Vibrio Infections Treatment & Management

  • Author: Hoi Ho, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Aug 15, 2011
 

Medical Care

Medical care depends on the clinical presentation and the presence of underlying medical conditions.

  • Gastroenteritis
    • Because Vibrio gastroenteritis is self-limited in most patients, no specific medical therapy is required. Patients who cannot tolerate oral fluid replacement may require intravenous fluid therapy.
    • Although most Vibrio species are sensitive to antibiotics such as doxycycline or quinolones, antibiotic therapy does not shorten the course of the illness or the duration of pathogen excretion. However, if the patient is ill and has a high fever or an underlying medical condition, oral antibiotic therapy with doxycycline or quinolone can be initiated.
  • Patients with noncholera Vibrio wound infection or septicemia are much more ill and frequently have other medical conditions. Medical therapy consists of the following:
    • Prompt initiation of effective antibiotic therapy
    • Intensive medical therapy with aggressive fluid replacement and vasopressors for hypotension and septic shock to correct acid-base and electrolytes abnormalities that may be associated with severe sepsis
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Surgical Care

  • Early fasciotomy within 24 hours after development of clinical symptoms can be life saving in patients with necrotizing fasciitis.
  • Early debridement of the infected wound has an important role in successful therapy and is especially indicated to avoid amputation of fingers, toes, or limbs.
  • Expeditious and serial surgical evaluation and intervention are required because patients may deteriorate rapidly, especially those with necrotizing fasciitis or compartment syndrome.
  • Reconstructive surgery, such as skin graft, is indicated in the recovery phase.
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Consultations

A team effort is required to ensure successful therapy in patients with noncholera Vibrio wound infection or septicemia.

  • Urgent consultation with an infectious diseases specialist for diagnosis and possible investigation of foodborne illness
  • Urgent consultation with a general surgeon or orthopedist for debridement
  • Consultation with a critical care specialist to manage possible developments such as severe sepsis, septic shock, and multiple organ dysfunction (eg, ARDS, renal failure)
  • Consultation with a gastroenterologist since many patients with Vibrio infections have advanced liver disease and may develop serious complications such as gastrointestinal bleeding
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Diet

  • Patients with Vibrio gastroenteritis are permitted oral intake as tolerated.
  • Patients with Vibrio wound infection and septicemia are frequently too ill to tolerate oral intake during the acute phase.
  • Some patients with advanced liver disease develop hepatic encephalopathy and may require oral or parenteral hepatic nutrition.
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Contributor Information and Disclosures
Author

Hoi Ho, MD  Associate Dean for Faculty Affairs and Development, Professor, Department of Internal Medicine, Director, Center for Advanced Teaching and Assessment in Clinical Simulation (ATACS), Paul L Foster School of Medicine, Texas Tech University Health Sciences Center; Consulting Physician, University Medical Center

Hoi Ho, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American College of Forensic Examiners, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Ogechika Karl Alozie, MBBS, MPH, AAHIVS  Assistant Professor of Infectious Diseases, Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L Foster School Of Medicine

Ogechika Karl Alozie, MBBS, MPH, AAHIVS is a member of the following medical societies: American Academy of HIV Medicine

Disclosure: Nothing to disclose.

Sun-Yu Tran  Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine

Sun-Yu Tran is a member of the following medical societies: American College of Physicians and Texas Medical Association

Disclosure: Nothing to disclose.

Tony Tran Ho, MS  Texas Tech University School of Medicine

Tony Tran Ho, MS is a member of the following medical societies: American Medical Association and Texas Medical Association

Disclosure: Nothing to disclose.

Thong Huy Do, MD  Staff Physician, Department of Internal Medicine, Thomason Hospital, Texas Tech University

Thong Huy Do, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary D Nettleman, MD, MS, MACP  Professor and Chair, Department of Medicine, Michigan State University College of Human Medicine

Mary D Nettleman, MD, MS, MACP is a member of the following medical societies: American College of Physicians, Association of Professors of Medicine, Central Society for Clinical Research, Infectious Diseases Society of America, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Richard B Brown, MD, FACP  Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine

Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthor Wei-L Wu, MS, to the development and writing of this article.

References

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Vibrio infections. Early bullous lesions appear over the dorsum of the foot of a patient with cirrhosis.
Vibrio infections. In a patient with cirrhosis, skin lesion rapidly becomes necrotic.
Vibrio infections. Bullous lesions in a patient with cirrhosis continue to progress, and the patient rapidly develops hypotension and shock despite aggressive medical therapy.
Table 1. Noncholera Vibrio Species and Associated Clinical Presentations
Infection TypeNoncholera Vibrio SpeciesCytotoxins/Enzymes
GastroenteritisV parahaemolyticus



Non-01 V cholerae



Vibrio fluvialis



V mimicus



Vibrio furnissii



Vibrio hollisae



Vibrio alginolyticus



V vulnificus



Cytotoxin



Hemolysin



Wound infectionV alginolyticus



V vulnificus



Non-01 V cholerae



Vibrio damsela



Vibrio carchariae



V fluvialis



V parahaemolyticus



V mimicus



Protease



Hemolysin



Lipase



DNAase



Cytolysin



SepticemiaV vulnificus



V fluvialis



V damsela



Non-01 V cholerae



Vibrio cincinnatiensis



Proteases



Endotoxic lipopolysaccharide



Table 2. Clinical Presentation Rates of Pathogenic Vibrio Infections
Vibrio SpeciesGastroenteritis



(%)



Wound Infection



(%)



Septicemia



(%)



Miscellaneous



(%)



V parahaemolyticus593452
V vulnificus545437
Non-01 V cholerae67915…
V alginolyticus5-1271110-15
V mimicus8533…
V fluvialis73106…
V damselaRare>95Rare…
V furnissii>90RareRare…
Vibrio metschnikoviiCommonRareRare…
V hollisae8575…
V cincinnatiensisRareRareRareMeningitis
Table 3. Clinical Signs and Symptoms of Vibrio Infections
Clinical PresentationSymptoms (Frequency)
GastroenteritisDiarrhea (100%)



Abdominal cramps (89%)



Nausea (76%)



Vomiting (55%)



Fever (47%)



Bloody stools (29%)



Headache (24%)



Myalgia (24%)



Wound infectionSwelling (100%)



Pain (100%)



Erythema (100%)



Bullae (30-50%)



Necrosis (30-50%)



Gangrene (< 10%)



SepticemiaFever (>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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