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 (eg, saltwater marshes/wetlands, river estuaries) 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 .
- Morris JG Jr, Black RE. Cholera and other vibrioses in the United States. N Engl J Med 1985; 312:343.
- Blake PA, Merson MH, Weaver RE, et al. Disease caused by a marine Vibrio. Clinical characteristics and epidemiology. N Engl J Med 1979; 300:1.
- Daniels NA. Vibrio vulnificus oysters: pearls and perils. Clin Infect Dis 2011; 52:788.
- Bisharat N, Cohen DI, Harding RM, et al. Hybrid Vibrio vulnificus. Emerg Infect Dis 2005; 11:30.
- Wright AC, Hill RT, Johnson JA, et al. Distribution of Vibrio vulnificus in the Chesapeake Bay. Appl Environ Microbiol 1996; 62:717.
- Griffitt KJ, Grimes DJ. Abundance and distribution of Vibrio cholerae, V. parahaemolyticus, and V. vulnificus following a major freshwater intrusion into the Mississippi Sound. Microb Ecol 2013; 65:578.
- Motes ML, DePaola A, Cook DW, et al. Influence of water temperature and salinity on Vibrio vulnificus in Northern Gulf and Atlantic Coast oysters (Crassostrea virginica). Appl Environ Microbiol 1998; 64:1459.
- Jones MK, Oliver JD. Vibrio vulnificus: disease and pathogenesis. Infect Immun 2009; 77:1723.
- 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; 46:970.
- Yoder JS, Hlavsa MC, Craun GF, et al. Surveillance for waterborne disease and outbreaks associated with recreational water use and other aquatic facility-associated health events--United States, 2005-2006. MMWR Surveill Summ 2008; 57:1.
- Centers for Disease Control and Prevention (CDC). Vibrio illnesses after Hurricane Katrina--multiple states, August-September 2005. MMWR Morb Mortal Wkly Rep 2005; 54:928.
- Kotton Y, Soboh S, Bisharat N. Vibrio Vulnificus Necrotizing Fasciitis Associated with Acupuncture. Infect Dis Rep 2015; 7:5901.
- Bisharat N, Agmon V, Finkelstein R, et al. Clinical, epidemiological, and microbiological features of Vibrio vulnificus biogroup 3 causing outbreaks of wound infection and bacteraemia in Israel. Israel Vibrio Study Group. Lancet 1999; 354:1421.
- Broza YY, Danin-Poleg Y, Lerner L, et al. Epidemiologic study of Vibrio vulnificus infections by using variable number tandem repeats. Emerg Infect Dis 2009; 15:1282.
- Paz S, Bisharat N, Paz E, et al. Climate change and the emergence of Vibrio vulnificus disease in Israel. Environ Res 2007; 103:390.
- Tacket CO, Brenner F, Blake PA. Clinical features and an epidemiological study of Vibrio vulnificus infections. J Infect Dis 1984; 149:558.
- Lee SH, Chung BH, Lee WC. Retrospective analysis of epidemiological aspects of Vibrio vulnificus infections in Korea in 2001-2010. Jpn J Infect Dis 2013; 66:331.
- Klontz KC, Lieb S, Schreiber M, et al. Syndromes of Vibrio vulnificus infections. Clinical and epidemiologic features in Florida cases, 1981-1987. Ann Intern Med 1988; 109:318.
- Johnston JM, Becker SF, McFarland LM. Vibrio vulnificus. Man and the sea. JAMA 1985; 253:2850.
- Hoge CW, Watsky D, Peeler RN, et al. Epidemiology and spectrum of Vibrio infections in a Chesapeake Bay community. J Infect Dis 1989; 160:985.
- Newton A, Kendall M, Vugia DJ, et al. Increasing rates of vibriosis in the United States, 1996-2010: review of surveillance data from 2 systems. Clin Infect Dis 2012; 54 Suppl 5:S391.
- CDC. National Enteric Disease Surveillance: COVIS Annual Summary, 2014. www.cdc.gov/nationalsurveillance/pdfs/covis-annual-summary-2014-508c.pdf (Accessed on February 22, 2017).
- Wright AC, Simpson LM, Oliver JD, Morris JG Jr. Phenotypic evaluation of acapsular transposon mutants of Vibrio vulnificus. Infect Immun 1990; 58:1769.
- Chung KJ, Cho EJ, Kim MK, et al. RtxA1-induced expression of the small GTPase Rac2 plays a key role in the pathogenicity of Vibrio vulnificus. J Infect Dis 2010; 201:97.
- Brennt CE, Wright AC, Dutta SK, Morris JG Jr. Growth of Vibrio vulnificus in serum from alcoholics: association with high transferrin iron saturation. J Infect Dis 1991; 164:1030.
- Kim CM, Park RY, Choi MH, et al. Ferrophilic characteristics of Vibrio vulnificus and potential usefulness of iron chelation therapy. J Infect Dis 2007; 195:90.
- Kim CM, Park YJ, Shin SH. A widespread deferoxamine-mediated iron-uptake system in Vibrio vulnificus. J Infect Dis 2007; 196:1537.
- Srivastava M, Tucker MS, Gulig PA, Wright AC. Phase variation, capsular polysaccharide, pilus and flagella contribute to uptake of Vibrio vulnificus by the Eastern oyster (Crassostrea virginica). Environ Microbiol 2009; 11:1934.
- Devi SJ, Hayat U, Powell JL, Morris JG Jr. Preclinical immunoprophylactic and immunotherapeutic efficacy of antisera to capsular polysaccharide-tetanus toxoid conjugate vaccines of Vibrio vulnificus. Infect Immun 1996; 64:2220.
- Bush CA, Patel P, Gunawardena S, et al. Classification of Vibrio vulnificus strains by the carbohydrate composition of their capsular polysaccharides. Anal Biochem 1997; 250:186.
- Powell JL, Wright AC, Wasserman SS, et al. Release of tumor necrosis factor alpha in response to Vibrio vulnificus capsular polysaccharide in in vivo and in vitro models. Infect Immun 1997; 65:3713.
- Gavin HE, Beubier NT, Satchell KJ. The Effector Domain Region of the Vibrio vulnificus MARTX Toxin Confers Biphasic Epithelial Barrier Disruption and Is Essential for Systemic Spread from the Intestine. PLoS Pathog 2017; 13:e1006119.
- Bullen JJ, Spalding PB, Ward CG, Gutteridge JM. Hemochromatosis, iron and septicemia caused by Vibrio vulnificus. Arch Intern Med 1991; 151:1606.
- Gerhard GS, Levin KA, Price Goldstein J, et al. Vibrio vulnificus septicemia in a patient with the hemochromatosis HFE C282Y mutation. Arch Pathol Lab Med 2001; 125:1107.
- Hayat U, Reddy GP, Bush CA, et al. Capsular types of Vibrio vulnificus: an analysis of strains from clinical and environmental sources. J Infect Dis 1993; 168:758.
- Tamplin ML, Jackson JK, Buchrieser C, et al. Pulsed-field gel electrophoresis and ribotype profiles of clinical and environmental Vibrio vulnificus isolates. Appl Environ Microbiol 1996; 62:3572.
- Jackson JK, Murphree RL, Tamplin ML. Evidence that mortality from Vibrio vulnificus infection results from single strains among heterogeneous populations in shellfish. J Clin Microbiol 1997; 35:2098.
- Nilsson WB, Paranjype RN, DePaola A, Strom MS. Sequence polymorphism of the 16S rRNA gene of Vibrio vulnificus is a possible indicator of strain virulence. J Clin Microbiol 2003; 41:442.
- 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; 49:381.
- Park SD, Shon HS, Joh NJ. Vibrio vulnificus septicemia in Korea: clinical and epidemiologic findings in seventy patients. J Am Acad Dermatol 1991; 24:397.
- Johnston JM, Becker SF, McFarland LM. Gastroenteritis in patients with stool isolates of Vibrio vulnificus. Am J Med 1986; 80:336.
- Mead PS, Slutsker L, Dietz V, et al. Food-related illness and death in the United States. Emerg Infect Dis 1999; 5:607.
- Liu JW, Lee IK, Tang HJ, et al. Prognostic factors and antibiotics in Vibrio vulnificus septicemia. Arch Intern Med 2006; 166:2117.
- 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; 9:e0003720.
- Jang HC, Choi SM, Kim HK, et al. In vivo efficacy of the combination of ciprofloxacin and cefotaxime against Vibrio vulnificus sepsis. PLoS One 2014; 9:e101118.
- Chao WN, Tsai CF, Chang HR, et al. Impact of timing of surgery on outcome of Vibrio vulnificus-related necrotizing fasciitis. Am J Surg 2013; 206:32.
- Chen SC, Lee YT, Tsai SJ, et al. Antibiotic therapy for necrotizing fasciitis caused by Vibrio vulnificus: retrospective analysis of an 8 year period. J Antimicrob Chemother 2012; 67:488.
- Lin YS, Hung MH, Chen CC, et al. Tigecycline salvage therapy for necrotizing fasciitis caused by Vibrio vulnificus: Case report in a child. J Microbiol Immunol Infect 2016; 49:138.
- Chuang YC, Ko WC, Wang ST, et al. Minocycline and cefotaxime in the treatment of experimental murine Vibrio vulnificus infection. Antimicrob Agents Chemother 1998; 42:1319.
- Tang HJ, Chang MC, Ko WC, et al. In vitro and in vivo activities of newer fluoroquinolones against Vibrio vulnificus. Antimicrob Agents Chemother 2002; 46:3580.
- Depaola A, Jones JL, Noe KE, et al. Survey of postharvest-processed oysters in the United States for levels of Vibrio vulnificus and Vibrio parahaemolyticus. J Food Prot 2009; 72:2110.