Infectious Disease Compendium

Vibrio

Microbiology

A gram negative rod. Includes V. alginolyticus, V. carchariae, V. cholerae, V. cincinnatiensis, V. damsela, V. fluvialis, V. furnissii, V. hollisae, V. metschnikovii, V. mimicus, V. parahaemolyticus, V. vulnificus.

Epidemiologic Risks

V. cholerae drinking contaminated water, the rest are associated with exposure to salt water and the eating of shellfish that were in the salt water. V. cholerae is found in the US SW (PubMed) and has been a huge problem in Haiti since the earthquake, imported from Asia, probably Bangladesh.

In Vietnam it was cholera was passed on with ice tea (PubMed). The lesson? Only drink alcohol when traveling.

In Africa, there is a marked increase in diseases during and after an El Nino (PubMed), adding at least 50,000 cases.

V. vulnificus is found in warm, brackish water, which all the oceans will become once Greenland melts. As the Baltic warms, for example, Vibrio infections rise rapidly (PubMed) and the waters of the Great Pacific Northwest are now worm enough to support Vibrio.

Infections are associated with Tilapia fish (as is S. iniae) and oysters. V. vulnificus wound infections are a manifestation of hemochromatosis and warrant iron studies.

A good review of non Cholera vibrio: (PubMed).

Syndromes

V. cholerae: cholera, an incredibly profuse, watery diarrhea. Untreated at least a 50% mortality rate and people die in a day or two.

V. parahaemolyticus: diarrhea and occasionally wound infections and septicemia.

V. vulnificus: sepsis in cirrhotics with hemorrhagic bullae, and necrotizing fasciitis in patients with hepatic disease, diabetes mellitus, chronic renal insufficiency, and adrenal insufficiency (PubMed).

V. vulnificus wound infections are a manifestation of hemochromatosis and warrant iron studies.

V. alginolyticus: cellulitis and acute otitis media or externa.

All the others cause either diarrhea or soft tissue infections.

Treatment

V. cholerae: fluid replacement lots and lots, lactated ringers best, they may be easily up to 25% volume short (CDC Guidelines). Tetracycline (single dose)> tmp/sulfa OR quinolone (single dose). Quinolone resistance is increasing as is TMP/Sulfa resistance, 1 gm single dose azithromycin was effective against Vibrio cholerae O1 or O139 (PubMed).

V. vulnificus: tetracycline PLUS a third generation cephalosporins has the best outcomes (PubMed) OR quinolone as an alternative. Resistant to aminoglycosides.

V. alginolyticus: All the others: if diarrhea, supportive treatment, if cellulitis or sepsis a tetracycline or third generation cephalosporins or quinolone are all active.

Notes

While I will eat damn near anything, I personally draw the line at raw oysters.