Vibrio Vulnificus Infection Follow-up
- Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD more...
Deterrence/Prevention
To prevent infection from V vulnificus, persons should avoid exposure to raw shellfish or thoroughly cook the shellfish. Persons should avoid cross-contamination of cooked shellfish with uncooked shellfish and eat shellfish promptly after cooking. Shellfish is best served hot.[13]
Identifying oysters that are affected by V vulnificus is difficult because the appearance, taste, color, and odor of the oysters are not affected. Through improved reporting of affected oysters, oyster beds that are affected can be identified and closed.[14]
Persons should avoid exposure of open wounds or broken skin to raw shellfish or infected waters. Patients who are immunocompromised should be especially careful to follow these guidelines because they are more susceptible to infection and complications.
Complications
Patients who are immunocompromised are at risk of septic shock from the infection, which can be fatal. Otherwise, no complications from V vulnificus infection occur.
Prognosis
Vibrio vulnificus infection is an acute illness that is quickly resolved with antibiotics and does not have any long-term consequences. The prognosis is often excellent with proper treatment.
Retrospective analysis of 30 patients with necrotizing fasciitis and sepsis caused by Vibrio species and initially treated with surgical debridement or immediate limb amputation showed 11 (37%) died within several days of admission.[15] A higher mortality rate was noted with the Vibrio cholerae non-O1 group (57%) compared with the V vulnificus group (30%). Other bad prognostic signs included a systolic blood pressure of less than or equal to 90 mm Hg, decreased platelet counts, and leukopenia. The combination of hepatic dysfunction and diabetes mellitus was also associated with a poor outcome.
Predictive factors for mortality in primary septicemia or wound infections caused by V vulnificus have been accessed using a variety of parameters. Multivariate analysis has revealed that the presence of hemorrhagic bullae/necrotizing fasciitis, primary septicemia, a greater severity of illness, absence of leukocytosis, and hypoalbuminemia were the significant risk factors for mortality in V vulnificus skin and soft tissue infections.[16]
The presence of hemorrhagic bullous skin lesions, necrotizing fasciitis, primary septicemia, a greater severity-of-illness, absence of leukocytosis, and hypoalbuminemia were found to be the significant risk factors for mortality in patients with V vulnificus infection.[16]
Patient Education
Counsel patients who are immunocompromised to prevent exposure to V vulnificus. The high mortality associated with this septicemia suggests susceptible individuals should be forewarned by signs displayed in restaurants; physicians should educate patients with chronic liver disease about the risk of raw oyster consumption. Additionally, harvesting methods that reduce contamination by V vulnificus should be used.[5]
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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].
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. Mar 2008;35(3):129-39. [Medline].
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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. May 2005;100(5):1195-9. [Medline].
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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. Mar 2008;58(3):196-202. [Medline].
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. Feb 2011;93(3):274-84. [Medline].
Inoue H. Vibrio vulnificus infection of the hand. J Orthop Sci. Jan 2006;11(1):85-7. [Medline].
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. Mar 2007;89(3):631-6. [Medline].
[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. Apr 16 2004;53:1-33. [Medline].
[Guideline] Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. Nov 15 2005;41(10):1373-406. [Medline].
Prutkin JM, Haq R. A dish best served hot. Am J Med. Apr 2006;119(4):307-9. [Medline].
Mouzin E, Mascola L, Tormey MP, Dassey DE. Prevention of Vibrio vulnificus infections. Assessment of regulatory educational strategies. JAMA. Aug 20 1997;278(7):576-8. [Medline].
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. Mar 2009;66(3):899-905. [Medline].
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. Feb 12 2010;[Medline].
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