What are the other Names for this Condition? (Also known as/Synonyms)

• Infection by Vibrio Vulnificus

What is Vibrio Vulnificus Infection? (Definition/Background Information)

• Vibrio vulnificus is a bacterium that lives in warm, seawater that causes infection through the consumption of raw or undercooked seafood and direct contact of open wounds with contaminated water or raw seafood
• In some cases, Vibrio Vulnificus Infection outbreaks can occur after natural calamities, such as hurricanes, typhoons, or tsunamis, which cause flooding of the coastal areas with seawater leading to increased risk of exposure in the coastal population
• Typically, the infection can result in gastroenteritis and highly lethal wound and bloodstream infections, especially in individuals with chronic liver disease and weak immune systems
  • It causes food poisoning (gastroenteritis) within 24 hours, in individuals who consume raw or undercooked shellfish or other contaminated foods, which presents with watery diarrhea and other symptoms such as fever, nausea/vomiting, and abdominal pain
  • Wound infection occurs when open wounds (from surgery, cuts, scratches, piercings, tattooing, etc.) get exposed to seawater or raw shellfish or its juices/extracts. Within 1-3 days of exposure, infection of the tissues (muscles, soft tissue, fascia) surrounding the open wound develops that can lead to widespread tissue destruction
  • When bacteria enter into blood from the digestive tract or infected wound, it can result in a bloodstream infection
• People with weak immunity, such as those with chronic liver disease, end-stage kidney disease, and immunodeficiency diseases, are at increased risk of severe life-threatening infections requiring intensive care and even limb amputations
• Vibrio Vulnificus Infection can be diagnosed by growing (culturing) the bacteria from feces, blood, and wound samples. Molecular techniques, such as polymerase chain reaction (PCR), are faster and better alternatives in diagnosing the condition
• The treatment of Vibrio Vulnificus Infection consists of antibiotics and other supportive measures depending on the presentation, severity, and complications. Wound infections require surgery to remove the infected tissue and may even necessitate amputation of the infected limb
• Currently, there is no vaccine available against Vibrio Vulnificus Infection. Preventative measures include the avoidance of raw shellfish and cross-contamination of other foods with raw seafood. It is important to protect open wounds and avoid exposing them to seawater or raw shellfish and their fluid discharges

Who gets Vibrio Vulnificus Infection? (Age and Sex Distribution)

• The infection can occur in both men and women of all ages, although men and older individuals are at a higher risk
• The condition is observed worldwide with no racial or ethnic predilection being noted
• The overall prevalence of Vibrio Vulnificus Infection is low. However, it is the most common cause of seafood related deaths in the United States

What are the Risk Factors for Vibrio Vulnificus Infection? (Predisposing Factors)

Some of the factors that place individuals at risk for Vibrio Vulnificus Infection include:

• Eating raw seafood, especially shellfish
• Individuals with open wounds getting into seawater or brackish water
• Handling raw seafood with bare hands, especially if there are cuts or other open wounds
• Occupations that involve the risk of sustaining wounds in seawater or brackish water. Hence, swimmers, fishers, scuba divers, snorkelers, beach walkers, coral collectors, and surfers are at an increased risk
• Natural calamities, such as hurricanes or tsunamis, flooding the coastal areas with salty seawater and contaminating freshwater bodies
• Individuals with chronic diseases and impaired ability to fight infections are at risk for severe disease and complications. These include individuals with:
  • Chronic liver disease
  • End-stage kidney disease
  • Diabetes mellitus
  • Cancer
  • Taking immunosuppressant medications
  • HIV infection and other immunodeficiency diseases
  • Taking acid suppressants or having undergone gastrectomy

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Vibrio Vulnificus Infection? (Etiology)

Vibrio vulnificus is a bacterium belonging to the same bacterial family as the cholera-causing bacteria.

• These bacteria live freely in warm, shallow salt waters (rivers, estuaries, deltas, shorelines as well as deeper ocean surfaces) and get concentrated inside shellfish, particularly oysters, which feed by filtering seawater
• Vibrio Vulnificus Infection is acquired in two ways:
  • By eating raw or undercooked shellfish, particularly oysters, which are filter feeders i.e., they feed by filtering seawater, as a result of which the bacteria get concentrated inside them and keep multiplying further
  • Infection can also occur when open wounds get exposed (comes into contact with) contaminated seawater, brackish water (freshwater mixed with seawater), or raw seafood and its juices (fluid discharges)
• Vibrio Vulnificus Infection occurs throughout the year with the higher number of cases reported during the warmer months when the bacteria are present in maximum concentrations in the seawater (the bacteria increase in quantity during the warmer months of the year)

The infection does not spread from one individual to another.

What are the Signs and Symptoms of Vibrio Vulnificus Infection?

Individuals with Vibrio Vulnificus Infection may present as one of the three distinct infections:

• Primary intestinal infection (gastroenteritis): 10-15% of the cases
• Primary wound infection: 25%
• Primary bloodstream infection (septicemia): 60%

Gastroenteritis:

• The signs and symptoms of intestinal infection usually develop within 24 hours of suspected seafood ingestion and may include:
  • Watery diarrhea
  • Nausea and vomiting
  • Mild fever
  • Abdominal pain
• The gastroenteritis may be self-limited or lead to serious life-threatening bloodstream infection. Therefore, caution is advised if V. Vulnificus Infection is suspected

Primary wound infections:

• Within 1-3 days of direct contact of open wounds with contaminated water or seafood, the infected wound may present with the following signs and symptoms:
  • Warm red or brownish-red swollen skin
  • Formation of ulcer, blister, or bullae
  • Pain and soreness in the affected limb/region; pain may be out of proportion to the skin changes
  • Fever
  • Sweating with or without chills
• The wound infection may rapidly progress to develop necrotizing fasciitis, which is an extensive destruction of the flesh around the wound including the muscles and connective tissue
• Individuals with primary digestive tract infection and primary wound infections are at risk of the infection spreading to the bloodstream, resulting in sepsis and other associated complications

Primary bloodstream infection (septicemia/sepsis):

• The individual may also develop systemic infection after consuming contaminated seafood without any history of gastroenteritis or skin infections. In such cases, the features may include:
  • Body temperatures above 38 deg. C or below 36 deg. C
  • Heart rate greater than 90 bpm
  • Breathing rate greater than 20 breaths per min (tachypnea)
• Individuals may appear extremely ill and may even be in shock (from low blood pressure) on arrival at the hospital
• Skin lesions abruptly appear within 24 hours of the onset of sepsis. In contrast to the primary wound infection, skin lesions in sepsis are usually present on both (lower) extremities

How is Vibrio Vulnificus Infection Diagnosed?

To make a diagnosis of Vibrio Vulnificus Infection, it is important to collect information about the following:

• Clinical data including signs and symptoms, physical examination, and course of the illness, including changes in blood chemistry
• Occupations, such as swimming, surfing, fishing, scuba diving, and snorkelling, including beach walking and coral collection
• Recent history of consumption of raw seafood, especially raw oysters
• Recent history of seafood purchase
• Recent history of travel to coastal areas and/or participation in recreational water activities

The following tests and procedures may be used to definitively diagnose the causative bacterium:

• Microscopic examination of wound discharge
• Growing (culturing) the bacteria from feces, blood or wound tissue, and tissue fluid
• Molecular techniques, such as polymerase chain reaction (PCR), are a faster and better alternative to conventional methods that typically depend on the more time-consuming culture methods

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Vibrio Vulnificus Infection?

Vibrio Vulnificus Infection can lead to life-threatening complications which may include:

• Spread of infection in blood and throughout the body leading to septicemia and septic shock
• The disease is also described as flesh-eating bacteria infection, since it can cause necrotizing fasciitis, myonecrosis, and extremity gangrene
• Amputation (from treatment of the infection)

Severe cases of infection are known to be fatal.

How is Vibrio Vulnificus Infection Treated?

In general, antibiotic therapy form the mainstay of treatment for Vibrio Vulnificus Infection.

• Individuals with mild intestinal infections may not require the administration of antibiotics. They may be advised rest and plenty of liquids to replenish lost fluids from diarrhea, to prevent dehydration
• Severe illness is treated with antibiotics and may require hospitalization along with supportive therapy to treat dehydration and other complications
• Sepsis and wound infections need careful attention and immediate antibiotic treatment to prevent severe complications and avoid mortalities
• Damaged and infected tissue may be surgically removed
• Severe infections may necessitate amputation of the affected limb, to remove the source of infection and control infection spread in the body

How can Vibrio Vulnificus Infection be Prevented?

There is no vaccine currently available to protect against Vibrio Vulnificus Infection. In general, the following preventive measures may be considered:

• Avoid eating raw or undercooked shellfish, cooking it properly before eating.
• Avoid contaminating other foods with raw shellfish and its juice
• Handle raw seafood with gloves or wash hands thoroughly with soap and clean water afterward
• Avoid exposure to seawater, brackish water (freshwater mixed with seawater), or coastal flood water, particularly if one has open wounds (wounds from recent surgery, cuts, scratches, piercing, tattooing, or any other skin lesion types). Covering open wounds with waterproof bandages in case contact with contaminated water/seawater is unavoidable
• Additionally, avoid exposing open wounds directly to raw seafood or its juices and drippings. In case of contact, washing the area thoroughly with soap and clean (bottled) water
• In case of coastal floods (following cyclones/hurricanes/typhoons/tsunamis), wear protective clothes and shoes while getting into the flood waters to avoid getting any cuts or other injuries

Individuals with weak immunity and chronic diseases, such as liver disease or diabetes, are advised to strictly adhere to all of the above preventive measures.

What is the Prognosis of Vibrio Vulnificus Infection? (Outcomes/Resolutions)

Vibrio Vulnificus Infection is a rapidly-forming lethal infection. Presently, the overall death rate is about 35%.

• Gastroenteritis is usually self-limited and rarely lethal, but it may lead to serious life-threatening bloodstream infections
• Overall death rate from wound infection is around 25%. If surgical debridement is delayed in necrotizing fasciitis and myonecrosis, mortality rates can be extremely high (even approach 100%)
• Mortality rate in individuals presenting with sepsis can be as high as 50% even after antibiotic treatment. Death rates can even approach 100%, if antibiotic treatment is delayed by over 72 hours

Additional and Relevant Useful Information for Vibrio Vulnificus Infection:

The following article link will help you understand necrotizing fasciitis and gas gangrene:

https://www.dovemed.com/diseases-conditions/necrotizing-fasciitis/

https://www.dovemed.com/diseases-conditions/gas-gangrene/