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Vibrio Infections Workup

  • Author: Hoi Ho, MD; Chief Editor: Michael Stuart Bronze, MD  more...
 
Updated: Sep 25, 2014
 

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.

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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.

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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.

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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.

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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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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 Institute, American College of Physicians, American Society for Microbiology, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

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.

Ogechika Karl Alozie, MBBS, MPH, AAHIVS Assistant Professor of Infectious Diseases/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: Received honoraria from AbbVie for speaking and teaching; Received honoraria from GSK for speaking and teaching.

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, Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

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

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

Disclosure: Nothing to disclose.

Acknowledgements

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.

Wei-I (Vickie) Wu, MS Texas Tech University School of Medicine

Disclosure: Nothing to disclose.

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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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