Vibrio Infections

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

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%

Culture

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