Vibrio Infections

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 contaminated, raw, or undercooked crustaceans or shellfish and warm (> 20°C [82.4°F]) 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 crampy abdominal pain and fever, typically within 24 hours 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, wound infections, and primary bacteremia after ingestion of contaminated shellfish or exposure to sea water

  • Cellulitis with or without sepsis may occur with

    • Bulla formation

    • Necrosis

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

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

Diagnosis

• Culture

Treatment

• Doxycycline, 100 mg orally twice daily, plus ceftriaxone, 2 g intravenously daily, for 7–10 days, is treatment of choice for suspected or documented primary bacteremia or cellulitis caused by Vibrio species

• 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