Vibrio vulnificus: Review of Mild to Life-threatening Skin Infections

Abstract

Vibrio vulnificus is a motile, gram-negative, halophilic, aquatic bacterium that is part of the normal estuarine microbiome and typically is found in warm coastal waters. Infection with the pathogen typically is due to consumption of contaminated seafood or exposure to contaminated seawater. Vibrio vulnificus has a mortality rate of almost 33% in the United States and is responsible for more than 95% of seafood-related deaths in the United States. Vibrio vulnificus can cause a vast spectrum of diseases, such as gastroenteritis, cellulitis, necrotizing fasciitis, and sepsis. Gastroenteritis is self-limited, whereas septicemia often is fatal. Gastroenteritis and septicemia are caused by ingestion of contaminated shellfish, whereas wound infections and necrotizing fasciitis are caused by exposure to contaminated seawater or handling of contaminated seafood. Septicemia is the most common presentation of V vulnificus and accounts for the most fatalities from the bacteria. Prompt diagnosis and treatment are vital to prevent mortality. It is important to keep V vulnificus on the differential when a patient presents with bullae or cellulitis or has a history of raw seafood consumption or exposure to brackish water, as missing the diagnosis could lead to necrotizing fasciitis, sepsis, and death. Cutis. 2021;107:E12-E17. V ibrio vulnificus is a member of the Vibrio genus. Most Vibrio species are nonpathogenic in humans; however, V vulnificus is one of the pathogenic strains. 1 In Latin, the term vulnificus means "wounding," and V vulnificus can cause life-threatening infections in patients. The mortality rate of V vulnificus infections is approximately 33% in the United States. 2 Vibrio vulnificus is a gram-negative bacterium that was first isolated by the Centers for Disease Control and Prevention in 1964 and was given its current name in 1979. 3-6 It has been found in numerous organisms, including oysters, crabs, clams, shrimp, mussels, mullets, and sea bass. 4 The vast majority of infections in the United States are due to oyster exposure and consumption. 2,7 Vibrio vulnificus is responsible for more than 95% of seafood-related deaths in the United States and has the highest mortality rate of all food-borne illness in the United States. 2,5 It also has the highest per-case economic impact of all food-related diseases in the United States. 1 What distinguishes a pathogenic vs nonpathogenic Vibrio isolate remains unknown; Vibrio species rapidly undergo horizontal gene transfer, making DNA isolation difficult. 1 Some characteristics of V vulnificus that may confer virulence are the capsular polysaccharide, lipopolysaccharide, binding proteins, and tissue-degrading enzymes. 1,5 First, encapsulated strains are more virulent

Purpura fulminans due to Vibrio vulnificus severe infection

“…V. vulnificus can cause mild infectious diseases in healthy hosts, which can resolve spontaneously without antibiotic treatment; however, in immunocompromised individuals, severity of the disease becomes much worse, with bacteremia being common, with a mortality rate greater than 50 % [10] ; fatal cases without prompt treatment who evolves to septic shock, mortality rate is close to 92 % [11] , [12] .…”

“…In case of oral ingestion, gastroenteritis may occur in the best-case scenario, meanwhile, wound infection can manifest heterogeneously, from mild symptoms with well-defined erythematous lesions, blisters, and cellulitis to deep infections such as myositis, necrotizing fasciitis, and purpura fulminans [11] . Less common pneumonia, osteomyelitis, ocular infections, meningitis, peritonitis, and endocarditis may occur [12] , [13] .…”

Vitamin B group levels and supplementations in dermatology: Review of the literature

“…The use of vitamin B7 (biotin) is common for hair, skin and nail problems. 4 Biotin (B7) is water soluble. It has been demonstrated to have a role as a co-factor in multiple metabolic processes including cell signalling, gene regulation, histone modification and carboxylation.…”

Climate Change, Cutaneous Disease, and the Dermatology Provider

“…vulnificus classically causes wound infection and cellulitis, which may progress to necrotizing fasciitis. 62,63 Expanding geographic range of V. vulnificus due to warmer temperatures. 26 Vibrio parahaemolyticus SSTI V. parahaemolyticus most commonly causes gastroenteritis but is also associated with wound infection.…”