Vibrio vulnificus: Difference between revisions
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==Overview== | ==Overview== | ||
'''''Vibrio vulnificus''''' is a species of [[Gram-negative]], motile, curved, rod-shaped [[Bacterium|bacteria]] in the genus ''[[Vibrio]]''. Present in marine environments such as [[Estuary|estuaries]], brackish ponds, or coastal areas, ''V. vulnificus'' is closely related to ''[[Vibrio cholerae|''V. cholerae'']]'', the causative agent of [[cholera]].<ref name=Doyle_2001_species>{{cite book | author = Oliver JD, Kaper J | title = Vibrio species. pp. 263-300 In: Food Microbiology: Fundamentals and Frontiers. (Doyle MP et al, editors) | edition = 2nd ed. | publisher = ASM Press | year = 2001 | id = 1555811175 }}</ref><sup>,</sup><ref name=Oliver_2005_Wound>{{cite journal | author=Oliver JD | title=Wound infections caused by Vibrio vulnificus and other marine bacteria | journal=Epidemiol Infect | year=2005 | pages=383-91 | volume=133 | issue=3 | id=PMID 15962544}}</ref> | '''''Vibrio vulnificus''''' is a species of [[Gram-negative]], motile, curved, rod-shaped [[Bacterium|bacteria]] in the genus ''[[Vibrio]]''. Present in marine environments such as [[Estuary|estuaries]], brackish ponds, or coastal areas, ''V. vulnificus'' is closely related to ''[[Vibrio cholerae|''V. cholerae'']]'', the causative agent of [[cholera]].<ref name=Doyle_2001_species>{{cite book | author = Oliver JD, Kaper J | title = Vibrio species. pp. 263-300 In: Food Microbiology: Fundamentals and Frontiers. (Doyle MP et al, editors) | edition = 2nd ed. | publisher = ASM Press | year = 2001 | id = 1555811175 }}</ref><sup>,</sup><ref name=Oliver_2005_Wound>{{cite journal | author=Oliver JD | title=Wound infections caused by Vibrio vulnificus and other marine bacteria | journal=Epidemiol Infect | year=2005 | pages=383-91 | volume=133 | issue=3 | id=PMID 15962544}}</ref> | ||
==Historical Perspective== | |||
Health officials clearly identified strains of ''V. vulnificus'' infections among refugees from [[Effect of Hurricane Katrina on New Orleans|New Orleans]] due to the flooding there caused by [[Hurricane Katrina]].<ref>{{cite news | first=Scott | last=Gold | pages= | title=Newest Peril from Flooding Is Disease | date=September 6, 2005 | publisher=Los Angeles Times | url=http://democrats.assembly.ca.gov/members/a48/hurricane/press/h482005010.htm }}</ref> | |||
==Clinical features== | ==Clinical features== | ||
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==Treatment== | ==Treatment== | ||
''Vibrio vulnificus'' infection has a mortality rate of 50% with the majority of patients dying within the first 48 hours of infection. The optimal treatment is not known, but in one retrospective study of 93 patients in Taiwan, use of a third-generation [[cephalosporin]] and a [[tetracycline]] (e.g., [[ceftriaxone]] and [[doxycycline]]) were associated with an improved outcome.<ref name="Liu2006">{{cite journal | Arch Intern Med | year=2006 | volume=166 | issue=19 | pages=2117–23 | title=Prognostic factors and antibiotics in ''Vibrio vulnificus'' septicemia | author=Liu JW, Lee IK, Tang HJ, ''et al.'' | id=PMID 17060542 }}</ref> Prospective clinical trials are needed to confirm this finding, but ''in vitro'' data supports the supposition that this combination is synergistic against ''Vibrio vulnificus''. | ''Vibrio vulnificus'' infection has a mortality rate of 50% with the majority of patients dying within the first 48 hours of infection. The optimal treatment is not known, but in one retrospective study of 93 patients in Taiwan, use of a third-generation [[cephalosporin]] and a [[tetracycline]] (e.g., [[ceftriaxone]] and [[doxycycline]]) were associated with an improved outcome.<ref name="Liu2006">{{cite journal | Arch Intern Med | year=2006 | volume=166 | issue=19 | pages=2117–23 | title=Prognostic factors and antibiotics in ''Vibrio vulnificus'' septicemia | author=Liu JW, Lee IK, Tang HJ, ''et al.'' | id=PMID 17060542 }}</ref> Prospective clinical trials are needed to confirm this finding, but ''in vitro'' data supports the supposition that this combination is synergistic against ''Vibrio vulnificus''. | ||
''Vibrio vulnificus'' often causes large, disfiguring ulcers which require extensive [[Wiktionary:debride|debridement]] or even amputation. | |||
===Antimicrobial regimen=== | ===Antimicrobial regimen=== | ||
* 1. '''Sepsis or Soft Tissue Infection Antibiotic Management''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref> | * 1. '''Sepsis or Soft Tissue Infection Antibiotic Management''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref> | ||
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==Prognosis== | ==Prognosis== | ||
The worst prognosis is in those patients who arrive at hospital in a state of [[Shock (medical)|shock]]. Total mortality in treated patients is around 33%. | * The worst prognosis is in those patients who arrive at hospital in a state of [[Shock (medical)|shock]]. Total mortality in treated patients is around 33%. | ||
* Those patients who are especially vulnerable, including those with [[immunocompromised]] states ([[cancer]], bone marrow suppression, [[Human immunodeficiency virus|HIV]], [[diabetes]], etc}. With these cases, ''V. vulnificus'' usually enters the bloodstream, where it may cause fever and chills, septic shock (with sharply decreased blood pressure), and blistering skin lesions.<ref name=Doyle_2005_Oceans>{{cite book | author = Oliver JD, Kaper J | title = Vibrio vulnificus. In: Oceans and Health: Pathogens in the Marine Environment. (Belken SS, Colwell RR, editors) | edition = 2nd ed. | publisher = Springer Science | year = 2005 | id = 0387237089 }}</ref> According to the [[Centers for Disease Control and Prevention|CDC]], about half of those who contract blood infections die. | |||
Those patients who are especially vulnerable, including those with [[immunocompromised]] states ([[cancer]], bone marrow suppression, [[Human immunodeficiency virus|HIV]], [[diabetes]], etc}. With these cases, ''V. vulnificus'' usually enters the bloodstream, where it may cause fever and chills, septic shock (with sharply decreased blood pressure), and blistering skin lesions.<ref name=Doyle_2005_Oceans>{{cite book | author = Oliver JD, Kaper J | title = Vibrio vulnificus. In: Oceans and Health: Pathogens in the Marine Environment. (Belken SS, Colwell RR, editors) | edition = 2nd ed. | publisher = Springer Science | year = 2005 | id = 0387237089 }}</ref> According to the [[Centers for Disease Control and Prevention|CDC]], about half of those who contract blood infections die. | * ''Vibrio vulnificus'' infections also disproportionately affect males; 85% of those who develop [[endotoxic]] shock from the bacteria are male. Females who have had an [[oophorectomy]] experienced increased mortality rates, as [[estrogen]] is believed to have a protective effect against ''V. vulnificus''.<ref>{{cite journal | author=Merkel SM, Alexander S, Zufall E, Oliver JD, Huet-Hudson YM | title=Essential Role for Estrogen in Protection against ''Vibrio vulnificus''-Induced Endotoxic Shock | journal=Infection and Immunity | volume=69 | issue=10 | year=2001 | pages=6119–22 | id=PMID 11553550}} | ||
''Vibrio vulnificus'' infections also disproportionately affect males; 85% of those who develop [[endotoxic]] shock from the bacteria are male. Females who have had an [[oophorectomy]] experienced increased mortality rates, as [[estrogen]] is believed to have a protective effect against ''V. vulnificus''.<ref>{{cite journal | author=Merkel SM, Alexander S, Zufall E, Oliver JD, Huet-Hudson YM | title=Essential Role for Estrogen in Protection against ''Vibrio vulnificus''-Induced Endotoxic Shock | journal=Infection and Immunity | volume=69 | issue=10 | year=2001 | pages=6119–22 | id=PMID 11553550}} | |||
</ref> | </ref> | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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==External links== | ==External links== | ||
*[http://textbookofbacteriology.net/V.vulnificus.html Large and detailed article on ''V. vulnificus'' at ''Todar's Online Textbook of Bacteriology''] | *[http://textbookofbacteriology.net/V.vulnificus.html Large and detailed article on ''V. vulnificus'' at ''Todar's Online Textbook of Bacteriology''] | ||
[[Category:Bacterial diseases]] | [[Category:Bacterial diseases]] | ||
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[[Category:Water-borne diseases]] | [[Category:Water-borne diseases]] | ||
[[Category:Infectious Disease Project]] | [[Category:Infectious Disease Project]] | ||
{{WH}} | {{WH}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
Revision as of 15:04, 14 August 2015
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Overview
Vibrio vulnificus is a species of Gram-negative, motile, curved, rod-shaped bacteria in the genus Vibrio. Present in marine environments such as estuaries, brackish ponds, or coastal areas, V. vulnificus is closely related to V. cholerae, the causative agent of cholera.[1],[2]
Historical Perspective
Health officials clearly identified strains of V. vulnificus infections among refugees from New Orleans due to the flooding there caused by Hurricane Katrina.[3]
Clinical features
Vibrio vulnificus causes an infection often incurred after eating seafood, especially oysters; the bacteria can also enter the body through open wounds when swimming or wading in infected waters,[2] or via puncture wounds from the spines of fish such as tilapia. Symptoms include vomiting, diarrhea, abdominal pain, and a blistering dermatitis that is sometimes mistaken for pemphigus or pemphigoid. Severe symptoms and even death can occur if the bacterium enters the bloodstream—something more common in people with compromised immune systems or liver disease.[4]
Treatment
Vibrio vulnificus infection has a mortality rate of 50% with the majority of patients dying within the first 48 hours of infection. The optimal treatment is not known, but in one retrospective study of 93 patients in Taiwan, use of a third-generation cephalosporin and a tetracycline (e.g., ceftriaxone and doxycycline) were associated with an improved outcome.[5] Prospective clinical trials are needed to confirm this finding, but in vitro data supports the supposition that this combination is synergistic against Vibrio vulnificus. Vibrio vulnificus often causes large, disfiguring ulcers which require extensive debridement or even amputation.
Antimicrobial regimen
- 1. Sepsis or Soft Tissue Infection Antibiotic Management [6]
- Preferred regimen: Doxycycline 100 mg IV q12h AND Ceftazidime 2 g IV q8h OR Fluoroquinolone
- Alternative regimen (1): Cefotaxime 2 g IV q6h AND Ciprofloxacin 400 mg IV q12h OR Moxifloxacin 400 mg IV q24h OR Levofloxacin 750 mg IV q24h
- Alternative regimen (2): Cefotaxime AND Minocycline
- 2. Gastroenteritis
- Most cases self-limiting
- Maintain hydration: oral or parenteral routes
- Role of Doxycycline or Fluoroquinolones unclear, does not appear to shorten duration of non-cholera gastroenteritis
- 3. Skin and soft tissue infections [7]
- Preferred regimen: Doxycycline 100 mg IV q12h AND ceftriaxone 1 g IV qid OR cefotaxime 2 g IV tid
- Note: Antibiotic treatment is not recommended for children but may need to use in life-threatening situation
Prognosis
- The worst prognosis is in those patients who arrive at hospital in a state of shock. Total mortality in treated patients is around 33%.
- Those patients who are especially vulnerable, including those with immunocompromised states (cancer, bone marrow suppression, HIV, diabetes, etc}. With these cases, V. vulnificus usually enters the bloodstream, where it may cause fever and chills, septic shock (with sharply decreased blood pressure), and blistering skin lesions.[8] According to the CDC, about half of those who contract blood infections die.
- Vibrio vulnificus infections also disproportionately affect males; 85% of those who develop endotoxic shock from the bacteria are male. Females who have had an oophorectomy experienced increased mortality rates, as estrogen is believed to have a protective effect against V. vulnificus.[9]
References
- ↑ Oliver JD, Kaper J (2001). Vibrio species. pp. 263-300 In: Food Microbiology: Fundamentals and Frontiers. (Doyle MP et al, editors) (2nd ed. ed.). ASM Press. 1555811175.
- ↑ 2.0 2.1 Oliver JD (2005). "Wound infections caused by Vibrio vulnificus and other marine bacteria". Epidemiol Infect. 133 (3): 383–91. PMID 15962544.
- ↑ Gold, Scott (September 6, 2005). "Newest Peril from Flooding Is Disease". Los Angeles Times.
- ↑ "Vibrio vulnificus". NCBI Genome Project. Retrieved 2005-09-01.
- ↑ Liu JW, Lee IK, Tang HJ; et al. (2006). "Prognostic factors and antibiotics in Vibrio vulnificus septicemia". 166 (19): 2117&ndash, 23. PMID 17060542. Text " Arch Intern Med " ignored (help)
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL; et al. (2014). "Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America". Clin Infect Dis. 59 (2): 147–59. doi:10.1093/cid/ciu296. PMID 24947530.
- ↑ Oliver JD, Kaper J (2005). Vibrio vulnificus. In: Oceans and Health: Pathogens in the Marine Environment. (Belken SS, Colwell RR, editors) (2nd ed. ed.). Springer Science. 0387237089.
- ↑ Merkel SM, Alexander S, Zufall E, Oliver JD, Huet-Hudson YM (2001). "Essential Role for Estrogen in Protection against Vibrio vulnificus-Induced Endotoxic Shock". Infection and Immunity. 69 (10): 6119–22. PMID 11553550.