Fluoroquinolones and TMP-SMZ

  • V vulnificus may also be susceptible to

    • Penicillin

    • Ampicillin

    • Cephalosporins

    • Chloramphenicol

    • Aminoglycosides

    • Fluoroquinolones

  • V parahaemolyticus and V alginolyticus

    • Resistant to penicillin and ampicillin

    • Otherwise, susceptibilities are similar to V vulnificus

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