Review Article

Varied Clinical Presentations of Vibrio vulnificus Infections: A Report of Four Unusual Cases and Review of the Literature

Authors: Ozlem Ulusarac, MD, Elliot Carter, MD

Abstract

Vibrio vulnificus is a Gram-negative, motile, curved bacillus of the family Vibrionaceae that is a rare cause of gastroenteritis, septicemia, and wound infections in humans. V. vulnificus is halophilic, flourishes in warm temperatures, and is part of the bacterial flora of the marine environment. The location of our health care setting, on the Gulf of Mexico, has given us the opportunity to observe a wide variety of clinical presentations of infections caused by this organism. In the first case, a 27-year-old man struck by lightning while windsurfing was found pulseless in the water and was resuscitated. The patient subsequently developed cardiac arrhythmias, respiratory failure, and necrotizing fasciitis; blood cultures yielded V. vulnificus. After antibiotic therapy and several fasciotomies, the patient recovered. The second case was that of a 43-year-old Asian man employed as an oyster shucker who presented with complaints of redness, tearing, and photophobia of the right eye. The diagnosis of corneal ulcer secondary to V. vulnificus was made after culture of the right eye revealed the organism. The third case involved a 46-year-old man who presented with complaints of abdominal pain, nausea, chills, and bullous lesions on the lower extremities. He developed disseminated intravascular coagulation, and cultures of the lesions on his lower extremities showed V. vulnificus. Initially, the patient denied any exposure to raw seafood or seawater, but he eventually remembered eating raw oysters 3 days before his illness. The fourth case is that of a 32-year-old, human immunodeficiency virus-positive, hepatitis C-positive woman with cirrhosis who presented with productive cough, chills, fever, and red spots on her extremities and buttocks. Blood cultures revealed V. vulnificus and the patient was treated with antibiotics and improved clinically. These four cases illustrate the wide range of clinical presentations associated with this organism.

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References

1. Hollis DG, Weaver RE, Baker CN, et al. Halophilic Vibrio species isolated from blood cultures. J Clin Microbiol 1976; 3: 425–431.
 
2. Farmer JJ III. Vibrio (“Beneckea”) vulnificus, the bacterium associated with sepsis, septicaemia, and the sea. Lancet 1979; 2: 903(letter).
 
3. Morris JG Jr, Black RE. Cholera and other vibrioses in the United States. N Engl J Med 1985; 312: 343–350.
 
4. Strom MS, Paranjpye RN. Epidemiology and pathogenesis of Vibrio vulnificus. Microbes Infect 2000; 2: 177–188.
 
5. Koneman EW, Allen SD, Janda WM, et al. Curved Gram-Negative Bacilli and Oxidase-Positive Fermenters: Campylobacteraceae and Vibrionaceae, in Color Atlas and Textbook of Diagnostic Microbiology. Philadelphia, Lippincott Williams & Wilkins, 1997, ed 5, pp 339–347.
 
6. Baron EJ, Finegold SM. Vibrio and Related Species, Aeromonas, Plesiomonas, Campylobacter, and Others, in Bailey and Scott’s Diagnostic Microbiology. St. Louis, MO, C.V. Mosby, 1990, ed 8, pp 432–434.
 
7. Centers for Disease Control and Prevention. Vibrio vulnificus infections associated with eating raw oysters: Los Angeles, 1996. MMWR Morb Mortal Wkly Rep 1996; 45( 29): 621–624.
 
8. Shapiro RL, Altekruse S, Hutwagner L, et al; Vibrio Working Group. The role of Gulf Coast oysters harvested in warmer months in Vibrio vulnificus infections in the United States, 1988–1996. J Infect Dis 1998; 178: 752–759.
 
9. DiGaetano M, Ball SF, Straus JG. Vibrio vulnificus corneal ulcer: Case reports. Arch Ophthalmol 1989; 107: 323–324.
 
10. Wongpaitoon V, Sathapatayavongs B, Prachaktam R, et al. Spontaneous Vibrio vulnificusperitonitis and primary sepsis in two patients with alcoholic cirrhosis. Am J Gastroenterol 1985; 80: 706–708.
 
11. Katz BZ. Vibrio vulnificus meningitis in a boy with thalassemia after eating raw oysters. Pediatrics 1988; 82: 784–786.
 
12. Kelly MT, McCormick WF. Acute bacterial myositis caused by Vibrio vulnificus. JAMA 1981; 246: 72–73.
 
13. Kelly MT, Avery DM. Lactose-positive Vibrio in seawater: A cause of pneumonia and septicemia in a drowning victim. J Clin Microbiol 1980; 11: 278–280.
 
14. Tison DL, Kelly MT. Vibrio vulnificus endometritis. J Clin Microbiol 1984; 20: 185–186.
 
15. Vartian CV, Septimus EJ. Osteomyelitis caused by Vibrio vulnificus. J Infect Dis 1990; 161: 363(letter).
 
16. Hlady WG, Klontz KC. The epidemiology of Vibrio infections in Florida, 1981–1993. J Infect Dis 1996; 173: 1176–1183.
 
17. Janda JM, Powers C, Bryant RG, et al. Current perspectives on the epidemiology and pathogenesis of clinically significant Vibrio spp. Clin Microbiol Rev 1988; 1: 245–267.
 
18. Blake PA, Merson MH, Weaver RE, et al. Disease caused by a marine Vibrio: Clinical characteristics and epidemiology. N Engl J Med 1979; 300: 1–5.
 
19. Johnston JM, Becker SF, McFarland LM. Vibrio vulnificus: Man and the sea. JAMA 1985; 253: 2850–2853.
 
20. Kelly MT. Effect of temperature and salinity on Vibrio (Beneckea) vulnificus occurrence in a Gulf Coast environment. Appl Environ Microbiol 1982; 44: 820–824.
 
21. Centers for Disease Control and Prevention. Summary of infections reported to Vibrio Surveillance System, 1999. Available at: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/files/VibCSTE99web.pdf. Accessed September 25, 2003.
 
22. Tacket CO, Brenner F, Blake PA. Clinical features and an epidemiological study of Vibrio vulnificusinfections. J Infect Dis 1984; 149: 558–561.
 
23. Klontz KC, Lieb S, Schreiber M, et al. Syndromes of Vibrio vulnificus infections: Clinical and epidemiologic features in Florida cases, 1981–1987. Ann Intern Med 1988; 109: 318–323.
 
24. Whitman CM, Griffin PM. Preventing Vibrio vulnificus infection in the high-risk patient. Infect Dis Clin Pract 1993; 2: 275–276.
 
25. Vollberg CM, Herrera JL. Vibrio vulnificus infection: An important cause of septicemia in patients with cirrhosis. South Med J 1997; 90: 1040–1042.
 
26. Centers for Disease Control and Prevention. Vibrio vulnificus: Technical information. Atlanta, Centers for Disease Control and Prevention, December 2002. Available at:http://www.cdc.gov/ncidod/dbmd/diseaseinfo/vibriovulnificus_t.htm. Accessed September 25, 2003.
 
27. Martin G, Wright AM, Banakarim K. A case of fatal food-borne septicemia: Can family physicians provide prevention? J Am Board Fam Pract 2000; 13: 197–200.
 
28. Mouzin E, Mascola L, Tormey MP, et al. Prevention of Vibrio vulnificus infections: Assessment of regulatory educational strategies. JAMA 1997; 278: 576–578.