Medscape is available in 5 Language Editions – Choose your Edition here.


Vibrio Vulnificus Infection Clinical Presentation

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
Updated: Jun 06, 2016


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.[10]

V vulnificus septicemia is the most common cause of death from seafood consumption in the United States.[8] 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.[11]

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.[14]  The same may be true for V vulnificus as compared with Klebsiella pneumoniae–induced necrotizing fasciitis, being 2.5 days versus 5.5 days.[15]



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.[16] These hemorrhagic bullae can progress to necrotic ulcerations, which require surgical debridement. Edema can be present.

Vibrio infections. Early bullous lesions appear ov Vibrio infections. Early bullous lesions appear over the dorsum of the foot of a patient with cirrhosis.

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.[17]



See Pathophysiology.

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.[18] 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%.[19] Sanitary working conditions and well-cooked shrimp should be encouraged.

Contributor Information and Disclosures

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.


Cris Jagar, MD Staff Physician, Department of Psychiatry, Trinitas Regional Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: XOMA; Biogen/IDEC; Novartis; Janssen Biotech, Abbvie, CSL pharma<br/>Received honoraria from UpToDate for author/editor; Received honoraria from JAMA Dermatology for associate editor and intermittent author; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for i inherited these trust accounts; for: Celgene; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble; Amgen.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Craig A Elmets, MD Professor and Chair, Department of Dermatology, Director, Chemoprevention Program Director, Comprehensive Cancer Center, UAB Skin Diseases Research Center, University of Alabama at Birmingham School of Medicine

Craig A Elmets, MD is a member of the following medical societies: American Academy of Dermatology, American Association of Immunologists, American College of Physicians, American Federation for Medical Research, Society for Investigative Dermatology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: University of Alabama at Birmingham; University of Alabama Health Services Foundation<br/>Serve(d) as a speaker or a member of a speakers bureau for: Ferndale Laboratories<br/>Received research grant from: NIH, Veterans Administration, California Grape Assn<br/>Received consulting fee from Astellas for review panel membership; Received salary from Massachusetts Medical Society for employment; Received salary from UpToDate for employment. for: Astellas.

  1. Lim PL. Wound infections in tsunami survivors: a commentary. Ann Acad Med Singapore. 2005 Oct. 34(9):582-5. [Medline].

  2. Rosche TM, Yano Y, Oliver JD. A rapid and simple PCR analysis indicates there are two subgroups of Vibrio vulnificus which correlate with clinical or environmental isolation. Microbiol Immunol. 2005. 49(4):381-9. [Medline].

  3. Broza YY, Raz N, Lerner L, Danin-Poleg Y, Kashi Y. Genetic diversity of the human pathogen Vibrio vulnificus: a new phylogroup. Int J Food Microbiol. 2012 Feb 15. 153(3):436-43. [Medline].

  4. Froelich BA, Williams TC, Noble RT, Oliver JD. Apparent Loss of Vibrio vulnificus from North Carolina Oysters Coincides with a Drought-Induced Increase in Salinity. Appl Environ Microbiol. 2012 Jun. 78(11):3885-9. [Medline].

  5. Inoue Y, Ono T, Matsui T, Miyasaka J, Kinoshita Y, Ihn H. Epidemiological survey of Vibrio vulnificus infection in Japan between 1999 and 2003. J Dermatol. 2008 Mar. 35(3):129-39. [Medline].

  6. Tsai YH, Huang TJ, Hsu RW, et al. Necrotizing soft-tissue infections and primary sepsis caused by Vibrio vulnificus and Vibrio cholerae non-O1. J Trauma. 2009 Mar. 66(3):899-905. [Medline].

  7. Kuo Chou TN, Chao WN, Yang C, Wong RH, Ueng KC, Chen SC. Predictors of Mortality in Skin and Soft-tissue Infections Caused by Vibrio vulnificus. World J Surg. 2010 Feb 12. [Medline].

  8. Haq SM, Dayal HH. Chronic liver disease and consumption of raw oysters: a potentially lethal combination--a review of Vibrio vulnificus septicemia. Am J Gastroenterol. 2005 May. 100(5):1195-9. [Medline].

  9. Huang KC, Tsai YH, Huang KC, Lee MS. Model for End-Stage Liver Disease (MELD) Score as a Predictor and Monitor of Mortality in Patients with Vibrio vulnificus Necrotizing Skin and Soft Tissue Infections. PLoS Negl Trop Dis. 2015 Apr. 9 (4):e0003720. [Medline].

  10. Partridge DG, Townsend R, Larkin S, Parsons HK. Vibrio vulnificus: an unusual mode of acquisition and novel use of rapid susceptibility testing. J Clin Pathol. 2009 Apr. 62(4):370-2. [Medline].

  11. Choi HJ, Lee DK, Lee MW, Choi JH, Moon KC, Koh JK. Vibrio vulnificus septicemia presenting as purpura fulminans. J Dermatol. 2005 Jan. 32(1):48-51. [Medline].

  12. Tajiri T, Tate G, Akita H, et al. Autopsy cases of fulminant-type bacterial infection with necrotizing fasciitis: group A (beta) hemolytic Streptococcus pyogenes versus Vibrio vulnificus infection. Pathol Int. 2008 Mar. 58(3):196-202. [Medline].

  13. Kitamura C, Yamauchi Y, Yamaguchi T, Aida Y, Ito K, Ishizawa Y, et al. Successful Treatment of a Case of Necrotizing Fasciitis due to Vibrio vulnificus in a Cold Climate in Japan. Intern Med. 2016. 55 (8):1007-10. [Medline].

  14. Tsai YH, Wen-Wei Hsu R, Huang KC, Huang TJ. Comparison of necrotizing fasciitis and sepsis caused by Vibrio vulnificus and Staphylococcus aureus. J Bone Joint Surg Am. 2011 Feb. 93(3):274-84. [Medline].

  15. de Klerk A. Should a patient have access to his medical records. Med Law. 1989. 8 (5):475-83. [Medline].

  16. Inoue H. Vibrio vulnificus infection of the hand. J Orthop Sci. 2006 Jan. 11(1):85-7. [Medline].

  17. Tsai YH, Hsu RW, Huang TJ, et al. Necrotizing soft-tissue infections and sepsis caused by Vibrio vulnificus compared with those caused by Aeromonas species. J Bone Joint Surg Am. 2007 Mar. 89(3):631-6. [Medline].

  18. Jones JL, Kinsey TP, Johnson LW, Porso R, Friedman B, Curtis M, et al. Effects of Intertidal Harvest Practices on Vibrio parahaemolyticus and Vibrio vulnificus Levels in Oysters. Appl Environ Microbiol. 2016 May 20. [Medline].

  19. Tra VT, Meng L, Pichpol D, Pham NH, Baumann M, Alter T, et al. Prevalence and antimicrobial resistance of Vibrio spp. in retail shrimps in Vietnam. Berl Munch Tierarztl Wochenschr. 2016 Jan-Feb. 129 (1-2):48-51. [Medline].

  20. Lee YC, Hor LI, Chiu HY, Lee JW, Shieh SJ. Prognostic factor of mortality and its clinical implications in patients with necrotizing fasciitis caused by Vibrio vulnificus. Eur J Clin Microbiol Infect Dis. 2014 Jun. 33(6):1011-8. [Medline].

  21. Hong G, Wu B, Lu C, Li M, Zhao G, Lu Z. Emergency treatment of 16 patients with necrotizing fasciitis caused by Vibrio vulnificus infection complicated with septic shock. Chin Med J (Engl). 2014 May. 127(10):1984-6. [Medline].

  22. [Guideline] American Medical Association; American Nurses Association-American Nurses Foundation; Centers for Disease Control and Prevention; et al. Diagnosis and management of foodborne illnesses: a primer for physicians and other health care professionals. MMWR Recomm Rep. 2004 Apr 16. 53:1-33. [Medline].

  23. [Guideline] Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15. 59(2):e10-52. [Medline].

  24. Prutkin JM, Haq R. A dish best served hot. Am J Med. 2006 Apr. 119(4):307-9. [Medline].

  25. Mouzin E, Mascola L, Tormey MP, Dassey DE. Prevention of Vibrio vulnificus infections. Assessment of regulatory educational strategies. JAMA. 1997 Aug 20. 278(7):576-8. [Medline].

  26. Lee TH, Kim MH, Lee CS, Lee JH, Rhee JH, Chung KM. Protection against Vibrio vulnificus infection by active and passive immunization with the C-terminal region of the RtxA1/MARTXVv protein. Vaccine. 2014 Jan 3. 32(2):271-6. [Medline].

Vibrio infections. Early bullous lesions appear over the dorsum of the foot of a patient with cirrhosis.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.