Vibriosis is a disease of the skin or digestive tract caused by any of several species of gram-negative bacteria belonging to the genus Vibrio. These species are sometimes referred to as noncholera Vibrio species to distinguish them from Vibrio cholerae, the causative organism of cholera. The most significant species that cause vibriosis in humans are V. vulnificus, V. alginolyticus, and V. parahaemolyticus.
All Vibrio bacteria are comma-shaped facultative anaerobes that move by means of flagella and are most commonly found in salt water, particularly in the warm summer months. Because Vibrio bacteria can infect fish and shellfish as well as humans, vibriosis is considered a zoonosis.
There are two major forms of vibriosis, gastrointestinal (enteric) and cutaneous.
Cutaneous vibriosis is an infection of open wounds or breaks in the skin exposed to salt water containing Vibrio bacteria. The first case in the United States was reported in 1979. Symptoms commonly include redness, pain, and swelling at the site of the infection, but the disorder may progress to gangrene, tissue death (necrosis), and necrotizing fasciitis, a potentially fatal condition.
Risk factors include both individual health-related conditions and climatic/weather-related factors.
The following health conditions are risk factors for Vibrio infections:
Climatic and weather-related risk factors include:
Vibriosis is a growing concern in North America and Australia because the number of cases has increased markedly since the early 2000s. The Centers for Disease Control and Prevention (CDC) estimates that there are about 80,000 cases of vibriosis in the United States each year, 52,000 of which are caused by eating contaminated seafood. The CDC estimates that there are about 100 deaths due to vibriosis in the United States in an average year. About 45,000 of the vibriosis cases in the United States are caused by V. parahaemolyticus. This estimate is considerably higher than the 35,000 cases of foodborne vibriosis estimated by the CDC in 2013, which itself represented an increase of 76% from the figures reported for 2006. Many researchers think that foodborne vibriosis is actually underestimated in Canada and the United States because of a low index of suspicion and failure to perform appropriate laboratory testing to diagnose the organism.
Elsewhere in the world, cases of vibriosis are commonly reported in Japan, Taiwan, China, Hong Kong, Korea, Italy, and Israel.
Most cases of foodborne vibriosis occur in adults because children are less likely to eat raw shellfish. About 82% of cases occur in males. Cutaneous vibriosis is more common in adults and children living along the Atlantic coastline of Canada and the United States and along the Gulf Coast of the southern United States. Most cases of cutaneous vibriosis occur in the summer months, when the water is warmer and more people are swimming or wading in coastal waters. Males between the ages of 50 and 60 are at greatest risk of developing severe cutaneous vibriosis.
As of 2018, statistics and research indicate that people of all races and ethnic groups are equally likely to develop vibriosis if they are exposed to the causative organisms.
The symptoms of cutaneous vibriosis develop between three and 24 hours after infection. The symptoms include severe pain surrounding the infected wound, swelling, and redness. The patient may report numbness if treatment has been delayed. Cutaneous vibriosis is most likely to occur on the fingers, palms, or soles of the feet. In patients with cancer, a weakened immune system, or other risk factors, the wound may rapidly progress to tissue necrosis, hemorrhagic bullae, and necrotizing fasciitis.
The symptoms of uncomplicated gastrointestinal vibriosis are similar to those of other foodborne illnesses; they usually begin between 12 and 24 hours after ingesting contaminated seafood and include:
In patients with liver disease or other risk factors, the Vibrio bacteria gain entry to the bloodstream through the weakened walls of the intestine and cause septicemia (blood poisoning), a potentially fatal condition characterized by fever, chills, low blood pressure, shock, bullae (skin lesions resembling blisters), respiratory distress, and multiple organ failure. The symptoms of septicemia take between seven and 14 days to develop after contact with the bacteria.
Diagnosis of vibriosis is typically based on the patient's history of eating raw shellfish, handling contaminated shellfish, or recreational exposure to salty or brackish water, followed by laboratory studies to culture the organism. Imaging studies are generally performed only if the patient develops signs of respiratory distress or necrotizing fasciitis.
Vibriosis is thought to be underdiagnosed because detection of the organism requires a specific laboratory test of a stool sample: the thiosulfate-citrate-bile salts-sucrose (TCBS) agar test. This particular culture medium is highly selective for Vibrio species because it inhibits the growth of other bacteria found in human stool samples.
Most cases of gastrointestinal vibriosis are self-limited and resolve without antibiotics, although the doctor may choose to prescribe a single dose of oral doxycycline or ciprofloxacin. Fluid replacement is necessary if the patient has severe diarrhea; if the patient cannot tolerate oral rehydration therapy, the person can be given fluids intravenously.
Patients with cutaneous vibriosis are given oral doxycycline or a quinolone antibiotic every 12 hours. Debridement of the wound is necessary if the patient develops signs of necrotizing fasciitis; in severe cases, amputation of the infected limb may be required to save the patient's life. Some patients will need skin grafts or other types of reconstructive surgery during the recovery period.
Patients who develop septicemia are usually treated by a critical care specialist if they develop septic shock or multiple organ failure.
Vibriosis has been a notifiable disease in the United States since 2007, though not in Canada as of 2018. The CDC maintains the Cholera and Other Vibrio Illness Surveillance (COVIS) system for recording and tracking outbreaks of vibriosis as well as cholera. COVIS was established in 1989 as a partnership between the CDC, the FDA, and the four Gulf Coast states of Texas, Louisiana, Florida, and Alabama, although almost all states reported cases of vibriosis to COVIS as of 2018. Other agencies that collect information about Vibrio infections are the Foodborne Diseases Active Surveillance Network (FoodNet) and the Foodborne Disease Outbreak Surveillance System (FDOSS).
Surveillance of Vibrio infections in Canada is carried out by the Canadian Food Inspection Agency (CFIA), the Public Health Agency of Canada (PHAC), and Health Canada.
In the United States, the National Shellfish Sanitation Program (NSSP) is a federal/state cooperative program recognized by the FDA and the ISSC to reduce the risk of shellfish contamination by Vibrio and other disease organisms. One measure that American oyster farmers use to reduce the risk of contamination of their shellfish is relaying. Relaying involves transplanting oysters from polluted water to clean water for a minimum of two weeks. The oyster's natural feeding process will cleanse it of bacteria and viruses. The government of Australia has similar policies in place.
The University of New Hampshire College of Life Sciences and Agriculture (COLSA) maintains the Northeast Center for Vibrio Disease and Ecology, a group of scientists who track the emergence of new strains of noncholera Vibrio species as well as recording outbreaks of Vibrio infections along the Atlantic coastline of Canada and northern New England.
The prognosis of vibriosis varies widely according to the location of the infection, the Vibrio species involved, and the presence of risk factors in the patient. Most otherwise healthy patients who develop foodborne vibriosis recover in 2–4 days without complications. However, although Vibrio infections are much less common than foodborne illnesses caused by Salmonella or Campylobacter bacteria, infection with V. vulnificus has the highest case fatality rate (39%) of all foodborne illnesses. In regard to risk factors, patients with cirrhosis of the liver are 80 times more likely to contract V. vulnificus infection from eating raw oysters, and 200 more times more likely to die than patients without liver disease.
There was no vaccine for vibriosis in humans as of 2018. Both cutaneous and gastrointestinal vibriosis can, however, be prevented. Cutaneous vibriosis can be prevented by avoiding swimming or wading in the sea or in brackish water with open cuts or wounds, including fresh tattoos. People who cut themselves on a shell or are bitten while in the water should wash the wound immediately with soap and water. If the wound begins to redden or show other signs of infection, they should see a doctor at once.
People can lower their risk of gastrointestinal vibriosis by the following measures:
See also Cholera ; Zoonoses .
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Rebecca J. Frey, PhD