Vibrio vulnificus

What is Vibrio vulnificus?

Vibrio vulnificus is a bacterium which normally lives in warm seawater and can cause disease in people who eat contaminated seafood or those who have an open wound that is exposed to seawater. V. vulnificus infection is relatively rare, but is probably under-reported.

What are the clinical features of a Vibrio vulnificus infection?

Ingestion of contaminated seafood

Raw oysters are most commonly implicated in transmission of V. vulnificus. In healthy people, ingestion of contaminated seafood can cause vomiting, diarrhoea, and abdominal pain. In people with impaired immunity, particularly those with chronic liver disease or diabetes mellitus, V. vulnificus can infect the bloodstream (septicaemia). This results in widespread haemorrhagic bullae (large blood-filled blisters) with fever and chills, and decreased blood pressure (septic shock). This condition is fatal in about 50% of patients.

Exposure of open wounds to seawater

Skin infection can result when open wounds are exposed to warm seawater. Wounds may be pre-existing or obtained in the water, eg from crabs, coral, or fishhooks. These infections may lead to cellulitis, necrosis (tissue death), haemorrhagic bullae, and infection of the bloodstream, particularly in people with impaired immunity.

How is a Vibrio vulnificus infection diagnosed?

V. vulnificus infection is diagnosed by stool, wound, or blood cultures using a special growth medium.

What is the treatment for a Vibrio vulnificus infection?

Antibiotic therapy with doxycycline and a third-generation cephalosporin (eg, ceftazidime) is generally recommended for V. vulnificus infection. Children can be treated with trimethoprim-sulfamethoxazole plus an aminoglycoside.

Necrotic tissue should be surgically removed. In contaminated wounds involving the limbs, amputation is sometimes necessary.