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A vaccine is available that confers short-lived, limited protection and may be required for entry into or reentry after travel to some countries It is administered in two doses 1 4 weeks apart A booster dose every 6 months is recommended for persons remaining in areas where cholera is a hazard Vaccination programs are expensive and not particularly effective in managing outbreaks of cholera When outbreaks occur, efforts should be directed toward establishing clean water and food sources and proper waste disposal
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therefore are resistant to penicillin and ampicillin, but susceptibilities otherwise are similar to those listed for V vulnificus
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Centers for Disease Control and Prevention Vibrio illnesses after Hurricane Katrina multiple states, August September 2005 MMWR Morb Mortal Wkly Rep 2005 Sep 23;54(37): 928 31 [PMID: 16177685] Liu JW et al Prognostic factors and antibiotics in Vibrio vulnificus septicemia Arch Intern Med 2006 Oct 23;166(19):2117 23 [PMID: 17060542]
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Treatment is by replacement of fluids In mild or moderate illness, oral rehydration usually is adequate A simple oral replacement fluid can be made from 1 teaspoon of table salt and 4 heaping teaspoons of sugar added to 1 L of water Intravenous fluids are indicated for persons with signs of severe hypovolemia and those who cannot take adequate fluids orally Lactated Ringer s infusion is satisfactory Antimicrobial therapy will shorten the course of illness Several antimicrobials are active against V cholerae, including tetracycline, ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, fluoroquinolones, and azithromycin Multiple drug-resistant strains are increasingly encountered, so susceptibility testing, if available, is advisable A single 1 g oral dose of azithromycin was effective for severe cholera caused by strains with reduced susceptibility to fluoroquinolones, but resistance is emerging to this drug as well
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Saha D et al Single-dose azithromycin for the treatment of cholera in adults N Engl J Med 2006 Jun 8;354(23):2452 62 [PMID: 16760445]
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INFECTIONS CAUSED BY CAMPYLOBACTER SPECIES
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Campylobacter organisms are microaerophilic, motile, gramnegative rods Two species infect humans: Campylobacter jejuni, an important cause of diarrheal disease, and Campylobacter fetus subsp fetus, which typically causes systemic infection and not diarrhea Dairy cattle and poultry are an important reservoir for campylobacters Outbreaks of enteritis have been associated with consumption of raw milk Campylobacter gastroenteritis is associated with fever, abdominal pain, and diarrhea characterized by loose, watery, or bloody stools The differential diagnosis includes shigellosis, salmonella gastroenteritis, and enteritis caused by Y enterocolitica or invasive E coli The disease is selflimited, but its duration can be shortened with antimicrobial therapy Either azithromycin, 1 g orally as a single dose, or ciprofloxacin, 500 mg orally twice daily for 3 days, is effective therapy C fetus causes systemic infections that can be fatal, including primary bacteremia, endocarditis, meningitis, and focal abscesses It infrequently causes gastroenteritis Patients infected with C fetus are often older, debilitated, or immunocompromised Closely related species, collectively termed campylobacter-like organisms, cause bacteremia in HIVinfected individuals Systemic infections respond to therapy with gentamicin, chloramphenicol, ceftriaxone, or ciprofloxacin Ceftriaxone or chloramphenicol should be used to treat infections of the central nervous system because of their ability to penetrate the blood-brain barrier
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Tribble DR et al Traveler s diarrhea in Thailand: randomized, double-blind trial comparing single-dose and 3-day azithromycin-based regimens with a 3-day levofloxacin regimen Clin Infect Dis 2007 Feb 1;44(3):338 46 [PMID: 17205438]
INFECTIONS CAUSED BY OTHER VIBRIO SPECIES
Vibrios other than V cholerae that cause human disease are Vibrio parahaemolyticus, Vibrio vulnificus, and Vibrio alginolyticus All are halophilic marine organisms Infection is acquired by exposure to organisms in contaminated, undercooked, or raw crustaceans or shellfish and warm (> 20 C) ocean waters and estuaries Infections are more common during the summer months from regions along the Atlantic coast and the Gulf of Mexico in the United States and from tropical waters around the world Oysters are implicated in up to 90% of food-related cases V parahaemolyticus causes an acute watery diarrhea with crampy abdominal pain and fever, typically occurring within 24 hours after ingestion of contaminated shellfish The disease is self-limited, and antimicrobial therapy is usually not necessary V parahaemolyticus may also cause cellulitis and sepsis, though these findings are more characteristic of V vulnificus infection V vulnificus and V alginolyticus neither of which is associated with diarrheal illness are important causes of cellulitis and primary bacteremia following ingestion of contaminated shellfish or exposure to sea water Cellulitis with or without sepsis may be accompanied by bulla formation and necrosis with extensive soft tissue destruction, at times requiring debridement and amputation The infection can be rapidly progressive and is particularly severe in immunocompromised individuals especially those with cirrhosis with death rates as high as 50% Patients with chronic liver disease and those who are immunocompromised should be cautioned to avoid eating raw oysters Tetracycline at a dose of 500 mg orally four times a day for 7 10 days is the drug of choice for treatment of suspected or documented primary bacteremia or cellulitis caused by Vibrio species V vulnificus is susceptible in vitro to penicillin, ampicillin, cephalosporins, chloramphenicol, aminoglycosides, and fluoroquinolones, and these agents may also be effective V parahaemolyticus and V alginolyticus produce -lactamase and
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