Close
New

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

 

Vibrio Infections Clinical Presentation

  • Author: Hoi Ho, MD; Chief Editor: Michael Stuart Bronze, MD  more...
 
Updated: Sep 25, 2014
 

History

Vparahaemolyticus is the leading cause of seafood-associated gastroenteritis in the United States. Most individuals with noncholera Vibrio infections report recent consumption or handling of contaminated seafood such as oysters, clams, crabs, or other shellfish. Others have a history of contact with brackish or salty waters. Persons with immunodeficiency disorders, chronic liver disease, and iron storage disorders may be particularly susceptible to severe infections and have rapid clinical deterioration. With the exception of dramatic clinical progression in wound infection and septicemia, no characteristic signs and symptoms of early-stage noncholera Vibrio infections exist (see Table 3).

Table 3. Clinical Signs and Symptoms of Vibrio Infections (Open Table in a new window)

Clinical Presentation Symptoms (Frequency)
Gastroenteritis Diarrhea (100%)



Abdominal cramps (89%)



Nausea (76%)



Vomiting (55%)



Fever (47%)



Bloody stools (29%)



Headache (24%)



Myalgia (24%)



Wound infection Swelling (100%)



Pain (100%)



Erythema (100%)



Bullae (30-50%)



Necrosis (30-50%)



Gangrene (< 10%)



Septicemia Fever (>90%)



Hypothermia (< 10%)



Hypotension (100%)



Tachycardia (80-90%)



Shock (50-70%)



Bullae (80-100%)



Acute respiratory distress syndrome (< 5%)



Multiple organ dysfunction (30-50%)



While atypical infections with Vibrio species involving peritonitis, pneumonia, endometritis, meningitis, septic arthritis, osteomyelitis, and keratitis have been reported, in general, Vibrio causes 3 clinical symptoms: gastroenteritis, skin and soft tissue infections, and septicemia.

Gastroenteritis

After an average incubation period of 19 hours (range, 12-52 h), patients with Vibrio gastroenteritis report abdominal pain or cramps, nausea, vomiting diarrhea, fevers and chills.[29] Patients frequently pass several watery stools (10-15/d). The occurrence of bloody diarrhea varies. It is reported in 25% of patients with V parahaemolyticus infection but may develop in up to 75% of patients with V fluvialis infection.

Low-grade fever may be observed in patients with Vibrio gastroenteritis.

Most patients remain alert upon admission. However, elderly patients may have decreased mental status due to dehydration or sepsis. Death is rare, but would most likely be caused by concomitant Vibrio septicemia.

Skin and soft tissue infections

Patients frequently report injury associated with handling contaminated shellfish (preparation of St Peter's fish (Tilapia zillii); preparation of crabs, lobsters, or mussels), particularly fishhooks within the fish. Injuries can also be sustained when stepping on seashells, crustaceans, or stingrays.[30]

Initially, patients with such infections almost always report severe pain of the involved limb or body part. Numbness of the wound and the surrounding area may predominate if the patient has delayed seeking medical attention.

Septicemia

Symptoms usually occur within 7-14 days of contact. Patients frequently exhibit a dramatic clinical presentation of bacteremia, minus a clear focus. This may be characterized by the abrupt onset of the following:

  • High fever
  • Shaking chills
  • Generalized myalgia
  • Exquisite pain in the lower extremities (most characteristic) or, rarely, pain in the lower trunk [31]
Next

Physical

The physical findings of Vibrio infections vary according to clinical presentations.

Acute gastroenteritis

Patients with acute Vibrio gastroenteritis are typically acutely ill with diarrhea, nausea, vomiting, abdominal pain, and fever (50%).

The vital signs, such as blood pressure and heart rate, vary depending on the level of dehydration.

Unless the patient has underlying disease, no physical findings are specific for acute Vibrio gastroenteritis.[29]

Skin and soft tissue infection

After a short incubation period (3-24 h), patients with Vibrio wound infections frequently present with rapidly progressing wound swelling and severe pain.

The majority of such wounds involve the fingers, palms, or soles of the feet.

In milder cases, erythema, edema, and pain are localized to the initial wound, without signs of compartment syndrome, necrosis, gangrene, or necrotizing fasciitis.

In patients with medical conditions such as cirrhosis or malignancies, the wound infection may progress very rapidly, with formation of hemorrhagic bullae and extensive soft-tissue necrosis.[30, 31]

Septicemia

After a short incubation period (12-48 h) following the consumption of raw seafood or exposure of broken skin to warm seawater, patients with Vibrio septicemia frequently develop fever, shaking chills, generalized myalgia, edema, and severe pain in the lower extremities.[31]

Within 3-24 hours, edema of the lower extremities worsens.

Multiple hemorrhagic bullae and extensive ecchymosis distributed predominantly over the lower extremities form rapidly (see the images below).


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

Vibrio infections. In a patient with cirrhosis, s Vibrio infections. In a patient with cirrhosis, skin lesion rapidly becomes necrotic.

Vibrio infections. Bullous lesions in a patient w Vibrio infections. Bullous lesions in a patient with cirrhosis continue to progress, and the patient rapidly develops hypotension and shock despite aggressive medical therapy.

Patients frequently become hypotensive despite aggressive intravenous fluid therapy.

Patients become lethargic, obtunded, and, finally, unconscious as the disease progresses.

Oliguria may develop.

Noncardiogenic pulmonary edema may develop.

Ocular infection

This may manifest as conjunctivitis, keratitis, or endophthalmitis.

Peritonitis

This may manifest as abdominal pain and cloudy peritoneal fluid in patients receiving CAPD.

Previous
Next

Causes

Noncholera Vibrio infections are foodborne diseases that are largely associated with the following:

  • Consumption of raw or undercooked seafood such as oysters, clams, crabs, or mussels
  • Exposure of wound to contaminated water

Acute gastroenteritis associated with noncholera Vibrio infection is frequently self-limited, although persons with certain underlying medical conditions may develop fulminant infections. These underlying medical conditions include the following:

  • Advanced liver diseases, such as cirrhosis, hepatitis B virus (HBV) infection, hepatitis C virus (HCV) infection, alcoholism, hemochromatosis, and liver transplantation
  • Hematologic diseases, such as acute leukemia, aplastic anemia, hemolytic anemia, and thalassemia
  • Immunosuppressive therapy, including cytotoxic chemotherapy, corticosteroids, and tacrolimus
  • Kidney disease involving kidney transplantation or hemodialysis
  • Miscellaneous procedures and conditions, including splenectomy and diabetes mellitus
Previous
 
 
Contributor Information and Disclosures
Author

Hoi Ho, MD Associate Dean for Faculty Affairs and Development, Professor, Department of Internal Medicine, Director, Center for Advanced Teaching and Assessment in Clinical Simulation (ATACS), Paul L Foster School of Medicine, Texas Tech University Health Sciences Center; Consulting Physician, University Medical Center

Hoi Ho, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American College of Forensic Examiners Institute, American College of Physicians, American Society for Microbiology, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Thong Huy Do, MD Staff Physician, Department of Internal Medicine, Thomason Hospital, Texas Tech University

Thong Huy Do, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Ogechika Karl Alozie, MBBS, MPH, AAHIVS Assistant Professor of Infectious Diseases/Internal Medicine, Texas Tech University Health Sciences Center, Paul L Foster School Of Medicine

Ogechika Karl Alozie, MBBS, MPH, AAHIVS is a member of the following medical societies: American Academy of HIV Medicine

Disclosure: Received honoraria from AbbVie for speaking and teaching; Received honoraria from GSK for speaking and teaching.

Sun-Yu Tran Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine

Sun-Yu Tran is a member of the following medical societies: American College of Physicians, Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Richard B Brown, MD, FACP Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine

Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Mary D Nettleman, MD, MS MACP, Professor and Chair, Department of Medicine, Michigan State University College of Human Medicine

Mary D Nettleman, MD, MS is a member of the following medical societies: American College of Physicians, Association of Professors of Medicine, Central Society for Clinical and Translational Research, Infectious Diseases Society of America, Society of General Internal Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Tony Tran Ho, MS Texas Tech University School of Medicine

Tony Tran Ho, MS is a member of the following medical societies: American Medical Association and Texas Medical Association

Disclosure: Nothing to disclose.

Wei-I (Vickie) Wu, MS Texas Tech University School of Medicine

Disclosure: Nothing to disclose.

References
  1. 2011 Estimates of foodborne illness in the united states. [Full Text].

  2. Scallan E, Hoekstra RM, Angulo FJ, Tauxe RV, Widdowson MA, Roy SL, et al. Foodborne illness acquired in the United States--major pathogens. Emerg Infect Dis. 2011 Jan. 17(1):7-15. [Medline].

  3. Vital Signs: Incidence and Trends of Infection with Pathogens Transmitted Commonly Through Food --- Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 1996—2010. [Full Text].

  4. FoodNet's Progress Reports. 2013 Progress Report on Six Key Pathogens Compared to 2006-2008. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/foodnet/data/trends/trends-2013-progress.html. Accessed: September 26, 2014.

  5. Marano NN, Daniels NA, Easton AN, McShan A, Ray B, Wells JG. A survey of stool culturing practices for vibrio species at clinical laboratories in Gulf Coast states. J Clin Microbiol. 2000 Jun. 38(6):2267-70. [Medline].

  6. Dechet AM, Yu PA, Koram N, Painter J. Nonfoodborne Vibrio infections: an important cause of morbidity and mortality in the United States, 1997-2006. Clin Infect Dis. 2008 Apr 1. 46(7):970-6. [Medline].

  7. Centers for Disease Control and Prevention (CDC). Vibrio illnesses after Hurricane Katrina--multiple states, August-September 2005. MMWR Morb Mortal Wkly Rep. 2005 Sep 23. 54(37):928-31. [Medline].

  8. Shapiro RL, Altekruse S, Hutwagner L. The role of Gulf Coast oysters harvested in warmer months in Vibrio vulnificus infections in the United States, 1988-1996. Vibrio Working Group. J Infect Dis. 1998 Sep. 178(3):752-9. [Medline].

  9. Richards GP, Watson MA, Boyd EF, Burkhardt W 3rd, Lau R, Uknalis J. Seasonal levels of the Vibrio predator bacteriovorax in atlantic, pacific, and gulf coast seawater. Int J Microbiol. 2013. 2013:375371. [Medline].

  10. Brennt CE, Wright AC, Dutta SK. Growth of Vibrio vulnificus in serum from alcoholics: association with high transferrin iron saturation. J Infect Dis. 1991 Nov. 164(5):1030-2. [Medline].

  11. Hor LI, Chang TT, Wang ST. Survival of Vibrio vulnificus in whole blood from patients with chronic liver diseases: association with phagocytosis by neutrophils and serum ferritin levels. J Infect Dis. 1999 Jan. 179(1):275-8. [Medline].

  12. Miyoshi S, Nakazawa H, Kawata K, Tomochika K, Tobe K, Shinoda S. Characterization of the hemorrhagic reaction caused by Vibrio vulnificus metalloprotease, a member of the thermolysin family. Infect Immun. 1998 Oct. 66(10):4851-5. [Medline].

  13. Shao CP, Hor LI. Metalloprotease is not essential for Vibrio vulnificus virulence in mice. Infect Immun. 2000 Jun. 68(6):3569-73. [Medline].

  14. Hilton T, Rosche T, Froelich B, Smith B, Oliver J. Capsular polysaccharide phase variation in Vibrio vulnificus. Appl Environ Microbiol. 2006 Nov. 72(11):6986-93. [Medline].

  15. Lee SE, Kim SY, Kim CM, Kim MK, Kim YR, Jeong K. The pyrH gene of Vibrio vulnificus is an essential in vivo survival factor. Infect Immun. 2007 Jun. 75(6):2795-801. [Medline].

  16. Wong TW, Wang YY, Sheu HM, Chuang YC. Bactericidal effects of toluidine blue-mediated photodynamic action on Vibrio vulnificus. Antimicrob Agents Chemother. 2005 Mar. 49(3):895-902. [Medline].

  17. Shirai H, Ito H, Hirayama T, Nakamoto Y, Nakabayashi N, Kumagai K. Molecular epidemiologic evidence for association of thermostable direct hemolysin (TDH) and TDH-related hemolysin of Vibrio parahaemolyticus with gastroenteritis. Infect Immun. 1990 Nov. 58(11):3568-73. [Medline].

  18. Nishibuchi M, Fasano A, Russell RG, Kaper JB. Enterotoxigenicity of Vibrio parahaemolyticus with and without genes encoding thermostable direct hemolysin. Infect Immun. 1992 Sep. 60(9):3539-45. [Medline].

  19. Vibrio parahaemolyticus infections associated with consumption of raw shellfish--three states, 2006. MMWR Morb Mortal Wkly Rep. 2006 Aug 11. 55(31):854-6. [Medline].

  20. Newton AE, Garrett N, Stroika SG, Halpin JL, Turnsek M, Mody RK. Increase in Vibrio parahaemolyticus infections associated with consumption of Atlantic Coast shellfish--2013. MMWR Morb Mortal Wkly Rep. 2014 Apr 18. 63(15):335-6. [Medline].

  21. Centers for Disease Control and Prevention. Non-O1 and Non-O139 Vibrio cholerae Infections. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/cholera/non-01-0139-infections.html. Accessed: September 26, 2014.

  22. Tsai YH, Huang TJ, Hsu RW, Weng YJ, Hsu WH, Huang KC. 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].

  23. Ralston EP, Kite-Powell H, Beet A. An estimate of the cost of acute health effects from food- and water-borne marine pathogens and toxins in the USA. J Water Health. 2011 Dec. 9(4):680-94. [Medline].

  24. Osaka K, Komatsuzaki M, Takahashi H, Sakano S, Okabe N. Vibrio vulnificus septicaemia in Japan: an estimated number of infections and physicians' knowledge of the syndrome. Epidemiol Infect. 2004 Oct. 132(5):993-6. [Medline].

  25. 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].

  26. Jones MK, Oliver JD. Vibrio vulnificus: disease and pathogenesis. Infect Immun. 2009 May. 77(5):1723-33. [Medline]. [Full Text].

  27. Chen SC, Chan KS, Chao WN, Wang PH, Lin DB, Ueng KC. Clinical outcomes and prognostic factors for patients with Vibrio vulnificus infections requiring intensive care: a 10-yr retrospective study. Crit Care Med. 2010 Oct. 38(10):1984-90. [Medline].

  28. Liu JW, Lee IK, Tang HJ, Ko WC, Lee HC, Liu YC. Prognostic Factors and Antibiotics in Vibrio vulnificus Septicemia. Arch Intern Med. 2006 Oct 23. 166(19):2117-23. [Medline].

  29. Dadisman TA Jr, Nelson R, Molenda JR. Vibrio parahaemolyticus gastroenteritis in Maryland. I. Clinical and epidemiologic aspects. Am J Epidemiol. 1972 Dec. 96(6):414-26. [Medline].

  30. Howard RJ, Lieb S. Soft-tissue infections caused by halophilic marine vibrios. Arch Surg. 1988 Feb. 123(2):245-9. [Medline].

  31. Klontz KC, Lieb S, Schreiber M. Syndromes of Vibrio vulnificus infections. Clinical and epidemiologic features in Florida cases, 1981-1987. Ann Intern Med. 1988 Aug 15. 109(4):318-23. [Medline].

  32. Centers for Disease Control and Prevention. Management of Vibrio vulnificus Wound Infections After a Disaster. Centers for Disease Control and Prevention. Available at http://www.bt.cdc.gov/disasters/disease/vibriofaq.asp. Accessed: September 26, 2014.

  33. Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, 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].

  34. Chen SC, Lee YT, Tsai SJ, Chan KS, Chao WN, Wang PH. Antibiotic therapy for necrotizing fasciitis caused by Vibrio vulnificus: retrospective analysis of an 8 year period. J Antimicrob Chemother. 2012 Feb. 67(2):488-93. [Medline].

  35. Chuang YC, Ko WC, Wang ST, Liu JW, Kuo CF, Wu JJ. Minocycline and cefotaxime in the treatment of experimental murine Vibrio vulnificus infection. Antimicrob Agents Chemother. 1998 Jun. 42(6):1319-22. [Medline].

  36. Anand RG, Lopez FA, deBoisblanc B. Vibrio vulnificus sepsis successfully treated with antibiotics, surgical debridement, and recombinant human activated protein C. J La State Med Soc. 2004 May-Jun. 156(3):130-3; quiz 133. [Medline].

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

  38. Lee HS, Choi S, Shin H, Lee JH, Choi SH. Vibrio vulnificus bacteriophage SSP002 as a possible biocontrol agent. Appl Environ Microbiol. 2014 Jan. 80(2):515-24. [Medline].

  39. Kingsley DH. High Pressure Processing of Bivalve Shellfish and HPP’s Use as a Virus Intervention. Foods. 2014. 3(2):336-50.

  40. Centers for Disease Control and Prevention (CDC). Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food--selected sites, United States, 2003. MMWR Morb Mortal Wkly Rep. 2004 Apr 30. 53(16):338-43. [Medline].

  41. DePaola A, Capers GM, Alexander D. Densities of Vibrio vulnificus in the intestines of fish from the U.S. Gulf Coast. Appl Environ Microbiol. 1994 Mar. 60(3):984-8. [Medline].

  42. Hiransuthikul N, Tantisiriwat W, Lertutsahakul K, Vibhagool A, Boonma P. Skin and soft-tissue infections among tsunami survivors in southern Thailand. Clin Infect Dis. 2005 Nov 15. 41(10):e93-6. [Medline].

  43. Hlady WG, Klontz KC. The epidemiology of Vibrio infections in Florida, 1981-1993. J Infect Dis. 1996 May. 173(5):1176-83. [Medline].

  44. Hollis DG, Weaver RE, Baker CN. Halophilic Vibrio species isolated from blood cultures. J Clin Microbiol. 1976 Apr. 3(4):425-31. [Medline].

  45. Richards GP, Watson MA, Boyd EF, Burkhardt W 3rd, Lau R, Uknalis J, et al. Seasonal levels of the Vibrio predator bacteriovorax in atlantic, pacific, and gulf coast seawater. Int J Microbiol. 2013. 2013:375371. [Medline]. [Full Text].

  46. Scallan E, Griffin PM, Angulo FJ, Tauxe RV, Hoekstra RM. Foodborne illness acquired in the United States--unspecified agents. Emerg Infect Dis. 2011 Jan. 17(1):16-22. [Medline].

  47. Summary of Notifiable Diseases in United States, 2009. [Full Text].

  48. Tao Z, Larsen AM, Bullard SA, Wright AC, Arias CR. Prevalence and population structure of Vibrio vulnificus on fishes from the northern Gulf of Mexico. Appl Environ Microbiol. 2012 Nov. 78(21):7611-8. [Medline]. [Full Text].

 
Previous
Next
 
Vibrio infections. Early bullous lesions appear over the dorsum of the foot of a patient with cirrhosis.
Vibrio infections. In a patient with cirrhosis, skin lesion rapidly becomes necrotic.
Vibrio infections. Bullous lesions in a patient with cirrhosis continue to progress, and the patient rapidly develops hypotension and shock despite aggressive medical therapy.
Table 1. Noncholera Vibrio Species and Associated Clinical Presentations
Infection Type Noncholera Vibrio Species Cytotoxins/Enzymes
Gastroenteritis V parahaemolyticus



Non-01 V cholerae



Vibrio fluvialis



V mimicus



Vibrio furnissii



Vibrio hollisae



Vibrio alginolyticus



V vulnificus



Cytotoxin



Hemolysin



Wound infection V alginolyticus



V vulnificus



Non-01 V cholerae



Vibrio damsela



Vibrio carchariae



V fluvialis



V parahaemolyticus



V mimicus



Protease



Hemolysin



Lipase



DNAase



Cytolysin



Septicemia V vulnificus



V fluvialis



V damsela



Non-01 V cholerae



Vibrio cincinnatiensis



Proteases



Endotoxic lipopolysaccharide



Table 2. Clinical Presentation Rates of Pathogenic Vibrio Infections
Vibrio Species Gastroenteritis



(%)



Wound Infection



(%)



Septicemia



(%)



Miscellaneous



(%)



V parahaemolyticus 59 34 5 2
V vulnificus 5 45 43 7
Non-01 V cholerae 67 9 15
V alginolyticus 5-12 71 1 10-15
V mimicus 85 3 3
V fluvialis 73 10 6
V damsela Rare >95 Rare
V furnissii >90 Rare Rare
Vibrio metschnikovii Common Rare Rare
V hollisae 85 7 5
V cincinnatiensis Rare Rare Rare Meningitis
Table 3. Clinical Signs and Symptoms of Vibrio Infections
Clinical Presentation Symptoms (Frequency)
Gastroenteritis Diarrhea (100%)



Abdominal cramps (89%)



Nausea (76%)



Vomiting (55%)



Fever (47%)



Bloody stools (29%)



Headache (24%)



Myalgia (24%)



Wound infection Swelling (100%)



Pain (100%)



Erythema (100%)



Bullae (30-50%)



Necrosis (30-50%)



Gangrene (< 10%)



Septicemia Fever (>90%)



Hypothermia (< 10%)



Hypotension (100%)



Tachycardia (80-90%)



Shock (50-70%)



Bullae (80-100%)



Acute respiratory distress syndrome (< 5%)



Multiple organ dysfunction (30-50%)



Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.