Vibrio vulnificus infections
- J Glenn Morris, Jr, MD, MPHTM
J Glenn Morris, Jr, MD, MPHTM
- Professor of Medicine
- Director, Emerging Pathogens Institute
- University of Florida
Vibrio vulnificus is a gram-negative bacterium that can cause serious wound infections, septicemia, and diarrhea [1-3]. It is the leading cause of shellfish-associated deaths in the United States. Infections due to V. vulnificus are most common in individuals who have chronic, underlying illness; individuals with liver disease or hemochromatosis are at greatest risk.
The pathogenesis, epidemiology, clinical features, diagnosis, and treatment of V. vulnificus infections will be reviewed here. The disease cholera, caused by "epidemic" strains of Vibrio cholerae, infections caused by Vibrio parahaemolyticus, and illnesses associated with other Vibrio strains and species are discussed separately. (See "Overview of cholera" and "Vibrio parahaemolyticus infections" and "Infections due to non-O1/O139 Vibrio cholerae".)
V. vulnificus exists as a free-living bacterium inhabiting estuarine or marine environments. Three biotypes are recognized: biotype 1, which accounts for almost all human infections; biotype 2, which consists primarily of eel pathogens; and biotype 3, an apparent hybrid of biotypes 1 and 2 that has been described in tilapia-associated wound infections in Israel .
V. vulnificus accounts for approximately eight percent of the aerobic bacteria in the Chesapeake Bay . Counts peak during summer and late fall, when water temperatures are highest. Reductions in counts have been correlated with drops in salinity of the water, such as occurred in 2011 in Louisiana when opening of the Bonne Carre spillway associated with flooding of the Mississippi river led to fresh water intrusion into estuarine areas .
Filter-feeding shellfish such as oysters concentrate bacteria and may have counts of V. vulnificus up to two orders of magnitude greater than those in the surrounding water. V. vulnificus can be isolated from virtually all oysters harvested in the Chesapeake Bay and the United States Gulf Coast when water temperatures exceed 20ºC [5,7]. Over 90 percent of patients with "primary" V. vulnificus septicemia (ie, septicemia without an obvious source such as a wound) report having consumed raw oysters prior to the onset of illness .
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