Vibriosis

Definition

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.

Description

There are two major forms of vibriosis, gastrointestinal (enteric) and cutaneous.

Gastrointestinal vibriosis




This scanning electron micrograph (SEM) depicts a Vibrio vulnificus bacterium; Vibrio vulnificus is a bacterium in the same family as those that cause cholera.





This scanning electron micrograph (SEM) depicts a Vibrio vulnificus bacterium; Vibrio vulnificus is a bacterium in the same family as those that cause cholera.
(CDC/Science Source)
Cutaneous vibriosis

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

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:

Demographics

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.

Causes and symptoms

Causes Symptoms

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

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.

Treatment

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.

Public health role and response

Surveillance

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.

Public education
KEY TERMS
Brackish water—
Water that is less salty than seawater but saltier than freshwater. It may result from mixing of salt water and freshwater, as in estuaries (arms of the sea at the mouth of rivers).
Bulla (plural, bullae)—
A raised fluid-filled skin lesion; a blister-like structure.
Cutaneous—
Pertaining to the skin.
Debridement—
Surgical or chemical removal of dead, dying, or infected tissue to assist the healing of surrounding healthy tissue.
Facultative anaerobe—
Any microbe that can live with or without molecular oxygen. Vibrio species are facultative anaerobes.
Gastroenteritis—
The medical term for inflammation of the stomach and small intestine characterized by diarrhea, vomiting, and abdominal cramps. Also known as infectious diarrhea, gastroenteritis may be caused by viruses, bacteria, fungi, and parasites.
Gram-negative—
Referring to a group of bacteria that do not retain the violet stain used in the Gram method of bacterial classification. The staining method is named for its inventor, Hans Christian Gram (1853–1938), a Danish bacteriologist.
Halophilic—
Requiring a salty environment for growth and survival. Vibrio bacteria are halophilic organisms.
Necrotizing fasciitis—
A life-threatening infection that results in the death of the body's soft tissues. It develops when bacteria enter the body through an open wound. Type III necrotizing fasciitis is caused by Vibrio vulnificus.
Notifiable disease—
Any disease that is required by law to be reported to government public health authorities. Vibriosis is a notifiable disease in the United States but not in Canada as of 2018.
Septicemia—
The presence of pathogens or their toxins in the bloodstream, characterized by chills, fever, and weakness. It is sometimes referred to as blood poisoning.
Zoonosis (plural, zoonoses)—
Any of a number of diseases transmitted to humans from animals. Diseases that can be transmitted from humans to animals are called reverse zoonoses.
Food safety measures

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.

Research

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.

Prognosis

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.

QUESTIONS TO ASK YOUR DOCTOR

Prevention

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 .

Resources

BOOKS

Dodd, Christine E. R., et al., editors. Foodborne Diseases, 3rd ed. London: Elsevier, 2017.

Liu, Dongyou, editor. Handbook of Foodborne Diseases. Boca Raton, FL: Taylor and Francis, 2019.

Mahon, Connie R., and Donald C. Lehman, editors. Text-book of Diagnostic Microbiology, 6th ed. St. Louis: Elsevier/Saunders, 2019.

McGuire-Wolfe, Christine. Foundations of Infection Control and Prevention. Burlington, MA: Jones and Bartlett Learning, 2018.

Williams, Angela L., editor. Environmental Health Sourcebook. 5th ed. Detroit, MI: Omnigraphics, 2018.

PERIODICALS

Baker-Austin, C., and J. D. Oliver. “Vibrio vulnificus: New Insights into a Deadly Opportunistic Pathogen.” Envi-ronmental Microbiology 20 (February 2018): 423–30.

Brennan-Krohn, T., et al. “The Brief Case: Safe to Go Back in the Water? Vibrio parahaemolyticus Wound Infection Associated with Brackish Water.” Journal of Clinical Microbiology 54 (June 2016): 1414–15.

Crim, S. M., et al. “Preliminary Incidence and Trends of Infection with Pathogens Transmitted Commonly through Food—Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2006–2014.” Morbidity and Mortality Weekly Report 64 (May 15, 2015): 495–99.

Foote, A., et al. “The Australian Mid-West Coastal Marine Wound Infections Study.” Australian Family Physician 46 (December 2017): 923–27.

Janda, J. M., A. E. Newton, and C. A. Bopp. “Vibriosis.” Clinics in Laboratory Medicine 35 (June 2015): 273–88.

Newton, A. E., et al. “Increase in Vibrio parahaemolyticus Infections Associated with Consumption of Atlantic Coast Shellfish—2013.” Morbidity and Mortality Weekly Report 63 (April 18, 2014): 335–36.

Raszi, S. M., et al. “Vibrio parahaemolyticus and Vibrio vulnificus in South America: Water, Seafood and Human Infections.” Journal of Applied Microbiology 121 (November 2016): 1201–22.

Trinh, S. A., H. E. Gavin, and K. J. F. Satchell. “Efficacy of Ceftriaxone, Cefepime, Doxycycline, Ciprofloxacin, and Combination Therapy for Vibrio vulnificus Food-borne Septicemia.” Antimicrobial Agents and Chemotherapy 61 (November 22, 2017): e01106–17.

WEBSITES https://www.cdc.gov/vibrio/surveillance.html (accessed March 20, 2018).

Centers for Disease Control and Prevention (CDC). “Vibrio Species Causing Vibriosis: Questions and Answers.” https://www.cdc.gov/vibrio/faq.html (accessed March 20, 2018).

Food and Drug Administration (FDA). “National Shellfish Sanitation Program (NSSP).” https://www.fda.gov/Food/GuidanceRegulation/FederalStateFoodPrograms/ucm2006754.htm (accessed March 22, 2018).

Foodsafety.gov . “Vibrio Infections.” https://www.foodsafety.gov/poisoning/causes/bacteriaviruses/vibrio_infections/index.html (accessed March 20, 2018).

Government of Canada/Gouvernement du Canada. “Vibrio.” https://www.canada.ca/en/public-health/services/food-poisoning/vibrio.html (accessed March 20, 2018).

Interstate Shellfish Sanitation Commission (ISSC). “Consumer Information.” http://www.issc.org/consumer-information (accessed March 22, 2018).

Medscape Reference. “Vibrio Infections.” https://emedicine.medscape.com/article/232038-overview (accessed March 20, 2018).

Medscape Reference. “Vibrio vulnificus Infection.” https://emedicine.medscape.com/article/1055523-overview (accessed March 22, 2018).

Merck Manual, Professional Version. “Noncholera Vibrio Infections.” https://www.merckmanuals.com/professional/infectious-diseases/gram-negative-bacilli/noncholera-vibrio-infections (accessed March 20, 2018).

Public Health Agency of Canada (PHAC). “Pathogen Safety Data Sheets: Infectious Substances—Vibrio parahaemolyticus.” https://www.canada.ca/en/public-health/services/laboratory-biosafety-biosecurity/pathogensafety-data-sheets-risk-assessment/vibrio-parahaemolyticus.html (accessed March 20, 2018).

WebMD. “FAQ: What to Know about Dangerous Vibrio Bacteria.” https://www.webmd.com/a-to-z-guides/news/20170713/faq-what-to-know-about-dangerous_vibrio-bacteria (accessed March 20, 2018).

ORGANIZATIONS

Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd., Atlanta, GA, 30329, (800) CDC-INFO, http://www.cdc.gov .

Infectious Diseases Society of America (IDSA), 1300 Wilson Blvd., Ste. 300, Arlington, VA, 22209, (703) 299-0200, Fax: (703) 299-0204, http://www.idsociety.org , http://www.idsociety.org .

Interstate Shellfish Sanitation Conference (ISSC), 209-1 Dawson Rd., Columbia, SC, (803) 788-7559, Fax: (803) 788-7576, issc@issc.org, http://www.issc.org .

Northeast Center for Vibrio Disease and Ecology, College of Life Sciences and Agriculture, Rudman Hall, 46 College Rd., University of New Hampshire, Durham, NH, 03824, (603) 862-1234, (800) 735-2964, https://colsa.unh.edu .

U.S. Food and Drug Administration (FDA), 10903 New Hampshire Ave., Silver Spring, MD, 20993, (888) 463-6332, https://www.fda.gov , https://www.fda.gov .

Rebecca J. Frey, PhD

  This information is not a tool for self-diagnosis or a substitute for professional care.