Vibrio Cellulitis

Aka: Vibrio Cellulitis, Vibrio vulnificus

1. See Also
   1. Cellulitis
   2. Marine Trauma
   3. Food Poisoning
2. Pathophysiology
   1. Laceration in salt water or brackish fresh water
      1. See Marine Trauma
      2. Warm water temperature (>68 degrees F)
      3. Not associated with pollution or fecal waste
   2. Wound exposure to drippings from raw seafood
   3. Ingestion of contaminated seafood (raw oysters)
      1. Especially oysters harvested in Gulf of Mexico
      2. Infection does not alter food taste, odor, appearance
3. Risk Factors
   1. Immunocompromising conditions
   2. Enhanced iron storage (high Transferrin Saturation)
      1. Alcoholic Cirrhosis
      2. Hemochromatosis
      3. Thalassemia
4. Symptoms and Signs: Ingestion
   1. Fever
   2. Diarrhea
   3. Nausea and Vomiting
   4. Mental status changes (50%)
   5. Septic shock (33%)
   6. Skin lesions with Ecchymoses and bullae
      1. See Cellulitis below
      2. Skin lesions develop within first 24 hours
5. Signs: Cellulitis (Primary wound infections)
   1. Fever and chills (Bacteremia in 50%)
   2. Mental status changes (33%)
   3. Hypotension (10%)
   4. Painful Cellulitis onset at open wound sites
      1. Rapidly progressive infection
      2. Hemorrhagic bullous lesions with marked local edema
      3. Necrotic ulcers
      4. Necrotizing Fasciitis
6. Labs
   1. Complete Blood Count with differential
   2. Blood Culture
   3. Gram Stain and Culture of skin lesions
7. Course
   1. Cellulitis
      1. Rapidly progressive necrosis and septicemia
      2. See Cellulitis or Marine Trauma
   2. Ingestion raw oysters
      1. Acute Gastroenteritis 24 hours after intake
      2. Hemorrhagic skin bullae
      3. See Foodborne Illness
8. Management
   1. Hospitalization
      1. Progresses rapidly with high mortality and morbidity
      2. Mortality rate rises with delayed treatment
   2. Surgical debridement
      1. Embedded debris
      2. Necrotic areas
   3. Antibiotics
      1. Recommended Protocol
         1. Doxycycline 100 mg PO or IV q12 hours AND
         2. Ceftazidime (Fortaz) 2 grams IV q8 hours
      2. Alternative protocol 1
         1. Doxycycline 100 mg PO or IV q12 hours AND
         2. Cefotaxime 2 grams IV q8 hours
      3. Alternative protocol 2
         1. Ciprofloxacin 750 mg PO or 400 mg IV q12 hours
9. Prognosis
   1. Very high case fatality rate: 30-40%
   2. Comorbid liver disease confers higher mortality
   3. Mortality increases with delay in treatment
      1. Prompt diagnosis: 33% mortality
      2. Delayed 24 hours: 53% mortality
      3. Delayed 72 hours: 100% mortality
      4. Klontz (1988) Ann Intern Med 109:318-23
10. Prevention
    1. See Prevention of Foodborne Illness
    2. Avoid seawater contact with open wounds
       1. Highest risk when water temperature >68 F degrees
       2. Wash exposed wounds with soap and water immediately
       3. Seak immediate attention for signs of Cellulitis
11. References
    1. Habif (1996) Dermatology, p. 491
    2. Jain (2003) Emerg Med Clin North Am 21(4):1117-44
    3. Perkins (2004) Am Fam Physician 69(4): 885-90
    4. Bross (2007) Am Fam Physician 76(4): 539-46