Vibrio vulnificus Infection

What is Vibrio vulnificus Infection ?

Vibrio vulnificus is a type of bacteria that belongs to the Vibrionaceae family, which also includes harmful species such as V. cholera and V. parahaemolyticus. The name Vibrio comes from the Latin word for ‘wiggle or vibrate’, and vulnificus means ‘to wound’ in Latin.

This bacteria can be found all over the world and can cause stomach related illnesses, infections from wounds, and a deadly condition known as septicemia. Even though the risk of getting an infection from V. vulnificus is low, it is responsible for the most deaths related to seafood in the United States.

What Causes Vibrio vulnificus Infection ?

Vibrio vulnificus is a type of bacteria that likes salty environments. It’s usually found in places like rivers, deltas, shorelines, and the ocean. These bacteria make themselves at home in the stomachs of shellfish, mainly oysters, and in the intestines of fish. People can then catch the bacteria by eating this contaminated seafood or by getting a wound in contact with contaminated water or seafood.

There are three ways Vibrio vulnificus infections can show up: primary septicemia, primary wound infection, and mild gastroenteritis.

If you eat food with these bacteria, you might get what’s called primary septicemia. This is a serious infection that can quickly affect your limbs. You might also have stomach issues like watery diarrhea, fever, nausea, and vomiting. It’s not clear how exactly the bacteria enter your body, but it might be through the small intestine or the colon. Primary sepsis is the most common type of infection from Vibrio vulnificus, making up around 60% of all cases. This type of infection is very serious and can be fatal in about half of all cases.

If you get a wound while swimming or fishing, for example, the bacteria can infect your skin, causing skin inflammation and blisters. Without treatment, this can lead to a severe skin infection called necrotizing fasciitis and muscle damage, and can even lead to overwhelming sepsis, a serious body-wide infection. This kind of infection happens in about 25% of all Vibrio vulnificus cases, but the risk of death goes up to 54% for people who have liver disease.

Some people might just get gastroenteritis, a stomach bug that causes sudden fever, chills, watery diarrhea, nausea, and vomiting. This happens in about 10% to 15% of all Vibrio vulnificus cases. Even though this form doesn’t usually cause sepsis, severe skin disease, or death, it’s still important to be careful because such stomach symptoms could also be the signs of a more serious Vibrio vulnificus infection.

Risk Factors and Frequency for Vibrio vulnificus Infection

Vibrionaceae, a type of bacteria, are most common in warm marine environments around the world. These bacteria are found more often during the summer months, particularly in areas with subtropical monsoon-type climates. The majority of cases come from the United States, South Korea, Taiwan, Japan, and Mexico. The southern hemisphere sees fewer cases, partly due to the lack of monsoon climates.

People with pre-existing health conditions are more likely to develop a severe response, known as sepsis, from the initial infection. This includes people with liver diseases, diabetes, cancer, kidney disease, HIV, or other conditions that can weaken the immune system. They make up 80% to 90% of all patients diagnosed with primary sepsis.

• Men are more likely to be infected than women.
• People aged over 40 are also at a higher risk.
• This risk could be due to the fact that liver disease is more common in older men.

The growing problem of global warming is thought to be linked to the increasing spread and impact of this organism. This may be connected to increasing sea temperatures and melting polar ice caps which cause the water to become saltier.

Signs and Symptoms of Vibrio vulnificus Infection

Patients who get infected with V. vulnificus, a bacterium present in marine environments, can experience three different types of symptoms.

• The first type is called primary septicemia in which patients usually look very ill, possibly even in shock when they first come to the hospital. They may not have any digestive symptoms or apparent skin problems yet, but if the condition progresses, they may have skin abnormalities suddenly appear.
• With wound infections, any wounds gotten in seawater or brackish water often signal the possibility of V. vulnificus infection. This is especially true for swimmers and anyone else who may have wounds or skin disease that came into contact with seawater. This also include those who got infections due to contaminated seafood touching their skin.
• Gastroenteritis from V. vulnificus comes on suddenly with vomiting, diarrhea, fever, and abdominal pain, usually within a day of eating the suspicious seafood. His type of infection usually has no lasting effects after treatment, but similar stomach symptoms could be a sign of a more severe infection, so it’s important to be vigilant.

Healthcare professionals should suspect V. vulnificus in patients who have recently eaten shellfish or been in contact with seawater. It is important to know from the patient about their recent dining experiences or visits to coastal areas, as well as any relevant water activities like swimming or snorkeling.

Knowing the patient’s full medical history is also crucial as any existing chronic health issues can increase the severity of a V. vulnificus infection. Any history of illness related to the liver, blood, immune system, or having diabetes or cancer is important to know about.

Checking the patient’s vitals, including blood pressure, pulse rate, respiratory rate, temperature, and pain level, is crucial to detect sepsis. Looking for skin abnormalities usually seen within a day of a sepsis onset is also important. These abnormalities could progress quickly into severe and dangerous skin conditions.

Patients with wound infections usually have severe skin inflammation, swelling, and potentially serious skin conditions of a wounded area. These patients are at a high risk of developing bacteremia, sepsis, and even losing a limb.

In patients with gastroenteritis, abdominal tenderness without any signs of peritonitis is common. Their liver and spleen remain normal unless they have an underlying preexisting condition that could lead to enlargement. Their body temperature may be normal or slightly elevated. It’s important to also check for the presence of blood in their stool.

Testing for Vibrio vulnificus Infection

If your doctor suspects that you have a severe infection known as early-onset sepsis, they may initiate several tests. These could include blood, stool, and wound samples, along with tests for complete blood count, metabolic panel, lactic acid, coagulation panel, and arterial blood gases. This is done to check your body’s reaction to the infection. Importantly, treatment to support your body, such as fluid replacement and blood pressure maintenance, won’t be delayed while waiting for these results.

Infections can sometimes lead to multiple organ dysfunction or failure, which can happen with a bug called ‘V. vulnificus.’ To look for signs of this, your doctor might track things like changes in your white blood cell count, clotting ability, kidney function, and muscle health, amongst others. Low white blood cell count or core body temperature could suggest a severe infection.

If you have certain risk factors, such as liver disease, diabetes, cancer, AIDS, or other conditions that weaken the immune system, your doctor might order additional lab tests. You might also have a CT or MRI scan—these can help identify any underlying tissue damage or infection, like necrotizing fasciitis or myonecrosis. The images from these scans can also guide doctors if they need to drain fluid from infected areas.

Another useful tool is a fast stool test which can identify a range of harmful bugs, including the three types of Vibrionaceae and many other gut pathogens. This test has been found to be highly accurate.

Your doctor may want to examine your skin for lesions, abscesses, or necrotic ulcers and take samples to check for the presence of V. vulnificus, which will appear as a negative result in a ‘gram-stain’ test.

Blood samples and wound fluid can also be tested using a technique called ‘real-time PCR.’ This has proven to be incredibly accurate in detecting the presence of V. vulnificus. High levels of V. vulnificus DNA or elevated levels of a protein called ‘TNF-alpha’ in your blood could predict a higher risk of mortality.

Treatment Options for Vibrio vulnificus Infection

Identifying septic shock calls for immediate medical efforts to resuscitate the patient. Hospitals have specific protocols in place to manage such serious infections.

For skin infections, such as cellulitis and blisters, samples should be taken for lab testing. If the skin has become dead or necrotic, it needs to be removed surgically. Abscesses, or pockets of pus, should be drained. There are topical treatments, such as silver sulfadiazine, that can help cover infected skin. More severe cases, where there’s an infection of the fascia (the band of tissue that surrounds muscles, nerves, and blood vessels) or muscles, demand immediate surgical intervention. These surgeries are necessary to prevent death of the limb, which could lead to amputation. During this process, it’s critical to ensure the patient is well-hydrated, that they have a functioning airway, and that their blood pressure is supported as needed. Neglecting to surgically treat a necrotizing fasciitis infection can lead to a very high risk of death.

It’s crucial that patients receive the correct antibiotics as directly after testing for bacterial cultures as possible. Cultures help identify the bacteria causing the infection. However, if testing will cause beneficial treatment to be delayed, administering antibiotics promptly is of greater importance. The use of multiple antibiotics is suggested, but it’s important to note that vibrio infections, which can cause severe complications like septic shock, have shown resistance to multiple antibiotics 50% of the time.

Laboratory tests reveal that a variety of antibiotics can be effective against V. vulnificus, a species of vibrio bacteria. Regardless, the Centers for Disease Control and Prevention (CDC) recommends a combination of two specific intravenous antibiotics. Note that many patients who were already septic upon arrival to the hospital and were given the appropriate antibiotics still experienced a mortality rate of roughly one-third. The risk of death approaches 100% if the right antibiotics are not supplied within 72 hours.

If a patient is experiencing a severe stomach or intestinal infection, it’s important to replace fluids, manage fever, control pain, and combat nausea. The body’s hydration, urine creation, electrolytes, and kidney function should be closely watched to guide the treatment.

Current research is exploring the development of a vaccine against V. vulnificus.

What else can Vibrio vulnificus Infection be?

Severe blistering and skin infection can suddenly occur due to a variety of causes. Some of these include:

• certain skin conditions like pemphigus, pemphigoid, Steven-Johnson syndrome, toxic epidermal necrosis, and erythema multiforme
• infections with group A streptococcus, pseudomonas, clostridial or Aeromonas bacteria
• exposure to radiation, scalding, or UV light

Anyone who gets these skin symptoms, most notable on both lower legs, after eating shellfish should be checked for a possible V. vulnificus infection.

If a patient comes in with similar skin symptoms (swelling, blistering, blood spots, or bruising) on a body part with a recent water-related injury, they may also have a V. vulnificus infection until proven otherwise. Other possible causes could include a reaction to a medicine applied to the skin (like iodine, silver sulfadiazine, or chlorhexidine), a local reaction to an adhesive bandage, or a simultaneous sunburn or exposure to direct heat.

There are many causes of acute infectious gastroenteritis (an infection causing stomach and bowel inflammation). Over half of the cases are from viruses, like noroviruses, rotaviruses, and adenoviruses. Another big chunk is from bacteria like salmonella, staphylococcus, campylobacteria, E. coli, Bacillus cereus, Shigella, Yersinia, Vibrionaceae, and Clostridia. Of these, a Clostridia infection is common in nursing homes. In addition, smaller percentages are caused by protozoa like Giardia lamblia, Entamoeba histolytica, and Cryptosporidium or intestinal parasites like Enterobius vermicularis, Ancylostoma duodenale, and Necator americanus.

On rare occasions, gastroenteritis can also arise from non-infectious causes. These might relate to conditions such as Crohn’s disease, irritable bowel syndrome, diabetes, intolerance to lactose (a sugar in milk), or medications like NSAIDs or colchicine.

What to expect with Vibrio vulnificus Infection

V. vulnificus is a very serious condition, with approximately 35% of cases resulting in death. The likelihood of death increases to 50-60% for patients with existing liver problems or a weakened immune system, compared to 16% for those without these conditions. If a patient comes in with sepsis, an extreme response to infection in the body, the overall mortality rate is 50%. However, if they begin antibiotics treatment beyond 72 hours of first arriving for medical help, their chance of survival is close to zero.

For those with symptoms of necrotizing fasciitis, a severe infection that causes tissue death, or myonecrosis, muscle tissue death, delaying surgical treatment also leaves them with close to zero chance of survival. Among patients with a V. vulnificus wound infection, 25% did not survive. However, for patients with a limited gastroenteritis, a stomach and intestine inflammation, death is rare.

Even though V. vulnificus infection isn’t common, it’s responsible for the most deaths related to seafood consumption in the United States, accounting for 95% of all cases.

Lastly, certain indicators in the blood, such as the level of the inflammation starter, Tissue necrosis factor (TNF-alpha), and the monitored presence of V. vulnificus DNA, can not only help with diagnosis but also predict mortality rates. Both of these levels appeared to be significantly higher in patients who did not survive.

Possible Complications When Diagnosed with Vibrio vulnificus Infection

:

The major issues that can arise from V. vulnificus infections are blood poisoning known as sepsis, necrotizing fasciitis (which is a severe infection of the skin, fat and tissues below the skin), muscle death, or myonecrosis. Sometimes, the infection can result in the decay of extremities like your hands and feet, which often leads to amputation.

Necrotizing fasciitis is a very serious skin infection that can be life-threatening. You may have heard of it described in common media as ‘flesh-eating bacteria’. It often affects the limbs but can occasionally target the area around your anus and genitals. If you have conditions like diabetes, liver disease, cancer, or if you’re a drug user, or if your immune system is suppressed, you’re at a higher risk for developing this condition.

Infection with V. vulnificus can also, though less commonly, lead to conditions like meningoencephalitis (a serious infection of the brain and the membranes surrounding it), peritonitis (infection in your abdomen), and pneumonitis (inflammation in your lungs).

Common Complications:

• Sepsis (blood poisoning)
• Necrotizing fasciitis (severe infection of skin, fat and tissues under the skin)
• Myonecrosis (muscle death)
• Extremity gangrene, often leading to amputation

Risk Factors:

• Diabetes
• Liver disease
• Cancer
• Drug abuse
• Immunosuppression

Rarer Complications:

• Meningoencephalitis (serious infection of the brain and its covering)
• Peritonitis (abdomen infection)
• Pneumonitis (lung inflammation)

Preventing Vibrio vulnificus Infection

Health organizations need to inform the public about the risks of eating uncooked or partially cooked seafood, particularly raw oysters. It would be helpful to have warnings in restaurants to alert diners about these dangers. The public should also be aware of the possible harm that can come from injuries sustained in ocean or sea environments.

People who love surfing, diving, swimming, and fishing should be informed about the risks of a bacteria called Vibrio, which can cause infections if a person gets wounded in waters where the bacteria lives. This information can be disseminated through mass media, as well as specific clubs and organizations that cater to these activities.

Moreover, those who participate in these activities in certain climates that favor the growth of V. vulnificus bacteria – such as warm weather, sub-tropical regions, or regions prone to monsoons – need to be extra cautious. Medical staff in these areas need to be fully aware and knowledgeable about the signs, symptoms, progression and complications that can arise from a V. vulnificus infection.