Vibrio Vulnificus Infection Clinical Presentation
- Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD more...
V vulnificus infection should be suspected in patients who give a history of ingestion of raw seafood or wound infection after exposure to seawater. Patients with V vulnificus infection report abrupt GI symptoms, such as vomiting, diarrhea, or abdominal pain, and may present with fever, chills, or shock. V vulnificus is normally found in warm estuarial and marine environments, lodging in filter feeders such as oysters. It occurs mainly in patients with chronic liver disease after the consumption of raw oysters. Partridge et al reported a case that was likely contracted from a thermal pool in Turkey, with no history of seawater or shellfish exposure.
V vulnificus septicemia is the most common cause of death from seafood consumption in the United States. V vulnificus septicemia may first become evident in the skin as purpura fulminans, which can take a catastrophic course without immediate and intensive empirical antibiotic treatment.
V vulnificus infection is a rare cause of necrotizing fasciitis, which can be fatal.[12, 13] Necrotizing fasciitis caused by V vulnificus progresses more rapidly with clinical characteristics more fulminant than either methicillin-resistant Staphylococcus aureus or methicillin-sensitive S aureus infection. The same may be true for V vulnificus as compared with Klebsiella pneumoniae–induced necrotizing fasciitis, being 2.5 days versus 5.5 days.
Most patients infected with V vulnificus have bullous skin lesions, which are found on the trunk and the lower extremities (see the image below). Infection of the hand has been reported. These hemorrhagic bullae can progress to necrotic ulcerations, which require surgical debridement. Edema can be present.
A rapid onset of cellulitis may represent infection with V vulnificus, especially if the patient had contact with seawater or raw seafood. Patients can progress to necrotizing fasciitis.
It is seen in a variety of seafood. V vulnificus can grow rapidly in shellfish owing to the ambient air conditions occurring with intertidal exposure. A study of Vibrio species isolated from retail shrimp in Hanoi found 201 of 202 samples were positive, with most having Vibrio parahaemolyticus (96.5%) and V vulnificus documented much less often, specifically in only 1.5%. Sanitary working conditions and well-cooked shrimp should be encouraged.
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