Vibrio Vulnificus Infection
- Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD more...
Vibrio vulnificus is a gram-negative bacillus that only affects humans and other primates. It is in the same family as bacteria that cause cholera. The first documented case of disease caused by the organism was in 1979.
V vulnificus is usually found in warm, shallow, coastal salt water in temperate climates throughout most of the world. It can be found in the Gulf of Mexico, along most of the East Coast of the United States, and along all of the West Coast of the United States. V vulnificus can be found in water; sediment; plankton; and shellfish, such as oysters, clams, and crabs. This organism can survive in seawater and can produce wound infections, a potentially serious problem among Asian tsunami survivors.
See image below, as well as the article Vibrio Infections.
V vulnificus infects the body in 2 ways, either by exposure to contaminated seafood, such as raw oysters, or through an open wound exposed to contaminated seawater. Among healthy individuals, within 16 hours of ingestion, they experience vomiting, diarrhea, and abdominal pain. Many patients develop distinctive bullous skin lesions. In patients who are immunocompromised, particularly those with chronic liver disease (especially cirrhosis), immunosuppression, end-stage renal disease, and hematopoietic disorders, V vulnificus can cause life-threatening septic shock and blistering skin lesions. Those who are immunocompromised are at a much greater risk for contracting V vulnificus and dying from overwhelming sepsis.
Because the incidence of disease is relatively low, not all strains of V vulnificus may be equally virulent. Recent data are consistent with the existence of 2 genotypes of V vulnificus, with the C-type being a strong indicator of potential virulence. The biotype 3 group of the human pathogen V vulnificus may have emerged in Israel due to genome hybridization of 2 bacterial populations. This new clonal subgroup emphasizes that the fish aquaculture environment, and possibly manmade ecological niches as a whole, may be a source of new pathogenic strains.
V vulnificus has been difficult to culture from North Carolina oyster samples since 2007. It may be that oysters were colonized with a more salt-tolerant bacterium during the drought, displacing V vulnificus, and may be preventing recolonization.
V vulnificus infections are rare but underreported. Most cases are found in the Gulf Coast states, and they are most common during warm weather months.
The frequency of V vulnificus infection, which is rare in Japan, was evaluated in 2008. Its prevalence varied in different districts.
All races are affected equally.
Males and females are affected equally.
All ages are affected equally.
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. 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.
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.
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.
Most V vulnificus infections are acute but have no long-term consequences; however, in patients who develop septic shock from infection with V vulnificus, the mortality rate is 50%. In rare instances, skin infection can result in necrotizing fasciitis. V vulnificus necrotizing skin and soft tissue infections may result in multiple organ failure and death. A prediction model to estimate the case-fatality rate has been proposed.
Lim PL. Wound infections in tsunami survivors: a commentary. Ann Acad Med Singapore. 2005 Oct. 34(9):582-5. [Medline].
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].
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].
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].
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].
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].
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].
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].
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].
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].
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].
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].
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].
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].
de Klerk A. Should a patient have access to his medical records. Med Law. 1989. 8 (5):475-83. [Medline].
Inoue H. Vibrio vulnificus infection of the hand. J Orthop Sci. 2006 Jan. 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. 2007 Mar. 89(3):631-6. [Medline].
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].
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].
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].
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].
[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].
[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].
Prutkin JM, Haq R. A dish best served hot. Am J Med. 2006 Apr. 119(4):307-9. [Medline].
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].
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].