Vibrio vulnificus

Vibrio vulnificus
False-color SEM image of Vibrio vulnificus
Scientific classification
Kingdom: Bacteria
Phylum: Proteobacteria
Class: Gammaproteobacteria
Order: Vibrionales
Family: Vibrionaceae
Genus: Vibrio
Species: V. vulnificus
Binomial name
Vibrio vulnificus
(Reichelt et al. 1976)[1]
Farmer 1979[2]
Synonyms

Beneckea vulnifica

Vibrio vulnificus is a species of Gram-negative, motile, curved, rod-shaped (bacillus), pathogenic bacteria of the genus Vibrio. Present in marine environments such as estuaries, brackish ponds, or coastal areas, V. vulnificus is related to V. cholerae, the causative agent of cholera.[3][4] Infection with V. vulnificus leads to rapidly expanding cellulitis or septicemia.[5]:279 It was first isolated as a source of disease in 1976.[6] The capsule, made of polysaccharides, is thought to protect against phagocytosis. The observed association of the infection with liver disease (associated with increased serum iron) might be due to the capability of more virulent strains to capture iron bound to transferrin. Toxin production plays a relevant role in pathogenicity.[7]

Signs and symptoms

V. vulnificus is an extremely virulent bacterium that can cause three types of infections:

Among healthy people, ingestion of V. vulnificus can cause vomiting, diarrhea, and abdominal pain. In someone with a compromised immune system, particularly those with chronic liver disease, it can infect the bloodstream, causing a severe and life-threatening illness characterized by fever and chills, decreased blood pressure (septic shock), and blistering skin lesions.

Treatment

V. vulnificus wound infections have a mortality rate around 25%. In patients in whom the infection worsens into septicemia, typically following ingestion, the mortality rate rises to 50%. The majority of these patients die 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, respectively) were associated with an improved outcome.[11] Prospective clinical trials are needed to confirm this finding, but in vitro data support the supposition this combination is synergistic against V. vulnificus. Likewise, the American Medical Association and the Centers for Disease Control and Prevention (CDC) recommend treating the patient with a quinolone or intravenous doxycycline with ceftazidime. The first successful documented treatment of fulminant V. vulnificus sepsis was in 1995. Treatment was Fortaz and intravenous (IV) Cipro and IV doxycycline, which proved successful. Prevention of secondary infections from respiratory failure and acute renal failure are crucial. Key to the diagnosis and treatment was early recognition of bullae in an immunocompromised patient with liver cirrhosis and oyster ingestion within the previous 48 hours, and request by the physician for STAT Gram staining and blood cultures for V. vulnificus.[12]

V. vulnificus often causes large, disfiguring ulcers that require extensive debridement or even amputation.

V. vulnificus is commonly found in the Gulf of Mexico, where more than a dozen people have died from the infection since 1990.[13] Most deaths at that time were occurring due to fulminant sepsis either in the area of oyster harvest and ingestion or in tourists returning home. Lack of disease recognition and the risk factors, presentation, and cause were and are major obstacles to good outcome and recovery.

After the successful treatment of the first patient, the Florida Department of Health was able to trace the origin of the outbreak to Apalachicola Bay oysters and their harvesting in water prone to excessive growth of the organism due to warmth of the water and lack of freshwater dilution by reduced flow of the Chattahoochee River into the Apalachicola River into Apalachicola Bay. A similar situation occurred after Hurricane Katrina in New Orleans.

Prognosis

The worst prognosis is in those patients arriving at hospital in a state of shock. Total mortality in treated patients (ingestion and wound) is around 33%.[11]

Patients especially vulnerable are those with liver disease (especially cirrhosis and hepatitis) or 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.[14] About half of those who contract blood infections die.

V. vulnificus infections also disproportionately affect males; 85% of those developing endotoxic shock from the bacteria are male. Females having had an oophorectomy experienced increased mortality rates, as estrogen has been shown experimentally to have a protective effect against V. vulnificus.[15]

History

The pathogen was first isolated in 1976 from a series of blood culture samples submitted to the CDC in Atlanta.[6] It was described as a "lactose-positive vibrio".[6] It was subsequently given the name Beneckea vulnifica,[1] and finally Vibrio vulnificus by Farmer in 1979.[2]

Increasing seasonal temperatures and decreasing coastal salinity levels seem to favor a greater concentration of Vibrio within filter-feeding shellfish of the US Atlantic seaboard and the Gulf of Mexico, especially oysters (Crassostrea virginica). Scientists have frequently demonstrated the presence of V. vulnificus in the gut of oysters and other shellfish and in the intestines of fish that inhabit oyster reefs. The vast majority of people who develop sepsis from V. vulnificus became ill after they ate raw oysters, most of these cases have been men.[16]

Health officials clearly identified strains of V. vulnificus infections among evacuees from New Orleans due to the flooding there caused by Hurricane Katrina.[17]

On Thursday, June 18, 2015, an online news story article, featured on the MSN News webpage, and written by Katy Galimberti, an AccuWeather.com staff writer, with commentary provided by AccuWeather meteorologist Alex Sosnowski, stated that eight cases of Vibrio vulnificus infection "have been reported so far in 2015 across six different counties. Two cases resulted in death – one in Brevard County, Florida and one in Marion County, Florida." Mr. Sosnowski then noted that Florida had had warm months previously, and the story said that the pathogen prefers brackish warm water around the Gulf Coastal area. With two deaths out of eight known cases, that localized outbreak would thus far have a fatality (mortality) rate of 25%, higher than many other pathogens, but still lower than many others with even higher fatality rates. Much of the mortality due to V. vulnificus occurs in those patients who develop generalized infections, and in turn develop sepsis or septic shock; many, but certainly not all, of those cases are in compromised individuals.[18]

References

  1. 1 2 Reichelt JL, Baumann P, Baumann L (October 1976). "Study of genetic relationships among marine species of the genera Beneckea and Photobacterium by means of in vitro DNA/DNA hybridization". Arch. Microbiol. 110 (1): 101–20. doi:10.1007/bf00416975. PMID 1015934.
  2. 1 2 Farmer JJ (October 1979). "Vibrio ("Beneckea") vulnificus, the bacterium associated with sepsis, septicaemia, and the sea". Lancet. 2 (8148): 903. doi:10.1016/S0140-6736(79)92715-6. PMID 90993.
  3. ↑ Oliver JD, Kaper J (2001). Vibrio species. pp. 263-300 In: Food Microbiology: Fundamentals and Frontiers. (Doyle MP et al., editors) (2nd ed.). ASM Press. ISBN 1-55581-117-5.
  4. 1 2 Oliver JD (2005). "Wound infections caused by Vibrio vulnificus and other marine bacteria". Epidemiol Infect. 133 (3): 383–91. doi:10.1017/S0950268805003894. PMC 2870261Freely accessible. PMID 15962544.
  5. ↑ James, William D.; Berger, Timothy G. (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
  6. 1 2 3 Hollis DG, Weaver RE, Baker CN, Thornsberry C (April 1976). "Halophilic Vibrio species isolated from blood cultures" (PDF). J. Clin. Microbiol. 3 (4): 425–31. PMC 274318Freely accessible. PMID 1262454.
  7. ↑ Oxford handbook of Infect Dis and Microbiol, 2009
  8. ↑ "Vibrio vulnificus General Information Frequently Asked Questions". Centers for Disease Control. Retrieved April 19, 2013.
  9. ↑ "Vibrio vulnificus". NCBI Genome Project. Retrieved 2005-09-01.
  10. 1 2 "Vibrio vulnificus General Information Frequently Asked Questions What type of illness does V. vulnificus cause?". Centers for Disease Control. Retrieved April 19, 2013.
  11. 1 2 Liu JW, Lee IK, Tang HJ, et al. (2006). "Prognostic factors and antibiotics in Vibrio vulnificus septicemia". Archives of Internal Medicine. 166 (19): 2117–23. doi:10.1001/archinte.166.19.2117. PMID 17060542.
  12. ↑ "Vibrio vulnificus fact sheet" (PDF). issc.org. Retrieved August 1, 2016.
  13. ↑ Flynn, Dan (November 22, 2011). "Still Too Many Raw Oyster Deaths in Gulf States". Food Safety News. Retrieved August 1, 2016.
  14. ↑ Oliver JD, Kaper J (2005). Vibrio vulnificus. In: Oceans and Health: Pathogens in the Marine Environment. (Belken SS, Colwell RR, editors) (2nd ed.). Springer Science. ISBN 0-387-23708-9.
  15. ↑ 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. doi:10.1128/IAI.69.10.6119-6122.2001. PMC 98741Freely accessible. PMID 11553550.
  16. ↑ Diaz, James H. (May 2014). "Skin and Soft Tissue Infections Following Marine Injuries and Exposures in Travelers". Journal of Travel Medicine. 21 (3): 207–213. doi:10.1111/jtm.12115. ISSN 1195-1982. PMID 24628985.
  17. ↑ Gold, Scott (September 6, 2005). "Newest Peril from Flooding Is Disease". Los Angeles Times.
  18. ↑ Katy Galimberti (June 18, 2015). "Flesh-Eating Bacteria Kills Two in Florida as Water Temperatures Rise". msn.com. Retrieved August 1, 2016.


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