Vibrio vulnificus infection

Vibrio vulnificus infection is a wound infection in oyster shuckers or fishermen. It can cause septicemia in immunocompromised patients within 7 days of eating raw oysters.

CASES/YEAR
94 (US); 1,880 (Global)
CATEGORY
Sapronoses
AGENT TYPE
Bacteria
OTHER NAMES
Streptococcus iniae cellulitis (Related Infection);
ACUITY
Acute-Severe
INCUBATION
12-72 hours; [CCDM]
INITIAL SYMPTOMS
Wound infections (cellulitis) in oyster shuckers or fishermen; Septicemia and metastatic skin lesions (vesicles and bullae) in immunocompromised patients within 7 days of eating raw oysters; [PPID, p. 2646-7]
PRECAUTIONS
Not transmitted directly from person to person; [CCDM]
COMMENTS
Vibrio vulnificus causes skin infections in normal hosts. It causes septic shock and bullous skin lesions in immunocompromised hosts, including patients with chronic liver disease and hemochromatosis. Wounds may become infected after contact with contaminated water, leading to cellulitis and myositis (can mimic clostridial myonecrosis). [CCDM, p. 111] Wound infections occur after cleaning fish, shelling crabs, or shucking oysters. The organisms grow in warm seawater (greater than 60 degrees F). Susceptible patients include those with cirrhosis, hemochromatosis, thalassemia, AIDS, diabetes, chronic renal failure, and malignancy. Eating undercooked seafood contaminated with Vibrio vulnificus can result in sepsis and shock in these immunocompromised patients. Septic arthritis is a rare complication. [ID, p. 667; PPID, p. 2646-7] The mortality rate is about 50%. [Harrison ID, p. 558] Streptococcus iniae cellulitis occurs in fish farmers, fish cutters, and cooks exposed to tilapia with complications including septic arthritis, meningitis, and endocarditis. [PPID, p. 1296] See "Cellulitis" for other fish-related skin infections.
DIAGNOSTIC
Culture; Grows on MacConkey agar, but clinician should advise lab to look specifically for this organism; PCR of stool (diarrhea panel); [PPID, p. 2647]
SCOPE
Global
SIGNS & SYMPTOMS
  • >fever
  • G diarrhea
  • H leukocytosis
  • H leukopenia
  • H thrombocytopenia
  • S cellulitis or rash, circinate
  • S papules or plaques
  • S petechiae and ecchymoses
  • S skin blister or vesicles
  • S ulcer of skin
  • *arthritis
  • *bleeding tendency
  • *sepsis
  • *shock
ANTIMICROBIC

Yes

VACCINE

No

ENTRY
Ingestion, Skin or Mucous Membranes (Includes Conjunctiva)
SOURCE
Animal Tissue, Eating Contaminated Food, Eating Infected or Toxin-Containing Fish, Eating Contaminated Mollusks or Crustacean, Waterborne (Ingesting, Inhaling, or Swimming)
RESERVOIR
Fish and Shellfish
RISK FACTORS
  • AIDS patients
  • Cancer patients
  • Eat undercooked meat or fish
  • Ingest infectious agents in food/water
  • Touch infected fish or shellfish
DRUG LINK
Merck Manual: Noncholera Vibrio Infections
REFERENCES FOR CASES/YEAR
1. (US) Published in MMWR 2011 (includes V. parahaemolyticus, V. vulnificus, and V. alginolyticus) = 832; Between 1988 and 2006, >900 V. vulnificus infections were reported to CDC. [CDC website] Calculate: 900/18 = 50; Estimated 94 cases in 1997; [Mead1999: PMID 10511517]
2. (Global) "Infection with V. vulnificus is rare . . ." [Harrison ID, p. 558] Guesstimate: global rate = US rate X 20;