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 | |
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Vibrio vulnificus (Reichelt et al. 1976) Farmer 1979 |
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| Synonyms | |
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Beneckea vulnifica |
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Beneckea vulnifica
Vibrio vulnificus is a species of Gram-negative, motile, curved, rod-shaped (bacillus), pathogenic 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. Infection with V. vulnificus leads to rapidly expanding cellulitis or septicemia. It was first isolated as a source of disease in 1976. The capsule, made of polysaccharides, is thought to protect against phagocytosis. The observed association of the infection with liver disease (associated with increased serum iron) might be due to the capability of more virulent strains to capture iron bound to transferrin.
V. vulnificus is an extremely virulent bacterium that can cause three types of infections:
Among healthy people, ingestion of V. vulnificus can cause vomiting, diarrhea, and abdominal pain. In someone with a compromised immune system, particularly those with chronic liver disease, it can infect the bloodstream, causing a severe and life-threatening illness characterized by fever and chills, decreased blood pressure (septic shock), and blistering skin lesions.
V. vulnificus wound infections have a mortality rate around 25%. In patients in whom the infection worsens into septicemia, typically following ingestion, the mortality rate rises 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. Prospective clinical trials are needed to confirm this finding, but in vitro data support the supposition this combination is synergistic against V. vulnificus. Likewise, the American Medical Association and the Centers for Disease Control and Prevention (CDC) recommend treating the patient with a quinolone or intravenous doxycycline with ceftazidime. The first successful documented treatment of fulminant V. vulnificus sepsis was in 1995. Treatment was Fortaz and intravenous (IV) Cipro and IV doxycycline, which proved successful. Prevention of secondary infections from respiratory failure and acute renal failure are crucial. Key to the diagnosis and treatment was early recognition of bullae in an immunocompromised patient with liver cirrhosis and oyster ingestion within the previous 48 hours, and request by the physician for STAT Gram staining and blood cultures for V. vulnificus.
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