As always, this is from the ever expanding google doc on bits and bobs I read and learn from and transfer here for all our learning pleasure.
At risk of this becoming an “Andy reviews EM:RAP” section here’s another one from the Dec 2014 program, again from the bounce back section. And once again it’s infectious disease.
As with the last one it falls into the category of pushing your diagnostic skills one step beyond. Most of us are happy to pick up the cellulitis that is sicker than normal but the step further is to track down the right bug and know why it matters.
Vibrio Vulnificans
If there was one take home point then it’s this:
- Water born infections
Risk Factors
- older male
- liver problems (mainly alcohol, cirrhosis, haemochromatosis)
- DM
Two types of Major Presentations
- Wound infections (stood on coral, cut getting off a boat, any cut sustained in the water). This can look like a necrotising infection but can be a simple cellulitis early
- Primary Septicaemia (classically from ingesting oysters). severe septic shock and usually with bullae formation on the skin
Treatment:
- Doxycycline and Ceftazidime were suggested on EM:RAP
- UpToDate suggested Doxy and Cefotaxime or Ceftriaxone
- If you’ve got someone with a mild wound cellulitis and water exposure and you want to just treat with orals then you could add doxycycline to your usual meds.
References:
- EM:RAP Dec 2014
- UpToDate
- Rosens 8th pg 1856 has a great table [137-2] for all the unusual skin infections and what to treat them with
Featured image from CDC public health image library via wikipedia
