You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.
 

 

Characteristic V. alginolyticus V. parahaemolyticus V. cholerae non-O1/O139 V. vulnificus Other species
Total patients 23 (100) 20 (100) 10 (100) 7 (100) 7 (100)
Demographics
Age, y, median (SD) 50 (+26.7) 53 (+22.8) 69 (+19.7) 66 (+11.5) 40 (+24.8)
Sex
M 19 (83) 15 (75) 7 (70) 7 (100) 6 (86)
F 4 (17) 5 (25) 3 (30) 0 1 (14)
Underlying condition
Heart failure 8 (35) 6 (30) 5 (50) 4 (57) 1 (14)
Neoplasia 1 (4) 5 (25) 4 (40) 0 (0) 1 (14)
Diabetes 2 (9) 3 (15) 1 (10) 1 (14) 1 (14)
Kidney failure 2 (9) 1 (5) 1 (10) 0 3 (43)
Immune disease 2 (9) 2 (10) 1 (10) 0 2 (29)
Hemopathy 1 (4) 1 (5) 1 (10) 1 (14) 1 (14)
Liver disease 1 (4) 1 (5) 2 (20) 1 (14) 0
Alcohol use disorder 2 (9) 1 (5) 2 (20) 2 (29) 0
Preexisting wound 3 (13) 0 0 3 (43) 0
Digestive surgery 2 (9) 2 (10) 1 (10) 0 1 (14)
Time to symptom onset, d, median (SD) 2.4 (+2.0) 1.3 (+0.9) 3 (+4.4) 5.6 (+8.1) 1 (+0.0)
Infection type
Acute 14 (61) 19 (95) 10 (100) 7 (100) 5 (71)
Chronic 9 (39) 1 (5) 0 0 2 (29)
Outcome
Recovered 21 (91) 17 (85) 8 (80) 6 (86) 7 (100)
Died 2 (9) 3 (15) 2 (20) 1 (14) 0

Table 1. Clinical characteristics of patients with Vibrio infection, by species, Bay of Biscay, France, 2001–2019*

*Values are no. (%) except as indicated.

 

Antibiotic V. alginolyticus   V. parahaemolyticus   V. cholerae non-O1/O139   V. vulnificus
S I R S I R S I R S I R
Amoxicillin 1 0 15   1 6 7   2 2 3   5 0 0
Ticarcillin 5 0 10   2 2 9   5 0 1   5 0 0
First-generation cephalosporin 10 4 0   13 1 0   4 1 0   4 1 0

Table 2. Available drug-susceptibility test results for the main antibiotics used to treat Vibrio infections, by species, Bay of Biscay, France, 2001–2019*

*Data are no. of cases. I, intermediate; R, resistant; S, susceptible.

 

Characteristic No sepsis, n = 42   Septic shock, n = 13 p value
No. % (95% CI) No. % (95% CI)
Patient sex
M 35 83 (72–95)   10 77 (54–100) 0.685
F 7 17 (5–28)   3 23 (0.2–46)  
Underlying conditions
Heart failure 18 43 (28–58)   6 46 (19–73) Referent
Neoplasia 6 14 (4–25)   4 31 (6–56) 0.223
Diabetes 7 17 (5–28)   1 8 (0–22) 0.664
Kidney failure 5 12 (2–22)   2 15 (0–35) 0.664
Immune disease 5 12 (2–22)   2 15 (0–35) 0.664
Hemopathy 3 7 (0–15)   2 15 (0–35) 0.582
Liver disease 2 5 (0–11)   3 23 (0–46) 0.318
Alcohol use disorder 3 7 (0–15)   4 31 (6–56) 0.102
Preexisting wound 6 14 (4–25)   0 0 (0–0) 0.317
Digestive surgery 4 10 (1–18)   2 15 (0–35) 0.618
Species
V. alginolyticus 10 24 (11–37)   4 31 (6–56)  
V. parahaemolyticus 14 33 (19–48)   5 38 (12–65)  
V. cholerae non-O1/O139 8 19 (7–31)   2 15 (0–35)  
V. vulnificus 6 14 (4–25)   1 8 (0–22)  
Other Vibrio species 4 10 (1–18)   1 8 (0–22)
Outcome
Recovered 40 95 (89–100)   7 54 (27–81) 0.001
Died 2 5 (0–11)   6 46 (19–73)  

Table 3. Clinical characteristics and outcome of patients with and without septic shock after acute Vibrio infection, Bay of Biscay, France, 2001–2019*

*Median patient age ( + SD) was 60 ( + 21.4) for no sepsis and 61 ( + 15.3) for septic shock.

CME / ABIM MOC

Clinical and Epidemiologic Characteristics and Therapeutic Management of Patients With Vibrio Infections, Bay of Biscay, France, 2001–2019

  • Authors: Florence Hoefler, MD; Xavier Pouget-Abadie, MD; Mariam Roncato-Saberan, MD; Romain Lemarié, MD; Eve-Marie Takoudju, MD; François Raffi, MD; Stéphane Corvec, MD; Morgane Le Bras, MS; Charles Cazanave, MD; Philippe Lehours, MD; Thomas Guimard, MD; Caroline Allix-Béguec, PhD
  • CME / ABIM MOC Released: 11/18/2022
  • Valid for credit through: 11/18/2023
Start Activity

  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 1.00 ABIM MOC points

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for primary care physicians, infectious disease specialists, and other clinicians who treat and manage patients who may become infected with Vibrio spp.

The goal of this activity is to assess the epidemiology, microbiology, and prognosis of infection with Vibrio spp.

Upon completion of this activity, participants will:

  • Assess the epidemiology of infection with Vibrio spp. in the current study
  • Evaluate common anatomic sites of infection with Vibrio spp.
  • Distinguish the most common Vibrio spp. isolated in the current study
  • Analyze the treatment and outcomes of Vibrio infections


Disclosures

Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.


Faculty

  • Florence Hoefler, MD

    Centre Hospitalier La Rochelle
    La Rochelle
    France
    Centre Hospitalier Troyes
    Troyes
    France

  • Xavier Pouget-Abadie, MD

    Centre Hospitalier La Rochelle
    La Rochelle
    France
     

  • Mariam Roncato-Saberan, MD

    Centre Hospitalier La Rochelle
    La Rochelle
    France
     

  • Romain Lemarié, MD

    Centre Hospitalier La Rochelle
    La Rochelle
    France
     

  • Eve-Marie Takoudju, MD

    Centre Hospitalier Départemental Vendée
    La Roche sur Yon
    France
     

  • François Raffi, MD

    Centre Hospitalier Universitaire de Nantes
    Nantes
    France
     

  • Stéphane Corvec, MD

    Centre Hospitalier Universitaire de Nantes
    Nantes
    France
     

  • Morgane Le Bras, MS

    Centre Hospitalier Universitaire de Nantes
    Nantes
    France
    Centre Hospitalier d'Auxerre
    Auxerre
    France

  • Charles Cazanave, MD

    Centre Hospitalier Universitaire de Bordeaux
    Bordeaux
    France
     

  • Philippe Lehours, MD

    Centre Hospitalier Universitaire de Bordeaux
    Bordeaux
    France

  • Thomas Guimard, MD

    Centre Hospitalier Départemental Vendée
    La Roche sur Yon
    France
     

  • Caroline Allix-Béguec, PhD

    Centre Hospitalier La Rochelle
    La Rochelle
    France

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine
     

    Disclosures

    Charles P. Vega, MD, has the following relevant financial relationships:
    Consultant or advisor for: GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.
     

Editor

  • Jude Rutledge, BA

    Copyeditor
    Emerging Infectious Diseases

Compliance Reviewer

  • Leigh Schmidt, MSN, RN, CNE, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Leigh Schmidt, MSN, RN, CNE, CHCP, has no relevant financial relationships.


Accreditation Statements


In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

    For Physicians

  • Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read about the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or print it out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate, but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period, you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.

CME / ABIM MOC

Clinical and Epidemiologic Characteristics and Therapeutic Management of Patients With Vibrio Infections, Bay of Biscay, France, 2001–2019: Discussion

processing....

Discussion

The cases of Vibrio infections reported in this study are the most severe cases that ended up requiring hospitalization. Non–V.cholerae and V. cholerae non-O1/O139 bacteria can cause mild diarrhea and gastroenteritis, for which patients typically are not hospitalized [7,14], and the number of vibriosis incidents per year in the region is probably higher that those reported in our study. Comparing the demographics of our population with those described in a 1996–2010 review surveillance in the United States [10], we observed a higher proportion of men (81% vs. 68%), and the age group with the highest percentage of cases was 60–69 years in our population compared with 40–49 years in the United States. This difference is probably attributable to the fact that our population mainly consists of the most severe cases of infection that occur most often in older person [15]. Vibrio infections are usually initiated from exposure to contaminated water or consumption of raw or undercooked contaminated seafood. As reported in 2008 by Dechet et al. [16], seawater-related activities as simple as walking on the beach can lead to Vibrio infections [16], which was also reported for >50% of the patients with environmental factors identified in our study. Vibrio species are responsible for 20% of bacterial illnesses related to shellfish consumption [17]. In our study, 39% of the cases were acquired after seafood handling or consumption. Vibrio bacteria caused more seafood-associated outbreaks during the warmer months [11], and all but 1 case occurred during June–September in our study population. Extreme heat waves led to unprecedented high sea surface temperatures, which appear to be responsible for the emergence of Vibrio bacteria in areas where they are usually not present [18,19]. In 2003, France experienced the hottest summer in a century, which may have led to an increase in the concentration of Vibrio on the Bay of Biscay, given that the number of reported Vibrio infections also increased this year.

We compared the results of our study to a similar investigation conducted in the US state of Florida [13]. The most common species reported in Florida over 10 years were V. vulnificus (33.1%), V. parahaemolyticus (29.4%), V. alginolyticus (15.7%), and V. cholerae non-O1/O139 (6.6%). In our study, we report a slightly different distribution: V. alginolyticus (34.3%), V. parahaemolyticus (29.9%), V. cholerae non-O1/O139 (14.9%), and V. vulnificus (10.4%). The incubation period of V. parahaemolyticus, V. vulnificus (when exposed to a wound), and V. cholerae non-O1/O139is <24 hours; for other clinical manifestations after infection with V. vulnificus, the incubation period ≈48 hours [7,14]. In our study, the time between known exposure and onset of symptoms was <48 hours in 74% of cases.

Clinical manifestations are different depending on the type of Vibrio species. V. alginolyticus has been identified as a relevant cause of superficial wound and ear infections [14]. In our study, V. alginolyticus was responsible for most cases of chronic otitis. However, contrary to what has been observed in Florida [13], this species also caused 1 death associated with wound infection. V. parahaemolyticus is the most prevalent foodborne bacterium associated with seafood consumption and typically causes acute gastroenteritis [20], but it has also been identified in wound-associated cases [13]. In our study, most V. parahaemolyticus infections caused either gastroenteritis or bacterial cellulitis, but the species was also responsible for pneumonia, phlegmonous ileitis, and otitis. V. cholerae non-O1/O139 is the causative agent of gastrointestinal and extraintestinal infections and has been reported to be the cause of one third of deaths in infected patients [21]. Of the 10 patients with V. cholerae non-O1/O139 infection reported in this study, 6 had >1 risk factor (e.g., cancer or malignant blood diseases, alcoholism, other liver diseases, and diabetes), and 1 died from the infection. V. vulnificus infections in Europe are rare and sporadic [22] but have the highest reported case-fatality rate of any foodborne pathogen [12,23]. In our study, 7 total cases were reported in 2005, 2007, 2015, 2017, and 2018, and 4 resulted in either amputation, septic shock, or death.

Because Vibrio infections can cause severe reaction or disease, treatment with a combination of a third-generation cephalosporin and a tetracycline or a fluoroquinolone alone is recommended. Higher mortality rates were observed with a β-lactam alone, compared with fluoroquinolone alone or fluoroquinolone or tetracycline plus a β-lactam [24]. In the United States, the most commonly used antibiotics for patients with Vibrio infections were quinolones (56.1%), followed by cephalosporins (24.1%), tetracyclines (23.5%), and penicillins (15.4%) [24]. Less than one third of patients with Vibrio infections received appropriate antibiotic therapy [13]. According to our study, in France, the main prescribed antibiotics for Vibrio infections were penicillins (91%), quinolones (36%), cephalosporins (30%), metronidazole (15%), and tetracycline (10%), and >50% of patients received a multidrug regimen.

The main limitations of our study are that vibriosis is not a notifiable disease in France, that not all hospitals in the Bay of Biscay participated, and that the reported cases probably underestimated the situation. Data were also not always complete on each case-patient, and details of food histories or other exposures were not always available.

In conclusion, the incidence of serious marine-related Vibrio infections has been low on the west coast of France. However, predicted rising ocean temperatures and demographic shifts (e.g., an aging population with increased risk factors) may lead to the emergence of opportunistic vibriosis in France and other coastal countries in temperate and tropical regions. Our retrospective case-series study provides a basis for identifying and treating new cases of Vibrio infections that might affect larger population sectors in the future.