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Vibrio Vulnificus Infection - medtigo

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Vibrio Vulnificus Infection

Updated : January 2, 2023





The pathogenic species of the Vibrionaceae family, which includes Vibrio cholera, Vibrio parahaemolyticus, & Vibrio vulnificus, include Vibrio vulnificus. The words “to wriggle or vibrate” and “to wound” are derived from the Latin, respectively, as is “vulnificus.”

The bacillus is widespread throughout the world and can cause septicemia, gastrointestinal illness, and wound infections. Despite having a low infection rate, V. vulnificus is the cause of the most seafood-related fatalities in the US.

The majority of Vibrionaceae are located in warmer marine habitats while being widespread. Disease annual incidences are higher in the summer, & Vibrionaceae are more likely to flourish in regions with subtropical monsoon climates. The United States, Taiwan, South Korea, & Japan are the nations with the most positive samples of V. vulnificus.

Due to the lack of monsoon conditions in the southern latitudes, disease there is assumed to be less prevalent than in the northern latitudes. According to one study, 32% of the shellfish sold at seafood markets along the Mexican coast contained Vibrio. Vulnificus, who develops septicemia after the primary infection, depends largely on host characteristics.

Patients over the age of forties are at higher risk, and males contract the infection more commonly than females do. The increased incidence of hepatic failure in older guys may be related to this sex and age discrepancy. The organism’s rising prevalence & virulence have been linked to the impact of climate change. This is assumed to be related to growing sea temperatures & polar ice caps melting, which causes the water’s salinity to increase.

 

 

Vibrionaceae’s shape plays a big part in its pathogenicity. In terms of structure, Vibrio. vulnificus is a motile, halophilic, flagellated bacillus with unique FHPs (flagellin homologous proteins), a CPS (capsular polysaccharide), and lipopolysaccharide (LPS). The organism’s capsule contains polysaccharides that protect it from the host’s stomach acid attack and also trigger the production of host cytokines, including TNF (tumor necrosis factor), interleukin-8, & interleukin-6. Both opsonization & complement stimulation, which are required for bacterial elimination, are inhibited by vulnificus infections.

Polysaccharides in the capsule are also thought to contribute to neutrophil & macrophage dysregulation. Surface pili make it easier for host cells to connect to them. For the establishment of a Vibrio biofilm, FHPs (flagellar components) are necessary. Both the cytotoxicity & environmental survival of V. vulnificus depend on the production of biofilms. V. vulnificus lipopolysaccharides cause cytokines & pyrogens to be released, mediating sepsis.

The iron that V. vulnificus absorbs while invading the host increases its cytotoxicity and pathogenicity. Some metabolic processes can deplete host transferrin of iron, resulting in sepsis and increased mortality. Patients with increased iron reserves, such as those with sickle cell anaemia, long-term liver disease, & hemochromatosis, are particularly at risk.

A flagellated, motile, halophilic, gram-negative rod known as Vibrio vulnificus. It lives in aquatic habitats such as rivers, estuaries, shorelines, deltas & deeper ocean surfaces. By settling in fish intestines as well as the guts of shellfish (mainly oysters), V. vulnificus penetrates the food chain. The bacilli subsequently contaminate human hosts by coming into direct contact with polluted water and seafood or by ingesting this tainted seafood.

Primary (and confined) gastroenteritis, primary wound infection, & primary (and distinct) septicemia are the three unique syndromic symptoms of V. vulnificus infestations. The bacilli can cause a primary septicemia condition after ingestion, which can quickly progress to significant extremities involvement. Watery diarrhea, vomiting, nausea, & fever are common gastrointestinal symptoms that can occur before, after, or in the complete absence of septicemia.

Although the specific point of entry is unknown, experts believe it to be either the colon or the small intestine. Sixty percent of all cases are primary sepsis. Overall, this presentation has a 50% death rate. Lacerations, abrasions, punctures, and envenomation wounds made in a marine environment can all be quickly colonized by the bacillus, resulting in a severe skin reaction & cellulitis with blisters bullae.

If left untreated, this might quickly progress from a cutaneous lesion to necrotizing fasciitis with myonecrosis, then to severe sepsis. About 25 percent of all V. vulnificus instances have a primary wound appearance. The overall fatality rate from wound infection is around 25%, but in patients with underlying hepatic illness, it is as high as 54%. With a fast onset of chills, fever, nausea, watery diarrhea & vomiting, a restricted gastrointestinal appearance is noticed.

There is little risk of sepsis, serious skin condition, or mortality in this manifestation. However, it is advisable to exercise caution when presuming GI symptoms are benign because comparable GI symptoms can occur before the primary septicemic type. 10% – 15% of all cases of V. vulnificus that are observed have this restricted GI appearance.

 

 

The illness V. vulnificus is fatal. The total mortality for all cases is about 35%. Patients who are diagnosed with an underlying immunosuppressive or hepatic condition have fatality rates that are close to 50% – 60%, compared to 16% for patients who do not have an underlying illness (hazard ratio 1.84, 95% CI 1.41-2.85). The mortality rate overall for sepsis patients who present is 50%, but the fatality rates for those who receive antibiotic treatment beyond 72 hours (after arrival) are reaching 100%.

Fatality rates for patients undergoing prolonged operative debridement after developing necrotizing fasciitis & myonecrosis are close to 100%. For all patients who come with chronic wounds, the overall mortality rate is 25%. It is uncommon for patients who have mild gastroenteritis to die. Even though V. vulnificus infections are uncommon, they account for 95% of all seafood-related deaths occurring in the United States.

Certain serologic indicators are helpful for both diagnosis and predicting mortality. Both levels of real-time PCR V. vulnificus DNA load and tissue necrosis factor (TNF-alpha) are significantly higher in individuals who pass away compared to those who survive in blood samples taken a right after arrival.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Resuscitation efforts should begin as soon as a septic shock is recognized. Sepsis measures used in facilities are crucial for managing patients. Blisters and skin cellulitis should be maintained. Debridement of necrotic skin disease is necessary. Abscesses on the skin need to be drained. Skin that has been infected should be covered with topicals such as silver sulfadiazine. Rapid surgical debridement & fasciotomy are required for the accompanying necrotizing fasciitis & myonecrosis.

To avoid limb necrosis and eventually amputation, this is essential. As always, any septic patient who needs to go into surgery should first receive proper fluid resuscitation, a sufficient airway, or any necessary vasopressors. Individuals with necrotizing fasciitis have a very increased mortality risk if operative debridement is delayed. Following culture, the proper antibiotic should be chosen & administered. The early administration of antibiotics should always be maintained by a delay in acquiring cultures. Antibiotic combination therapy is advised.

Up to 50 percent of Vibrio illnesses have been reported to have multiple drug resistance, nevertheless. Third generation cephalosporins, sulfa-trimethoprim, tetracyclines, fluoroquinolones, carbapenems, piperacillin-tazobactam, & aminoglycosides are all effective towards V. vulnificus, according to in vitro susceptibility testing. However, the CDC advises using injectable ceftazidime combined with ciprofloxacin (quinolone) or doxycycline (tetracycline) as part of a combination treatment.

It has also been successfully utilized to administer intravenous ciprofloxacin along with intravenous doxycycline and intravenous tigecycline. Notably, the death rate for individuals who were septic upon admission and received the proper antibiotics before 24 hours of being admitted was still close to one-third. When the administration is put off for longer than 72 hours, mortality exceeds 100%.

Fluid replacement, analgesics, antipyretics, & antiemetics should all be used in the treatment of primary, limiting gastroenteritis. Kidney function, electrolytes, fluid intake, & urine output should all be continuously evaluated and used to guide replacement treatment. The goal of current research is to create a vaccine to protect against V. vulnificus.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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https://www.ncbi.nlm.nih.gov/books/NBK554404/

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Vibrio Vulnificus Infection

Updated : January 2, 2023




The pathogenic species of the Vibrionaceae family, which includes Vibrio cholera, Vibrio parahaemolyticus, & Vibrio vulnificus, include Vibrio vulnificus. The words “to wriggle or vibrate” and “to wound” are derived from the Latin, respectively, as is “vulnificus.”

The bacillus is widespread throughout the world and can cause septicemia, gastrointestinal illness, and wound infections. Despite having a low infection rate, V. vulnificus is the cause of the most seafood-related fatalities in the US.

The majority of Vibrionaceae are located in warmer marine habitats while being widespread. Disease annual incidences are higher in the summer, & Vibrionaceae are more likely to flourish in regions with subtropical monsoon climates. The United States, Taiwan, South Korea, & Japan are the nations with the most positive samples of V. vulnificus.

Due to the lack of monsoon conditions in the southern latitudes, disease there is assumed to be less prevalent than in the northern latitudes. According to one study, 32% of the shellfish sold at seafood markets along the Mexican coast contained Vibrio. Vulnificus, who develops septicemia after the primary infection, depends largely on host characteristics.

Patients over the age of forties are at higher risk, and males contract the infection more commonly than females do. The increased incidence of hepatic failure in older guys may be related to this sex and age discrepancy. The organism’s rising prevalence & virulence have been linked to the impact of climate change. This is assumed to be related to growing sea temperatures & polar ice caps melting, which causes the water’s salinity to increase.

 

 

Vibrionaceae’s shape plays a big part in its pathogenicity. In terms of structure, Vibrio. vulnificus is a motile, halophilic, flagellated bacillus with unique FHPs (flagellin homologous proteins), a CPS (capsular polysaccharide), and lipopolysaccharide (LPS). The organism’s capsule contains polysaccharides that protect it from the host’s stomach acid attack and also trigger the production of host cytokines, including TNF (tumor necrosis factor), interleukin-8, & interleukin-6. Both opsonization & complement stimulation, which are required for bacterial elimination, are inhibited by vulnificus infections.

Polysaccharides in the capsule are also thought to contribute to neutrophil & macrophage dysregulation. Surface pili make it easier for host cells to connect to them. For the establishment of a Vibrio biofilm, FHPs (flagellar components) are necessary. Both the cytotoxicity & environmental survival of V. vulnificus depend on the production of biofilms. V. vulnificus lipopolysaccharides cause cytokines & pyrogens to be released, mediating sepsis.

The iron that V. vulnificus absorbs while invading the host increases its cytotoxicity and pathogenicity. Some metabolic processes can deplete host transferrin of iron, resulting in sepsis and increased mortality. Patients with increased iron reserves, such as those with sickle cell anaemia, long-term liver disease, & hemochromatosis, are particularly at risk.

A flagellated, motile, halophilic, gram-negative rod known as Vibrio vulnificus. It lives in aquatic habitats such as rivers, estuaries, shorelines, deltas & deeper ocean surfaces. By settling in fish intestines as well as the guts of shellfish (mainly oysters), V. vulnificus penetrates the food chain. The bacilli subsequently contaminate human hosts by coming into direct contact with polluted water and seafood or by ingesting this tainted seafood.

Primary (and confined) gastroenteritis, primary wound infection, & primary (and distinct) septicemia are the three unique syndromic symptoms of V. vulnificus infestations. The bacilli can cause a primary septicemia condition after ingestion, which can quickly progress to significant extremities involvement. Watery diarrhea, vomiting, nausea, & fever are common gastrointestinal symptoms that can occur before, after, or in the complete absence of septicemia.

Although the specific point of entry is unknown, experts believe it to be either the colon or the small intestine. Sixty percent of all cases are primary sepsis. Overall, this presentation has a 50% death rate. Lacerations, abrasions, punctures, and envenomation wounds made in a marine environment can all be quickly colonized by the bacillus, resulting in a severe skin reaction & cellulitis with blisters bullae.

If left untreated, this might quickly progress from a cutaneous lesion to necrotizing fasciitis with myonecrosis, then to severe sepsis. About 25 percent of all V. vulnificus instances have a primary wound appearance. The overall fatality rate from wound infection is around 25%, but in patients with underlying hepatic illness, it is as high as 54%. With a fast onset of chills, fever, nausea, watery diarrhea & vomiting, a restricted gastrointestinal appearance is noticed.

There is little risk of sepsis, serious skin condition, or mortality in this manifestation. However, it is advisable to exercise caution when presuming GI symptoms are benign because comparable GI symptoms can occur before the primary septicemic type. 10% – 15% of all cases of V. vulnificus that are observed have this restricted GI appearance.

 

 

The illness V. vulnificus is fatal. The total mortality for all cases is about 35%. Patients who are diagnosed with an underlying immunosuppressive or hepatic condition have fatality rates that are close to 50% – 60%, compared to 16% for patients who do not have an underlying illness (hazard ratio 1.84, 95% CI 1.41-2.85). The mortality rate overall for sepsis patients who present is 50%, but the fatality rates for those who receive antibiotic treatment beyond 72 hours (after arrival) are reaching 100%.

Fatality rates for patients undergoing prolonged operative debridement after developing necrotizing fasciitis & myonecrosis are close to 100%. For all patients who come with chronic wounds, the overall mortality rate is 25%. It is uncommon for patients who have mild gastroenteritis to die. Even though V. vulnificus infections are uncommon, they account for 95% of all seafood-related deaths occurring in the United States.

Certain serologic indicators are helpful for both diagnosis and predicting mortality. Both levels of real-time PCR V. vulnificus DNA load and tissue necrosis factor (TNF-alpha) are significantly higher in individuals who pass away compared to those who survive in blood samples taken a right after arrival.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Resuscitation efforts should begin as soon as a septic shock is recognized. Sepsis measures used in facilities are crucial for managing patients. Blisters and skin cellulitis should be maintained. Debridement of necrotic skin disease is necessary. Abscesses on the skin need to be drained. Skin that has been infected should be covered with topicals such as silver sulfadiazine. Rapid surgical debridement & fasciotomy are required for the accompanying necrotizing fasciitis & myonecrosis.

To avoid limb necrosis and eventually amputation, this is essential. As always, any septic patient who needs to go into surgery should first receive proper fluid resuscitation, a sufficient airway, or any necessary vasopressors. Individuals with necrotizing fasciitis have a very increased mortality risk if operative debridement is delayed. Following culture, the proper antibiotic should be chosen & administered. The early administration of antibiotics should always be maintained by a delay in acquiring cultures. Antibiotic combination therapy is advised.

Up to 50 percent of Vibrio illnesses have been reported to have multiple drug resistance, nevertheless. Third generation cephalosporins, sulfa-trimethoprim, tetracyclines, fluoroquinolones, carbapenems, piperacillin-tazobactam, & aminoglycosides are all effective towards V. vulnificus, according to in vitro susceptibility testing. However, the CDC advises using injectable ceftazidime combined with ciprofloxacin (quinolone) or doxycycline (tetracycline) as part of a combination treatment.

It has also been successfully utilized to administer intravenous ciprofloxacin along with intravenous doxycycline and intravenous tigecycline. Notably, the death rate for individuals who were septic upon admission and received the proper antibiotics before 24 hours of being admitted was still close to one-third. When the administration is put off for longer than 72 hours, mortality exceeds 100%.

Fluid replacement, analgesics, antipyretics, & antiemetics should all be used in the treatment of primary, limiting gastroenteritis. Kidney function, electrolytes, fluid intake, & urine output should all be continuously evaluated and used to guide replacement treatment. The goal of current research is to create a vaccine to protect against V. vulnificus.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

https://www.ncbi.nlm.nih.gov/books/NBK554404/

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