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Diagnosis of Vibrio vulnificus infections
Diagnosis of V. vulnificus is often elusive due to vague symptoms and a fulminant illness. Sepsis may occur rapidly in high-risk patients with mortality rates of approximately 40-50%. One-third of patients with septicemia will present to the hospital in shock or may develop hypotension within the first 24 hours after admission. Mortality rate exceeds 90% in patients with hypotension. Therefore, prompt diagnosis is critical (1, 2, 3).
Immunocompromised patients, particularly those with alcoholic cirrhosis or chronic liver disease, presenting with hypotension, signs of shock, and/or hemorrhagic bullous skin lesions (see photo) should be considered to have V. vulnificus septicemia. Diagnosis should be confirmed with standard blood or wound cultures, but treatment should not wait for blood culture results (1). So, in high-risk patients, THINK VIBRIO.
Immunocompromised patients presenting with hemmorhagic bullae should be considered to have V. vulnificus septicemia.
Begin treatment immediately. (Image courtesy Florida Dept of Public Health)
In patients with gastroenteritis symptoms and a history of seafood consumption or contact with saltwater or marine life, a stool culture using TCBS media (thiosulfate citrate bile-salts sucrose) should be used to identify V. vulnificus and other Vibrio infections (3, 4).
References
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Daniels N.A., Shafaie A. 2000. A review of pathogenic Vibrio infections for clinicians. J Infect Med.17(10):665-685.
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Martin G, Wright A.M., Banakaim K. 2000. A case of fatal food-borne septicemia:can family physicians provide prevention? J Am Board Fam Pract. 13:197-200.
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Morris, J.G. 2003. Vibrio vulnificus infections. UpToDate.
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American Medical Association, Centers for Disease Control and Prevention, U.S. Food and Drug Administration. 2004. Diagnosis and management of foodborne illnesses, a primer for physicians.
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Page last updated: August 18, 2017