Vibrio parahaemolyticus / vulnificus

Snapshot

A 45-year-old woman presents to a local hospital in Mexico with a swollen, erythematous left ankle. She reports that she recently obtained a tattoo on her left ankle 5 days ago. Since then, she went to Mexico on vacation, swam in seawater, and ate copious amounts of seafood, including raw oysters and ceviche. On physical exam, she has a warm and erythematous plaque over her left ankle where her tattoo is located and has 2 red bullae. Wound cultures are sent to the laboratory and she is started on the appropriate antibiotics. (Vibrio vulnificus infection)

Introduction

Classification
- a facultative anaerobe, gram-negative bacillus
- found in raw shellfish, sediment, and seawater
- Vibrio vulnificus
  - gastroenteritis
  - necrotizing fasciitis
  - cellulitis
- Vibrio parahaemolyticus
  - gastroenteritis
Epidemiology
- incidence
  - more common in warm weather
  - V. vulnificus is the most common cause of death from seafood consumption in the US
  - V. parahaemolyticus is the most common cause of diarrhea in Japan
- risk factors
  - eating undercooked seafood
  - chronic liver disease
    - in particular, cirrhosis
  - disorders of iron metabolism
  - immunocompromised status
  - shucking oysters
  - tsunami
    - organism can infect current wounds
Pathogenesis
- infects via contaminated seafood or direct contact in the case of wound infections
Prevention
- ensure properly cooked seafood
Prognosis
- typically resolves with treatment
mortality is high in those who develop septic shock

Presentation

Studies

Differential

Viral gastroenteritis
- distinguishing factor
  - typically does not present with skin lesions such as bullae
not associated with seawater or seafood

Treatment

Complications