- Discussion:
- gram-negative facultative coccobacillus
- vibrios are among the most common organisms found in waters in US and around the world;
- in the US these infections occur mainly on the gulf coast and southern atlantic seaboard;
- these organisms tend to proliferate in the warm months from May thru October, in waters of moderate salinity and alkaline pH.
- two known sources of infection are direct inoculation and enteric involvement from ingestion of raw seafood;
- may cause gram negative septic shock within hours;
- most of wound infections are open, traumatic lesions that are contaminated with water, soil, and other bacteria;
- Septic Shock:
- gram- negative septicemia & septic shock may begin within hours of onset, and cardiovascular collapse may occur rapidly;
- infection accompanied by septicemia is most common in immunocompromised hosts, including those who have diabetes mellitus;
- once organism invades the tissue, destruction may be extensive and may be accompanied by bulli, vasculitis, arterial and venous thrombosis,
massive necrosis to the deep fascia, and septic myositis;
- myonecrosis, gas gangrene, and sepsis due to A. hydrophila have been reported in patients who are immunologically competent;
- bacteremia, sepsis, and metastatic lesions involving skin and muscle, however, are more likely to develop in immunocompromised patients;
- Treatment:
- organism is sensitive to a variety of broad-spectrum antibiotics, including
doxycycline (perhaps antibiotic of choice), tetracycline,
ampicillin, most cephalosporins, and gentamicin;
- all strains are susceptible to penicillin, ampicillin, cephalothin, chloramphenicol, gentamicin, tetracycline, rifampin, and sulfisoxazole;
- infection spreads rapidly, especially if antibiotic therapy and radical debridement of all infected and necrotic tissue are delayed;
- radical debridement is manditiory;
Infections caused by halophilic marine Vibrio bacteria.
Roland FP. Leg gangrene and endotoxin shock due to Vibrio parahaemolyticus -- an infection acquired in New England coastal waters.
N Engl J Med 1970; 282:1306.
Clinical manifestations of halophilic non-cholera vibrio infections.
Thorsteinsson SB, Minuth JN, Musher DM.
Lancet 1974; 2:1283-4.
Vibrio vulnificus infection of the lower limb after fish spine injuries.
Systemic Vibrio Infection Presenting as Necrotizing Fasciitis and Sepsis.
