eMedicine Specialties > Dermatology > Bacterial Infections

Vibrio Vulnificus Infection

Author: Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Coauthor(s): Cris Jagar, MD, Staff Physician, Department of Psychiatry, Saint Vincent Catholic Medical Centers
Contributor Information and Disclosures

Updated: Apr 23, 2008

Introduction

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

An eMedicine article of possible interest is Vibrio Infections. Additionally, a food-safety Medscape CME course is Hepatitis A & B Vaccines.

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

Frequency

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.3

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.

Race

All races are affected equally.

Sex

Males and females are affected equally.

Age

All ages are affected equally.

Clinical

History

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.

V vulnificus septicemia is the most common cause of death from seafood consumption in the United States.4 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.5

V vulnificus infection may be a rare cause of necrotizing fasciitis, which can be fatal.6

Physical

  • Most patients infected with V vulnificus have bullous skin lesions, which are found on the trunk and the lower extremities. 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.7

Causes

See Pathophysiology.

More on Vibrio Vulnificus Infection

Overview: Vibrio Vulnificus Infection
Differential Diagnoses & Workup: Vibrio Vulnificus Infection
Treatment & Medication: Vibrio Vulnificus Infection
Follow-up: Vibrio Vulnificus Infection
References
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References

  1. Lim PL. Wound infections in tsunami survivors: a commentary. Ann Acad Med Singapore. Oct 2005;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. 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].

  4. 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].

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

  6. Tajiri T, Tate G, Akita H, Ohike N, Masunaga A, Kunimura T, 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].

  7. Tsai YH, Hsu RW, Huang TJ, Hsu WH, Huang KC, Li YY, 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].

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

  9. Eastaugh J, Shepherd S. Infectious and toxic syndromes from fish and shellfish consumption. A review. Arch Intern Med. Aug 1989;149(8):1735-40. [Medline].

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

  11. Koenig KL, Mueller J, Rose T. Vibrio vulnificus. Hazard on the half shell. West J Med. Oct 1991;155(4):400-3. [Medline].

  12. Kumamoto KS, Vukich DJ. Clinical infections of Vibrio vulnificus: a case report and review of the literature. J Emerg Med. Jan-Feb 1998;16(1):61-6. [Medline].

  13. Laughlin TJ, Lavery LA. Lower extremity manifestations of Vibrio vulnificus infection. J Foot Ankle Surg. Jul-Aug 1995;34(4):354-7. [Medline].

  14. Lehane L, Rawlin GT. Topically acquired bacterial zoonoses from fish: a review. Med J Aust. Sep 2000;173(5):256-9. [Medline].

  15. Linkous DA, Oliver JD. Pathogenesis of Vibrio vulnificus. FEMS Microbiol Lett. May 15 1999;174(2):207-14. [Medline].

  16. 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].

  17. Serrano-Jaen L, Vega-Lopez F. Fulminating septicaemia caused by Vibrio vulnificus. Br J Dermatol. Feb 2000;142(2):386-7. [Medline].

  18. Strom MS, Paranjpye RN. Epidemiology and pathogenesis of Vibrio vulnificus. Microbes Infect. Feb 2000;2(2):177-88. [Medline].

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Further Reading

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Keywords

V vulnificus, consumption of raw shellfish, exposure to contaminated seawater

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Contributor Information and Disclosures

Author

Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Cris Jagar, MD, Staff Physician, Department of Psychiatry, Saint Vincent Catholic Medical Centers
Disclosure: Nothing to disclose.

Medical Editor

Craig A Elmets, MD, Director of Dermatology, Departments of Dermatology, Pathology, and Environmental Health Sciences; Professor, The Kirklin Clinic, University of Alabama at Birmingham
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, and Society for Investigative Dermatology
Disclosure: Palomar Medical Technologies Stock None; Merck Consulting fee Independent contractor; Tronox Consulting fee Independent contractor; Amgen Consulting fee Review panel membership; Astellas Consulting fee Review panel membership; Massachusetts Medical Society Salary Employment

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Director, Division of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

Jeffrey P Callen, MD, Professor of Medicine, 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, and American College of Rheumatology
Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Honoraria Consulting; Centocor Honoraria Consulting

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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