Makindo Medical Notes

🦠 Vibrio vulnificus is the leading cause of death from seafood consumption in the US. ⚠️ Around 25% of infections occur from direct inoculation of an open wound exposed to warm seawater containing the organism.

ℹ️ About

• 🌊 Marine-borne, motile, curved rod-shaped Gram-negative bacillus
• 🧑‍⚕️ Causes fulminant sepsis in immunocompromised hosts, especially those with liver disease or cirrhosis
• 🍤 Acquired via ingestion of raw/undercooked seafood (esp. oysters) or direct wound exposure to contaminated seawater
• 🧬 Closely related to Vibrio cholerae

🧬 Aetiology

• 🌍 Found in estuaries, brackish ponds, and coastal waters, especially in warm climates
• 🍽️ ~75% via ingestion of infected seafood (esp. raw oysters in the US)
• 🩸 ~25% via direct wound contact with contaminated seawater

🩺 Clinical Features

• 💩 Gastrointestinal: watery diarrhoea, cramping, nausea, vomiting, fever
• 🌡️ Septicaemia: fever, chills, hypotension, rapidly progressive shock
• 🩹 Skin/soft tissue: painful haemorrhagic bullae, blistering lesions, ecchymoses, deep cellulitis
• ⚠️ Necrotising fasciitis and purpura fulminans may develop within hours
• 🚨 Mortality is very high (>50%) even with prompt antibiotics

🔎 Investigations

• 🧪 Bloods: FBC, U&E, LFTs, CRP
• 🧫 Blood cultures and wound cultures for organism identification
• ⚡ Early recognition is key → do not delay treatment while awaiting cultures

💊 Management

• 💉 Immediate empiric antibiotics: Doxycycline (or Vibramycin) + Ceftazidime is recommended
• 🩹 Aggressive wound care and supportive therapy
• 🔪 Surgical debridement required for necrotising infection; limb amputation may be lifesaving
• 🚨 Patients with painful, rapidly progressive haemorrhagic bullae should receive urgent surgical review
• 📉 Mortality >50% despite early antibiotics; higher in patients with cirrhosis, immunosuppression, or delayed treatment

📌 Exam Pearl: – Think of Vibrio vulnificus in any patient with rapidly progressive haemorrhagic bullae after raw seafood ingestion or seawater exposure, especially if cirrhotic. – This is one of the few infections where doxycycline is first-line for severe Gram-negative sepsis.

📚 References

• AAFP: Vibrio vulnificus Infection – Diagnosis and Treatment