Vibrio Vulnificus Infection Clinical Presentation

Updated: Mar 23, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Presentation

History

V vulnificus infection should be suspected in patients who give a history of ingestion of raw seafood or wound infection after exposure to seawater. Patients with V vulnificus infection report abrupt GI symptoms, such as vomiting, diarrhea, or abdominal pain, and may present with fever, chills, or shock. V vulnificus is normally found in warm estuarial and marine environments, lodging in filter feeders such as oysters. It occurs mainly in patients with chronic liver disease after the consumption of raw oysters. Partridge et al reported a case that was likely contracted from a thermal pool in Turkey, with no history of seawater or shellfish exposure. [20]

V vulnificus septicemia is the most common cause of death from seafood consumption in the United States. [19] V vulnificus septicemia may first become evident in the skin as purpura fulminans, which can take a catastrophic course without immediate and intensive empirical antibiotic treatment. [21]

V vulnificus infection is a rare cause of necrotizing fasciitis, which can be fatal. [22, 23] Necrotizing fasciitis caused by V vulnificus progresses more rapidly with clinical characteristics more fulminant than either methicillin-resistant Staphylococcus aureus or methicillin-sensitive S aureus infection. [24]  The same may be true for V vulnificus as compared with Klebsiella pneumoniae–induced necrotizing fasciitis, being 2.5 days versus 5.5 days. [25]

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Physical Examination

Most patients infected with V vulnificus have bullous skin lesions, which are found on the trunk and the lower extremities (see the image below). Infection of the hand has been reported. [26] These hemorrhagic bullae can progress to necrotic ulcerations, which require surgical debridement. Edema can be present.

Vibrio infections. Early bullous lesions appear ov Vibrio infections. Early bullous lesions appear over the dorsum of the foot of a patient with cirrhosis.

A rapid onset of cellulitis may represent infection with V vulnificus, especially if the patient had contact with seawater or raw seafood. Patients can progress to necrotizing fasciitis. [27]

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Complications

Patients who are immunocompromised are at risk of septic shock from the infection, which can be fatal. Otherwise, no complications from V vulnificus infection occur.

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