Medical Care

Antibiotics are necessary to eradicate the infection (see Medication). In case of wound infection, aggressive debridement is necessary to remove necrotic tissue. If the patient is in shock, perform necessary interventions to resuscitate the patient. V vulnificus as the etiologic agent of necrotizing fasciitis requires emergency approaches to treat potential septic shock and multiple organ failure,^[29]particularly in those with preexisting medical complications, including hypotension, lactic acidosis, coagulation disorders, and thrombocytopenia.^[30]

Available guidelines that may be helpful include the Practice guidelines for the diagnosis and management of skin and soft-tissue infections from the Infectious Diseases Society of America and the Diagnosis and management of foodborne illnesses: a primer for physicians and other health care professionals from the American Medical Association, American Nurses Association, American Nurses Foundation, Centers for Disease Control and Prevention, Center for Food Safety and Applied Nutrition, US Food and Drug Administration, Food Safety and Inspection Service, and US Department of Agriculture.^{[31, 32]}

Consultations

Because many patients with V vulnificus infection experience overwhelming sepsis, consultation with an infectious disease specialist is warranted. Consider consultation with an infectious disease specialist if the diagnosis is unclear or if the patient has atypical symptoms or does not respond to antibiotic treatment.

Activity

No restrictions are necessary.

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.^[33]

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.^[34]

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.

Chicken egg yolk anti–V vulnificus immunoglobulins have been shown to be effective for prophylaxis and therapy in V vulnificus infections.^[35]

Therapeutic vaccination against V vulnificus infection by active and passive immunization with the C-terminal region of the RtxA1/MARTXVv protein has been suggested by studies in mice.^[36]

There is a need for a good natural food preservative or biocontrol agent to control V vulnificus in seafood, and the bacteriophage VVP001 has been suggested as a novel approach.^[37]

Medication

Lim PL. Wound infections in tsunami survivors: a commentary. Ann Acad Med Singapore. 2005 Oct. 34(9):582-5. [QxMD MEDLINE Link].
Park SY, Yu SN, Lee EJ, Kim T, Jeon MH, Choo EJ, et al. Monomicrobial gram-negative necrotizing fasciitis: An uncommon but fatal syndrome. Diagn Microbiol Infect Dis. 2019 Jan 4. [QxMD MEDLINE Link].
Phillips KE, Satchell KJ. Vibrio vulnificus: From Oyster Colonist to Human Pathogen. PLoS Pathog. 2017 Jan. 13 (1):e1006053. [QxMD MEDLINE Link].
Tiba-Casas MR, Lemes-Marques EG, Almeida EA, Soares FB, Camargo CH. Draft Genome Sequence of a Pathogenic Vibrio vulnificus Strain Isolated in Brazil. Genome Announc. 2018 Feb 15. 6 (7):[QxMD MEDLINE Link].
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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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Barbieri R, Aboudharam G, Raoult D, Drancourt M. Vibrio vulnificus casualties during the American Civil War. Lancet Infect Dis. 2020 Feb. 20 (2):170-171. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Sangeetha MS, Shekar M, Venugopal MN. Occurrence of clinical genotype Vibrio vulnificus in clam samples in Mangalore, Southwest coast of India. J Food Sci Technol. 2017 Mar. 54 (3):786-791. [QxMD MEDLINE Link].
Li G, Wang MY. The role of Vibrio vulnificus virulence factors and regulators in its infection-induced sepsis. Folia Microbiol (Praha). 2020 Apr. 65 (2):265-274. [QxMD MEDLINE Link].
Baker-Austin C, Oliver JD. Vibrio vulnificus: new insights into a deadly opportunistic pathogen. Environ Microbiol. 2018 Feb. 20 (2):423-430. [QxMD MEDLINE Link].
Hendren N, Sukumar S, Glazer CS. Vibrio vulnificus septic shock due to a contaminated tattoo. BMJ Case Rep. 2017 May 27. 2017:[QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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Tsai YH, Chen PH, Yu PA, Chen CL, Kuo LT, Huang KC. A multiplex PCR assay for detection of Vibrio vulnificus, Aeromonas hydrophila, methicillin-resistant Staphylococcus aureus, Streptococcus pyogenes, and Streptococcus agalactiae from the isolates of patients with necrotizing fasciitis. Int J Infect Dis. 2019 Apr. 81:73-80. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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Media Gallery

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

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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

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 Former 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: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

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: Biogen US (Adjudicator for study entry cutaneous lupus erythematosus); Priovant (Adjudicator for entry into a dermatomyositis study); IQVIA (Serono - adjudicator for a study of cutaneous LE) <br/>Received honoraria from UpToDate for author/editor; 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 these trust accounts for: Stocks held in various trust accounts: Allergen; Amgen; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble;; Celgene; Gilead; CVS; Walgreens; Bristol-Myers Squibb.

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.

Vibrio Vulnificus Infection Treatment & Management

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Prevention

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