Laboratory Studies
- It is important to remember that initial laboratory findings may be unremarkable, but they may yield clues to underlying medical conditions such as chronic liver disease, chronic hemolytic anemia, hemochromatosis, diabetes, renal insufficiency, or adrenal insufficiency..
- CBC count with differential and platelet count
- Findings on blood count are initially nondiagnostic in patients with Vibrio infection.
- In patients with underlying medical conditions, such as cirrhosis, the presence of thrombocytopenia and/or schistocytes is an early indicator of disseminated intravascular coagulation (DIC).
- Serum chemistries (comprehensive metabolic panel)
- Serum electrolytes, BUN, and creatinine levels may become abnormal in patients with dehydration, hypotension, and severe sepsis.
- Monitoring serum electrolytes is essential in the treatment of severe gastroenteritis.
- Stool examination for occult blood and fecal leukocytes: The presence of either fecal occult blood or fecal leukocytes is a reliable marker for invasive infectious diarrhea.
- Stool examination for ova and parasites and stool cultures for Salmonella, Shigella, Campylobacter, Yersinia, and Vibrio species
- Stool examination for parasites and stool culture are indicated in patients who present with diarrhea and who have a history of recent travel and/or consumption of contaminated food or water.
- Perform these tests in patients with gastroenteritis, especially upon suspicion of foodborne illness.
- The physician may alert the public health department if a specific pathogen is identified in a group of people.
- Prothrombin time and activated partial thromboplastin time
- Prothrombin time (PT) and activated partial thromboplastin time (aPTT) may be prolonged in patients with DIC.
- Coagulation tests are indicated in patients who require extensive surgical debridement.
- Gram stain and culture
- Organisms may be recovered from blood (patients with sepsis), bullae or wounds (skins and soft tissue infections), and stool (gastroenteritis).
- Gram stain may reveal gram-negative rods, or studies may be used to isolate a specific pathogen for antibiotic sensitivity testing.
- Organisms may be recovered or demonstrated in other body fluids and/or exudates such as peritoneal fluid or ocular exudates.
- Blood cultures
- Blood cultures are indicated in patients with sepsis, severe skin and soft tissue infections, or unstable vital signs (eg, hypotension, multiple organ dysfunction).
- Patients with advanced liver disease, malignancies, or hemochromatosis may develop bacteremia and serious complications more often than those without these medical conditions.
- Blood cultures are frequently positive in patients with V vulnificus infections.
- Arterial blood gas
- Arterial blood gas (ABG) is indicated in patients with severe sepsis, septic shock, multiple organ dysfunction, DIC, or acute respiratory distress syndrome (ARDS).
- ABG may show severe metabolic acidosis due to tissue hypoperfusion and/or hypoxia.
Imaging Studies
- Chest radiography in patients with Vibrio infections may show fluffy bilateral pulmonary infiltrates compatible with ARDS. Radiographic examination of the injured anatomical parts, such as fingers, hand, foot, or trunk may reveal foreign objects, such as fragments of fishhooks or seashells. The presence of gas feathering in the soft tissue may help to identify other potential diagnoses, such as gas gangrene.
- CT scanning of the injured body parts may be indicated if the patient develops signs and symptoms of compartment syndrome or necrotizing fasciitis.
Other Tests
- Other tests may be unnecessary upon admission but may help identify the underlying medical conditions that predispose the patient to serious Vibrio infection and/or complications.
- Serology for HBV and HCV and serum iron studies are used to identify the etiology of advanced liver disease.
Procedures
- Aspiration of skin bullae or a wound can be performed for Gram stain and culture in patients with skin and soft tissue infections.
- Placement of central venous catheter for intravenous rehydration may be indicated in patients with profound hypovolemia or shock.
- Early wound debridement is indicated in patients with Vibrio wound infection or septicemia. A delay of wound debridement may lead to amputation. Debridement must be performed urgently if the patient develops compartment syndrome.
Histologic Findings
Findings on histologic examination of the skin and/or soft tissue in patients with noncholera Vibrio wound infection frequently demonstrate gram-negative bacilli, acute inflammatory reaction with extensive tissue necrosis, and fat infarction. In patients with rapidly progressing illness, examination of biopsy specimens of the skin may demonstrate an absence of cellular response.
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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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