Non-cholera Vibrio infections

Last reviewed: May 2019

Last updated: September 2018

Summary

V vulnificus is the most virulent and can rapidly produce fatal septic shock in immunocompromised patients or those with underlying liver disease.

The diagnosis is based on blood, wound, and/or stool cultures.

Treatment consists of intravenous ceftazidime plus doxycycline for those with sepsis or severe systemic infection. Patients with necrotising skin/soft-tissue infection also require early aggressive debridement of the infected tissue. Localised skin/soft-tissue wound infections are managed with oral antibiotics and close observation.

Gastroenteritis syndromes are treated with rehydration. Oral antibiotics are indicated if diarrhoea persists >5 days.

Prognosis varies with the host's underlying comorbidity and the clinical presentation of the infection.

Definition

Non-cholera Vibrio infections are infections caused by Vibrio species other than V cholerae . Vibrio infections are most often associated with consumption of raw or undercooked shellfish, or traumatic exposure to sea or brackish water. They are characterised by diarrhoea and vomiting, sepsis, and/or skin/soft-tissue infections.

History and exam

Key diagnostic factors

presence of risk factors
leg pain
cellulitis
diarrhoea
abdominal cramps
ear pain
eye pain, redness

Full details

Other diagnostic factors

fever
altered mental status
nausea
vomiting
hypotension

Full details

Risk factors

exposure to brackish or marine waters
handling and/or cleaning seafood
ingestion of raw or undercooked shellfish
underlying hepatic disease (cirrhosis, hepatitis B or C, haemochromatosis)
current corticosteroid use or other immunosuppression (HIV, chemotherapy, solid organ transplantation)

Full details

Diagnostic investigations

1st investigations to order

full blood count
platelet count
basic metabolic panel
blood culture
wound swab for Gram stain
wound swab for culture
stool culture
ear canal swab for culture
conjunctival swab, corneal scraping, or chamber aspirates for culture

Full details

Treatment algorithm

ACUTE

Contributors

Authors VIEW ALL 

Michael Sands, MD, MPH & TM, FIDSA

Professor of Medicine

College of Medicine

University of Florida

Jacksonville

Disclosures

MS declares that he has no competing interests.

Carmen Isache, MD

Assistant Professor of Medicine

College of Medicine

University of Florida

Jacksonville

Disclosures

CI declares that she has no competing interests.

Peer reviewers VIEW ALL 

Christopher Huston, MD

Assistant Professor of Medicine

Division of Infectious Diseases

University of Vermont College of Medicine

Burlington

Disclosures

CH declares that he has no competing interests.

Franz Allerberger, MD, MPH

Professor of Clinical Microbiology

Austrian Agency for Health and Food Safety (AGES)

Vienna

Austria

Disclosures

FA declares that he has no competing interests.

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Non-cholera Vibrio infections

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Treatment algorithm

sepsis or severe systemic infection

localised skin/soft-tissue infection alone

gastroenteritis

superficial inoculation infections

Contributors

Authors VIEW ALL 

Michael Sands, MD, MPH & TM, FIDSA

Disclosures

Carmen Isache, MD

Disclosures

Peer reviewers VIEW ALL 

Christopher Huston, MD

Disclosures

Franz Allerberger, MD, MPH

Disclosures

Differentials

Guidelines

Patient leaflets

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