Vibrio vulnificus
| Vibrio vulnificus | |
|---|---|
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| 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. 1979) Farmer 1980 |
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Vibrio vulnificus is a species of Gram-negative, motile, curved, rod-shaped 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.[1],[2] Infection with V. vulnificus leads to rapidly expanding cellulitis or septicemia.[3]:279 It was first isolated in 1976.[4]
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[edit] Signs and symptoms
Vibrio vulnificus causes an infection often incurred after eating seafood, especially raw or undercooked 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.
In people with compromised immune systems such as in chronic liver disease, a cut infected with Vibrio bacteria can quickly become worse and spread into the bloodstream. Severe symptoms and even death can then occur.[5]
[edit] Treatment
Vibrio vulnificus wound infections have a mortality of approximately 25%. In patients in whom the infection worsens into septicemia, typically following ingestion, the mortality rate rises dramatically 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.[6] Prospective clinical trials are needed to confirm this finding, but in vitro data support the supposition this combination is synergistic against Vibrio vulnificus. Similarly, the American Medical Association and the Centers for Disease Control and Prevention recommend treating the patient with tetracycline and intravenous doxycycline with ceftazidime.[7]
V. vulnificus often causes large, disfiguring ulcers that require extensive debridement or even amputation.
V. vulnificus is commonly found in the Pacific Northwest.
[edit] Prognosis
The worst prognosis is in those patients who arrive at hospital in a state of shock. Total mortality in treated patients (ingestion and wound) is around 33%.[6]
Patients especially vulnerable are those with liver disease (especially chirrhosis 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.[8] According to the Centers for Disease Control and Prevention (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 has been shown experimentally to have a protective effect against V. vulnificus.[9]
[edit] History
The pathogen was first isolated in 1976 from a series of blood culture samples submitted to the CDC in Atlanta.[4] It was described as a "lactose-positive vibrio".[4] It was subsequently given the name Beneckea vulnifica,[10] and finally Vibrio vulnificus by Farmer in 1979.[11]
Health officials clearly identified strains of V. vulnificus infections among evacuees from New Orleans due to the flooding there caused by Hurricane Katrina.[12]
[edit] References
- ^ 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 1555811175.
- ^ a b Oliver JD (2005). "Wound infections caused by Vibrio vulnificus and other marine bacteria". Epidemiol Infect 133 (3): 383–91. doi:10.1017/S0950268805003894. PMC 2870261. PMID 15962544. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2870261.
- ^ James, William D.; Berger, Timothy G. (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
- ^ a b c 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 274318. PMID 1262454. http://jcm.asm.org/content/3/4/425.long.
- ^ "Vibrio vulnificus". NCBI Genome Project. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=genomeprj&cmd=Retrieve&dopt=Overview&list_uids=12341. Retrieved 2005-09-01.
- ^ a b 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.
- ^ http://www.issc.org/client_resources/Education/VvFactSheet.pdf
- ^ 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 0387237089.
- ^ 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 98741. PMID 11553550. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=98741.
- ^ 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. PMID 1015934.
- ^ 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.
- ^ Gold, Scott (September 6, 2005). "Newest Peril from Flooding Is Disease". Los Angeles Times.
