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A Physician’s Guide to
Infection, Prevention & Treatment |
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This presentation is part of a national effort
to promote education to health care providers, their high risk patients and
other consumers regarding Vibrio vulnficus and ways to prevent it. |
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V. vulnificus |
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V. cholera 01 |
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V. cholera non-01 |
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V. parahaemolyticus |
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V. alginolyticus |
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V. fluvialis |
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V. hollisae |
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V. mimicus |
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V. carchariae |
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V. cincinnatiensis |
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V. damsela |
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V. furnissii |
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V. hollisae |
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V. metschnikovii |
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Occurs
naturally in coastal waters - especially in warm months |
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Can cause illness: wound infections,
gastroenteritis, primary septicemia |
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Associated foods - primarily raw oysters, but
also clams, mussels, and crabs |
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Not the result of fecal pollution or poor
product handling |
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Oysters are filter-feeders |
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Vibrios attach to plankton |
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Oysters filter & concentrate vibrios in
oyster tissues ~100x |
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Rapid multiplication in warm conditions after
harvest |
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Low salinity |
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Warm temperatures (86 - 95º F) |
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Best conditions in May-October |
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Highest number of cases same period |
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Wound infections |
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Gastroenteritis |
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Primary septicemia |
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No outbreaks reported, only sporadic cases |
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Unknown for healthy persons, but for
high-risk people, septicemia can presumably occur with < 100 total
organisms |
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Culture of V. vulnificus from |
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wounds, |
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diarrheic stools, or |
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blood |
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Symptoms |
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Gastrointestinal illness |
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Fever |
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Shock |
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After |
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Ingestion of raw seafood (especially oysters) |
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Wound infection after exposure to seawater |
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How |
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Contaminating an open wound with sea water
harboring the organism, or |
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Lacerating part of the body on coral, fish, etc.
followed by contamination with the organism. |
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Range from |
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Mild, self-limited lesions to |
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Rapidly progressive cellulitis and myositis |
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Can mimic clostridial myonecrosis |
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Consumption of raw or undercooked seafood,
primarily molluscan shellfish containing the organism can cause
gastroenteritis in otherwise healthy individuals. |
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Microorganism enters the blood stream |
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Resulting in septic shock |
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Hypotension (death in 90% cases) |
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Distinctive bulbous skin lesions |
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Followed by death in @ 50% of cases |
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Early ID & treatment critical, rapid
progression into death |
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Extensive necrosis & tissue destruction
around wounds and lower extremities, requiring surgical debridement to
avoid amputation |
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Fluid leakage from capillaries into tissues
causing shock |
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Septicemia - bacteria in blood |
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Highly invasive through host tissues |
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Resists host defenses |
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Very rapid growth in tissues, especially where
iron present |
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Highly destructive of tissues - extracellular
toxins & enzymmes |
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Wound infections & primary septicemia
require antimicrobial treatment. Most effective: |
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tetracycline, |
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fluoroquinolones (e.g. ciprofloxacin); |
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3rd generation cephalosporins (e.g.
ceftazidime), |
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aminoglycosides (e.g. gentaminicin) |
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Early administration may reduce morbidity &
mortality associated with infection |
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Liver disease - accounts for most cases of
severe illness |
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Diseases of the stomach |
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Diabetes |
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AIDs or HIV positive |
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Impaired immune systems due to medication or
chronic illness |
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5 states account for 79% of all cases in last
decade (178/224) |
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Florida 36% |
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Texas 12% |
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Louisiana 11% |
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California 11% |
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Alabama 9% |
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Male (85% of cases) |
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White (77%) |
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Hispanic 88% in California, 21% Texas |
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Asian 13% in Louisiana |
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40-59 years old (53 years mean & median) |
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Slightly younger in Texas & California |
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70% ate
shellfish in restaurants |
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More frequent in Texas 91% & Florida 79%;
Louisiana, Alabama, California ~50% |
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26% ate shellfish at home |
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California 44%, Alabama 37%, Louisiana 29%,
Florida 18%, Texas 3% |
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Persons with liver disease at very high risk for
serious illness & death following exposure to V. vulnificus |
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RR of infection after exposure 30x higher for
person with liver disease |
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RR of death 200x higher for those with liver
disease |
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40 - 75 year old male |
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Heavy drinker, cirrhosis |
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Unaware of or in denial about dietary risks |
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# oysters consumed: 3 - 12 |
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Septicemia |
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50% mortality |
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High risk groups should avoid consumption of raw
shellfish (or any raw animal protein) |
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Cooking shellfish to certain temperatures for
specified time periods will kill
the organism (along with many other pathogens) |
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Warnings regarding high risk groups and raw
shellfish consumption are required to be posted in Florida at restaurants
and retail seafood markets |
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Industry and regulators are considering several
post harvest treatments (PHTs) that could eliminate the organism in oysters
including: |
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Irradiation |
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Mild pasteurization |
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Pressure treatments |
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Freezing and frozen storage |
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1. Clinical confirmation |
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2. Epidemiological interviews |
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3. Traceback of shellfish source |
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Date and time of shellfish consumption or other
exposure |
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Date and time of symptom onset |
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Symptoms and duration |
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Pre-existing conditions |
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Date of hospitalization |
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Date of death (where applicable) |
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NSSP Model Ordinance |
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for molluscan shellfish |
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classifies dealer types and requirements |
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shellfish tag information |
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dealer name and address |
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certification number |
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date of harvest |
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harvest location |
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Tags not kept by seller |
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Invoices not kept by seller |
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Numerous intermediate sellers |
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No leftover shellfish available |
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Between physicians, laboratories and health
departments |
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Between laboratories and health departments |
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Between state agencies |
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Between state and federal agencies |
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Urge at-risk patients to avoid eating raw
shellfish; to eat only shellfish that has been thoroughly cooked. |
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Suspect V. vulnificus infection in those at risk
who have recently eaten shellfish or been exposed to warm sea water. |
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Request specific testing for V. vulnificus in
stool, blood or wound cultures. |
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Notes