Further Inpatient Care
- Daily or repeated surgical debridement may be necessary.
- Continue intensive medical care for fluid, electrolytes, and acid-base abnormalities.
- Blood transfusion or infusion of platelet or clotting factors is necessary for the treatment of DIC.
- Perform hemodialysis for renal failure, if indicated.
- Medically monitor and treat other underlying medical conditions such as advanced liver disease, diabetes mellitus, or leukemia.
Further Outpatient Care
- Noncholera Vibrio gastroenteritis is self-limited and does not require further outpatient care.
- Patients who survive devastating halophilic Vibrio infections may sustain finger, toe, or limb amputation and massive destruction of skin and soft tissue. These patients require extensive reconstructive surgery and physical rehabilitation.
Transfer
- Patients with serious noncholera Vibrio infections may require transfer to a facility where intensive monitoring and surgical expertise is available.
- In contrast to the treatment of gas gangrene, hyperbaric oxygen therapy (HBO) has not been studied or proven effective in the treatment of serious halophilic Vibrio infections. Therefore, transfer to an HBO facility is not recommended.
Deterrence/Prevention
- Avoid eating raw or undercooked seafood. Contaminated seafood cannot be distinguished by smell or taste. This is especially important for individuals with conditions that predispose to invasive Vibrio infections.[26]
- Fry, bake, steam, or boil oysters, clams, and mussels 4-9 minutes or until plump.
- Boil shrimp or crab until shells turn pink and the meat is cooked in the middle.
- Fish is cooked until the thickest part is opaque.
- Avoid exposure to seawater in summer months or along the coastal regions in the southeastern United States.
- Promptly seek medical attention if fever, nausea, abdominal cramps, diarrhea, myalgia, or severe pain in the lower extremities develops.
Complications
- Although reactive arthritis may occur, other complications are rare in immunocompetent patients who have noncholera Vibrio gastroenteritis.
- Patients with advanced liver disease or other underlying medical conditions are prone to developing serious complications of Vibrio infections, including the following:
- Hypotension, shock
- Compartment syndrome
- Multiple organ dysfunction
- DIC
- ARDS
- Hemolysis
- A delay in performing fasciotomy or debridement in a patient with a Vibrio wound infection may result in death or rapid disease progression, which may lead to amputation.
- Avoid admitting patients with noncholera Vibrio wound infection or septicemia to the regular ward. Hypotension or shock can develop very quickly.
- Frequent surgical evaluation is necessary to detect the rapid development of compartment syndrome.
Prognosis
- The prognosis is excellent in immunocompetent patients who have acute Vibrio gastroenteritis.
- In patients with Vibrio wound infection or septicemia, the prognosis is very grave (12), and depends on the following:
- Underlying medical conditions such as cirrhosis or leukemia
- Pathogen (V vulnificus infection is associated with a 50% mortality rate.)
- Prompt initiation of effective antibiotic therapy
- Early fasciotomy and debridement
- Availability of intensive monitoring and medical care for serious complications
- Availability of reconstructive surgery and physical rehabilitation
Patient Education
- Educate patients with appropriate underlying medical conditions about the serious medical illness that may be associated with the consumption of raw or undercooked seafood.
- Educate patients to seek medical attention promptly if fever, nausea, abdominal cramps, diarrhea, myalgia, or severe pain develops in the lower extremities.
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| Infection Type | Noncholera Vibrio Species | Cytotoxins/Enzymes |
| Gastroenteritis | V parahaemolyticus Non-01 V cholerae Vibrio fluvialis V mimicus Vibrio furnissii Vibrio hollisae Vibrio alginolyticus V vulnificus | Cytotoxin Hemolysin |
| Wound infection | V alginolyticus V vulnificus Non-01 V cholerae Vibrio damsela Vibrio carchariae V fluvialis V parahaemolyticus V mimicus | Protease Hemolysin Lipase DNAase Cytolysin |
| Septicemia | V vulnificus V fluvialis V damsela Non-01 V cholerae Vibrio cincinnatiensis | Proteases Endotoxic lipopolysaccharide |
| Vibrio Species | Gastroenteritis (%) | Wound Infection (%) | Septicemia (%) | Miscellaneous (%) |
| V parahaemolyticus | 59 | 34 | 5 | 2 |
| V vulnificus | 5 | 45 | 43 | 7 |
| Non-01 V cholerae | 67 | 9 | 15 | … |
| V alginolyticus | 5-12 | 71 | 1 | 10-15 |
| V mimicus | 85 | 3 | 3 | … |
| V fluvialis | 73 | 10 | 6 | … |
| V damsela | Rare | >95 | Rare | … |
| V furnissii | >90 | Rare | Rare | … |
| Vibrio metschnikovii | Common | Rare | Rare | … |
| V hollisae | 85 | 7 | 5 | … |
| V cincinnatiensis | Rare | Rare | Rare | Meningitis |
| Clinical Presentation | Symptoms (Frequency) |
| Gastroenteritis | Diarrhea (100%) Abdominal cramps (89%) Nausea (76%) Vomiting (55%) Fever (47%) Bloody stools (29%) Headache (24%) Myalgia (24%) |
| Wound infection | Swelling (100%) Pain (100%) Erythema (100%) Bullae (30-50%) Necrosis (30-50%) Gangrene (< 10%) |
| Septicemia | Fever (>90%) Hypothermia (< 10%) Hypotension (100%) Tachycardia (80-90%) Shock (50-70%) Bullae (80-100%) Acute respiratory distress syndrome (< 5%) Multiple organ dysfunction (30-50%) |
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