Vibrio vulnificus

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Vibrio vulnificus
False-color SEM image of Vibrio vulnificus
False-color SEM image of Vibrio vulnificus
Scientific classification
Kingdom: Bacteria
Phylum: Proteobacteria
Class: Gamma Proteobacteria
Order: Vibrionales
Family: Vibrionaceae
Genus: Vibrio
Species: V. vulnificus
Binomial name
Vibrio vulnificus
(Reichelt et al. 1979)
Farmer 1980

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Vibrio vulnificus is a species of Gram-negative, motile, curved, rod-shaped bacteria in the genus Vibrio. Present in marine environments such as estuaries, brackish ponds, or coastal areas, V. vulnificus is closely related to V. cholerae, the causative agent of cholera.[1],[2]

Historical Perspective

Health officials clearly identified strains of V. vulnificus infections among refugees from New Orleans due to the flooding there caused by Hurricane Katrina.[3]

Clinical features

Vibrio vulnificus causes an infection often incurred after eating seafood, especially oysters; the bacteria can also enter the body through open wounds when swimming or wading in infected waters,[2] or via puncture wounds from the spines of fish such as tilapia. Symptoms include vomiting, diarrhea, abdominal pain, and a blistering dermatitis that is sometimes mistaken for pemphigus or pemphigoid. Severe symptoms and even death can occur if the bacterium enters the bloodstream—something more common in people with compromised immune systems or liver disease.[4]

Treatment

Vibrio vulnificus infection has a mortality rate of 50% with the majority of patients dying within the first 48 hours of infection. The optimal treatment is not known, but in one retrospective study of 93 patients in Taiwan, use of a third-generation cephalosporin and a tetracycline (e.g., ceftriaxone and doxycycline) were associated with an improved outcome.[5] Prospective clinical trials are needed to confirm this finding, but in vitro data supports the supposition that this combination is synergistic against Vibrio vulnificus. Vibrio vulnificus often causes large, disfiguring ulcers which require extensive debridement or even amputation.

Antimicrobial regimen

  • 1. Sepsis or Soft Tissue Infection Antibiotic Management [6]
  • 2. Gastroenteritis
  • Most cases self-limiting
  • Maintain hydration: oral or parenteral routes
  • Role of Doxycycline or Fluoroquinolones unclear, does not appear to shorten duration of non-cholera gastroenteritis
  • 3. Skin and soft tissue infections [7]
  • Preferred regimen: Doxycycline 100 mg IV q12h AND ceftriaxone 1 g IV qid OR cefotaxime 2 g IV tid
  • Note: Antibiotic treatment is not recommended for children but may need to use in life-threatening situation

Prognosis

  • The worst prognosis is in those patients who arrive at hospital in a state of shock. Total mortality in treated patients is around 33%.
  • Those patients who are especially vulnerable, including those with immunocompromised states (cancer, bone marrow suppression, HIV, diabetes, etc}. With these cases, V. vulnificus usually enters the bloodstream, where it may cause fever and chills, septic shock (with sharply decreased blood pressure), and blistering skin lesions.[8] According to the CDC, about half of those who contract blood infections die.
  • Vibrio vulnificus infections also disproportionately affect males; 85% of those who develop endotoxic shock from the bacteria are male. Females who have had an oophorectomy experienced increased mortality rates, as estrogen is believed to have a protective effect against V. vulnificus.[9]

References

  1. Oliver JD, Kaper J (2001). Vibrio species. pp. 263-300 In: Food Microbiology: Fundamentals and Frontiers. (Doyle MP et al, editors) (2nd ed. ed.). ASM Press. 1555811175.
  2. 2.0 2.1 Oliver JD (2005). "Wound infections caused by Vibrio vulnificus and other marine bacteria". Epidemiol Infect. 133 (3): 383–91. PMID 15962544.
  3. Gold, Scott (September 6, 2005). "Newest Peril from Flooding Is Disease". Los Angeles Times.
  4. "Vibrio vulnificus". NCBI Genome Project. Retrieved 2005-09-01.
  5. Liu JW, Lee IK, Tang HJ; et al. (2006). "Prognostic factors and antibiotics in Vibrio vulnificus septicemia". 166 (19): 2117&ndash, 23. PMID 17060542. Text " Arch Intern Med " ignored (help)
  6. Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  7. Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL; et al. (2014). "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. 59 (2): 147–59. doi:10.1093/cid/ciu296. PMID 24947530.
  8. Oliver JD, Kaper J (2005). Vibrio vulnificus. In: Oceans and Health: Pathogens in the Marine Environment. (Belken SS, Colwell RR, editors) (2nd ed. ed.). Springer Science. 0387237089.
  9. Merkel SM, Alexander S, Zufall E, Oliver JD, Huet-Hudson YM (2001). "Essential Role for Estrogen in Protection against Vibrio vulnificus-Induced Endotoxic Shock". Infection and Immunity. 69 (10): 6119–22. PMID 11553550.

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