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Vibrio vulnificus

- Discussion:
    - gram-negative facultative coccobacillus
    - vibrios are among the most common organisms found in waters in US and around the world;
            - in the US these infections occur mainly on the gulf coast and southern atlantic seaboard;
    - these organisms tend to proliferate in the warm months from May thru October, in waters of moderate salinity and alkaline pH.
    - two known sources of infection are direct inoculation and enteric involvement from ingestion of raw seafood;
    - may cause gram negative septic shock within hours;
    - most of wound infections are open, traumatic lesions that are contaminated with water, soil, and other bacteria;

- Septic Shock:
    - gram- negative septicemia & septic shock may begin within hours of onset, and cardiovascular collapse may occur rapidly;
    - infection accompanied by septicemia is most common in immunocompromised hosts, including those who have diabetes mellitus;
    - once organism invades the tissue, destruction may be extensive and may be accompanied by bulli, vasculitis, arterial and venous thrombosis,
           massive necrosis to the deep fascia, and septic myositis;
    - myonecrosis, gas gangrene, and sepsis due to A. hydrophila have been reported in patients who are immunologically competent;
    - bacteremia, sepsis, and metastatic lesions involving skin and muscle, however, are more likely to develop in immunocompromised patients;

- Treatment:
    - organism is sensitive to a variety of broad-spectrum antibiotics, including doxycycline (perhaps antibiotic of choice), tetracycline,
           ampicillin, most cephalosporins, and gentamicin;
           - all strains are susceptible to penicillin, ampicillin, cephalothin, chloramphenicol, gentamicin, tetracycline, rifampin, and sulfisoxazole;
    - infection spreads rapidly, especially if antibiotic therapy and radical debridement of all infected and necrotic tissue are delayed;
    - radical debridement is mandatory

Infections caused by halophilic marine Vibrio bacteria.

Leg gangrene and endotoxin shock due to Vibrio parahaemolyticus -- an infection acquired in New England coastal waters.

Clinical manifestations of halophilic non-cholera Vibrio infections.

Vibrio vulnificus infection of the lower limb after fish spine injuries.

Systemic Vibrio Infection Presenting as Necrotizing Fasciitis and Sepsis.

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