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Vibrio Vulnificus Infection

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

Background

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.[1]

See image below, as well as the article Vibrio Infections.

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

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.[2] 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.[3]

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.[4]

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Epidemiology

United States

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.

International

The frequency of V vulnificus infection, which is rare in Japan, was evaluated in 2008. Its prevalence varied in different districts.[5]

Race

All races are affected equally.

Sex

Males and females are affected equally.

Age

All ages are affected equally.

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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.[6] 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.[7]

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.[7]

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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.[8]

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Mortality/Morbidity

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.[9]

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Contributor Information and Disclosures
Author

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.

Coauthor(s)

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.

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