The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Vibrio Vulnificus Sepsis

비브리오 패혈증

  • Kim, Dong-Min (Department of Internal Medicine, Chosun University School of Medicine) ;
  • Hong, Su-Jin (Department of Internal Medicine, Chosun University School of Medicine)
  • 김동민 (조선대학교 의과대학 내과학교실) ;
  • 홍수진 (조선대학교 의과대학 내과학교실)
  • Published : 2012.06.01
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Abstract

Vibrio vulnificus (V. vulnificus) is a halophilic motile, gram-negative rod which can cause fatal human infections. The spectrum of illness caused by V. vulnificus is gastroenteritis, primary sepsis, and wound infection. Most of patients infected with V. vulnificus have at least one risk factor such as chronic liver diseases, immunocompromiased hosts, hematologic disorders characterized by elevated iron level. V. vulnificus infection is suspected by clinical and epidemiological history. Radiological studies of affected lesions are helpful to diagnosis of necrotizing soft tissue infection. The definitive diagnosis is made by the isolation of V. vulnificus from blood and wound cultures. The mortality of V. vulnificus primary sepsis is above 50%, so early diagnosis, early surgical debridement and administration of appropriate antibiotics is essential.

Keywords

References

  1. Klontz KC, Lieb S, Schreiber M, Janowski HT, Baldy LM, Gunn RA. Syndromes of Vibrio vulnificus infections: clinical and epidemiologic features in Florida cases, 1981-1987. Ann Intern Med 1988;109:318-323. https://doi.org/10.7326/0003-4819-109-4-318
  2. Shapiro RL, Altekruse S, Hutwagner L, et al. The role of Gulf Coast oysters harvested in warmer months in Vibrio vulnificus infections in the United States, 1988-1996: Vibrio Working Group. J Infect Dis 1998;178:752-759. https://doi.org/10.1086/515367
  3. Horseman MA, Surani S. A comprehensive review of Vibrio vulnificus: an important cause of severe sepsis and skin and soft-tissue infection. Int J Infect Dis 2011;15:e157-e166. https://doi.org/10.1016/j.ijid.2010.11.003
  4. Hlady WG, Klontz KC. The epidemiology of Vibrio infections in Florida, 1981-1993. J Infect Dis 1996;173:1176-1183. https://doi.org/10.1093/infdis/173.5.1176
  5. Kaspar CW, Tamplin ML. Effects of temperature and salinity on the survival of Vibrio vulnificus in seawater and shellfish. Appl Environ Microbiol 1993;59:2425-2429.
  6. Kaysner CA, Abeyta C Jr, Wekell MM, DePaola A Jr, Stott RF, Leitch JM. Virulent strains of Vibrio vulnificus isolated from estuaries of the United States West Coast. Appl Environ Microbiol 1987;53:1349-1351.
  7. Oliver JD, Warner RA, Cleland DR. Distribution and ecology of Vibrio vulnificus and other lactose-fermenting marine vibrios in coastal waters of the southeastern United States. Appl Environ Microbiol 1982;44:1404-1414.
  8. Oliver JD. Wound infections caused by Vibrio vulnificus and other marine bacteria. Epidemiol Infect 2005;133:383-391. https://doi.org/10.1017/S0950268805003894
  9. Strom MS, Paranjpye RN. Epidemiology and pathogenesis of Vibrio vulnificus. Microbes Infect 2000;2:177-188. https://doi.org/10.1016/S1286-4579(00)00270-7
  10. Motes ML, DePaola A, Cook DW, et al. Influence of water temperature and salinity on Vibrio vulnificus in Northern Gulf and Atlantic Coast oysters (Crassostrea Virginica). Appl Environ Microbiol 1998;64:1459-1465.
  11. Zaidenstein R, Sadik C, Lerner L, et al. Clinical characteristics and molecular subtyping of Vibrio vulnificus illnesses, Israel. Emerg Infect Dis 2008;14:1875-1882. https://doi.org/10.3201/eid1412.080499
  12. Hollis DG, Weaver RE, Baker CN, Thornsberry C. Halophilic Vibrio species isolated from blood cultures. J Clin Microbiol 1976;3:425-431.
  13. Blake PA, Merson MH, Weaver RE, Hollis DG, Heublein PC. Disease caused by a marine Vibrio: clinical characteristics and epidemiology. N Engl J Med 1979;300:1-5. https://doi.org/10.1056/NEJM197901043000101
  14. Goo JS, Kim DW, Han KS, Suk JS, Park MH, Kim SI. Lactose Fermenting Vibrio (Vibrio vulnificus) Septicemia -Report of five cases-. Korean J Pathol 1982;16:463-468.
  15. World Health Organization. Risk assessment of Vibrio vulnificus in raw oysters: interpretative summary and technical report. Geneva: World Health Organization, 2005.
  16. Johnston JM, Becker SF, McFarland LM. Vibrio vulnificus: man and the sea. JAMA 1985;253:2850-2853. https://doi.org/10.1001/jama.1985.03350430062026
  17. Barton JC, Acton RT. Hemochromatosis and Vibrio vulnificus wound infections. J Clin Gastroenterol 2009;43:890-893. https://doi.org/10.1097/MCG.0b013e31819069c1
  18. Merkel SM, Alexander S, Zufall E, Oliver JD, Huet-Hudson YM. Essential role for estrogen in protection against Vibrio vulnificus-induced endotoxic shock. Infect Immun 2001;69: 6119-6122. https://doi.org/10.1128/IAI.69.10.6119-6122.2001
  19. Koenig KL, Mueller J, Rose T. Vibrio vulnificus. Hazard on the half shell. West J Med 1991;155:400-403.
  20. Seo PS, Kim BS, Kim SM, Park SD. Determination of the biogroup of Vibrio vulnificus isolates from patients and oysters in Korea. Korean J Dermatol 2008;46:1453-1456.
  21. Jones MK, Oliver JD. Vibrio vulnificus: disease and pathogenesis. Infect Immun 2009;77:1723-1733. https://doi.org/10.1128/IAI.01046-08
  22. Gulig PA, Bourdage KL, Starks AM. Molecular Pathogenesis of Vibrio vulnificus. J Microbiol 2005;43:118-131.
  23. Lee SE, Kim SY, Jeong BC, Kim YR, Bae SJ, Ahn OS, et al. A bacterial flagellin, Vibrio vulnificus FlaB, has a strong mucosal adjuvant activity to induce protective immunity. Infect Immun 2006;74:694-702. https://doi.org/10.1128/IAI.74.1.694-702.2006
  24. Wright AC, Simpson LM, Oliver JD, Morris JG Jr. Phenotypic evaluation of acapsular transposon mutants of Vibrio vulnificus. Infect Immun 1990;58:1769-1773.
  25. Powell JL, Wright AC, Wasserman SS, Hone DM, Morris JG Jr. Release of tumor necrosis factor alpha in response to Vibrio vulnificus capsular polysaccharide in in vivo and in vitro models. Infect Immun 1997;65:3713-3718.
  26. Bush CA, Patel P, Gunawardena S, et al. Classification of Vibrio vulnificus strains by the carbohydrate composition of their capsular polysaccharides. Anal Biochem 1997;250: 186-195. https://doi.org/10.1006/abio.1997.2219
  27. Shin SH, Shin DH, Ryu PY, Chung SS, Rhee JH. Proinflammatory cytokine profile in Vibrio vulnificus septicemic patients' sera. FEMS Immunol Med Microbiol 2002;33: 133-138. https://doi.org/10.1111/j.1574-695X.2002.tb00582.x
  28. Fan JJ, Shao CP, Ho YC, Yu CK, Hor LI. Isolation and characterization of a Vibrio vulnificus mutant deficient in both extracellular metalloprotease and cytolysin. Infect Immun 2001;69:5943-5948. https://doi.org/10.1128/IAI.69.9.5943-5948.2001
  29. Wright AC, Simpson LM, Oliver JD. Role of iron in the pathogenesis of Vibrio vulnificus infections. Infect Immun 1981;34:503-507.
  30. Brennt CE, Wright AC, Dutta SK, Morris JG Jr. Growth of Vibrio vulnificus in serum from alcoholics: association with high transferrin iron saturation. J Infect Dis 1991;164: 1030-1032. https://doi.org/10.1093/infdis/164.5.1030
  31. Hor LI, Chang YK, Chang CC, Lei HY, Ou JT. Mechanism of high susceptibility of iron-overloaded mouse to Vibrio vulnificus infection. Microbiol Immunol 2000;44:871-878. https://doi.org/10.1111/j.1348-0421.2000.tb02577.x
  32. Dechet AM, Yu PA, Koram N, Painter J. Nonfoodborne Vibrio infections: an important cause of morbidity and mortality in the United States, 1997-2006. Clin Infect Dis 2008;46:970-976. https://doi.org/10.1086/529148
  33. Tacket CO, Brenner F, Blake PA. Clinical features and an epidemiological study of Vibrio vulnificus infections. J Infect Dis 1984;149:558-561. https://doi.org/10.1093/infdis/149.4.558
  34. Wang SM, Liu CC, Chiou YY, Yang HB, Chen CT. Vibrio vulnificus infection complicated by acute respiratory distress syndrome in a child with nephrotic syndrome. Pediatr Pulmonol 2000;29:400-403. https://doi.org/10.1002/(SICI)1099-0496(200005)29:5<400::AID-PPUL10>3.0.CO;2-J
  35. Kuo YL, Shieh SJ, Chiu HY, Lee JW. Necrotizing fasciitis caused by Vibrio vulnificus: epidemiology, clinical findings, treatment and prevention. Eur J Clin Microbiol Infect Dis 2007;26:785-792. https://doi.org/10.1007/s10096-007-0358-5
  36. Chen Y, Satoh T, Tokunaga O. Vibrio vulnificus infection in patients with liver disease: report of five autopsy cases. Virchows Arch 2002;441:88-92. https://doi.org/10.1007/s00428-002-0613-1
  37. Haq SM, Dayal HH. Chronic liver disease and consumption of raw oysters: a potentially lethal combination: a review of Vibrio vulnificus septicemia. Am J Gastroenterol 2005;100: 1195-1199. https://doi.org/10.1111/j.1572-0241.2005.40814.x
  38. Paik KW, Moon B, Park CW, et al. Clinical characteristics of ninety-two cases of Vibrio vulnificus infections. Korean J Infect Dis 1995;27:355-365.
  39. Ma KA, Lee SM, Kim MS, et al. Emergency debridement with empirical antibiotics treatment for clinically diagnosed vibrio sepsis. Korean J Infect Dis 1997;29:297-303.
  40. Park SD, Shon HS, Joh NJ. Vibrio vulnificus septicemia in Korea: clinical and epidemiologic findings in seventy patients. J Am Acad Dermatol 1991;24:397-403. https://doi.org/10.1016/0190-9622(91)70059-B
  41. Yang DO, Kim HS, Kim HW, Shin DH, Kim SJ. Clinical characteristics in fifty-eight cases of microbiologically confirmed Vibrio vulnificus septicemia. Korean J Med 1991; 41:383-391.
  42. Choi KW, Song YW. Clinical characteristics of Vibrio vulnicifus infection. Korean J Infect Dis 1988;20:67-73.
  43. Lu ZQ, Lu CJ, Qiu QM, et al. A protocol for diagnosis and treatment of Vibrio vulnificus sepsis. Chinese critical care medicine 2008;20:4-6.
  44. Lerstloompleephunt N, Tantawichien T, Sitprija V. Renal failure in vibrio vulnificus infection. Ren Fail 2000;22:337-343. https://doi.org/10.1081/JDI-100100877
  45. Nakafusa J, Misago N, Miura Y, Kayaba M, Tanaka T, Narisawa Y. The importance of serum creatine phosphokinase level in the early diagnosis, and as a prognostic factor, of Vibrio vulnificus infection. Br J Dermatol 2001;145:280-284. https://doi.org/10.1046/j.1365-2133.2001.04347.x
  46. Bross MH, Soch K, Morales R, Mitchell RB. Vibrio vulnificus infection: diagnosis and treatment. Am Fam Physician 2007; 76:539-544.
  47. Majeski J, Majeski E. Necrotizing fasciitis: improved survival with early recognition by tissue biopsy and aggressive surgical treatment. South Med J 1997;90:1065-1068. https://doi.org/10.1097/00007611-199711000-00001
  48. Kim DM, Jung SI, Jang HC, et al. Vibrio vulnificus DNA load and mortality. J Clin Microbiol 2011;49:413-415. https://doi.org/10.1128/JCM.01913-09
  49. Panicker G, Bej AK. Real-time PCR detection of Vibrio vulnificus in oysters: comparison of oligonucleotide primers and probes targeting vvhA. Appl Environ Microbiol 2005;71: 5702-5709. https://doi.org/10.1128/AEM.71.10.5702-5709.2005
  50. Harwood VJ, Gandhi JP, Wright AC. Methods for isolation and confirmation of Vibrio vulnificus from oysters and environmental sources: a review. J Microbiol Methods 2004; 59:301-316. https://doi.org/10.1016/j.mimet.2004.08.001
  51. Hill WE, Keasler SP, Trucksess MW, Feng P, Kaysner CA, Lampel KA. Polymerase chain reaction identification of Vibrio vulnificus in artificially contaminated oysters. Appl Environ Microbiol 1991;57:707-711.
  52. Arias CR, Garay E, Aznar R. Nested PCR method for rapid and sensitive detection of Vibrio vulnificus in fish, sediments, and water. Appl Environ Microbiol 1995;61:3476-3478.
  53. Kim HS, Kim DM, Neupane GP, et al. Comparison of conventional, nested, and real-time PCR assays for rapid and accurate detection of Vibrio vulnificus. J Clin Microbiol 2008;46:2992-2998. https://doi.org/10.1128/JCM.00027-08
  54. Han F, Walker RD, Janes ME, Prinyawiwatkul W, Ge B. Antimicrobial susceptibilities of Vibrio parahaemolyticus and Vibrio vulnificus isolates from Louisiana Gulf and retail raw oysters. Appl Environ Microbiol 2007;73:7096-7098. https://doi.org/10.1128/AEM.01116-07
  55. Chuang YC, Liu JW, Ko WC, Lin KY, Wu JJ, Huang KY. In vitro synergism between cefotaxime and minocycline against Vibrio vulnificus. Antimicrob Agents Chemother 1997;41: 2214-2217.
  56. French GL, Woo ML, Hui YW, Chan KY. Antimicrobial susceptibilities of halophilic vibrios. J Antimicrob Chemother 1989;24:183-194.
  57. Centers for Disease Control and Prevention. Vibrio vulnificus general information: how is V. vulnificus treated [Internet]? Atlanta (GA): Centers for Disease Control and Prevention, c2010 [cited 2010 Jun 5]. Available from: http://www.cdc.gov/ nczved/divisions/dfbmd/diseases/vibriov/#treatment.
  58. Tang HJ, Chang MC, Ko WC, Huang KY, Lee CL, Chuang YC. In Vitro and In Vivo Activities of Newer Fluoroquinolones against Vibrio vulnificus Antimicrob. Agents Chemother. November 2002 vol. 46 no. 11 3580-3584. https://doi.org/10.1128/AAC.46.11.3580-3584.2002
  59. Neupane GP, Kim DM, Yun NR, Shin SH, Lim SC, Choi CH. Quantitative PCR and in vivo efficacy of antibiotics in the treatment of Vibrio vulnificus infection in a mouse model. Eur J Clin Microbiol Infect Dis 2012 Mar 21 [Epub]. http://dx. doi.org/10.1007/s10096-012-1592-z.
  60. McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg 1995;221:558-563. https://doi.org/10.1097/00000658-199505000-00013
  61. Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) Score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 2004;32:1535-1541. https://doi.org/10.1097/01.CCM.0000129486.35458.7D
  62. Wong CH. Tissue oxygen saturation monitoring in diagnosing necrotizing fasciitis of the lower limb: a valuable tool but only for a select few. Ann Emerg Med 2005;45:461-462. https://doi.org/10.1016/j.annemergmed.2004.10.039
  63. Kim DM, Cho HS, Kang JI, Kim HS, Park CY. Deferasirox plus ciprofloxacin combination therapy after rapid diagnosis of Vibrio vulnificus sepsis using real-time polymerase chain reaction. J Infect 2008;57:489-492. https://doi.org/10.1016/j.jinf.2008.08.003
  64. Neupane GP, Kim DM. Comparison of the effects of deferasirox, deferiprone, and deferoxamine on the growth and virulence of Vibrio vulnificus. Transfusion 2009;49:1762-1769. https://doi.org/10.1111/j.1537-2995.2009.02186.x
  65. Simpson AJ, Smith MD, Weverling GJ, et al. Prognostic value of cytokine concentrations (tumor necrosis factor-alpha, interleukin-6, and interleukin-10) and clinical parameters in severe melioidosis. J Infect Dis 2000;181:621-625. https://doi.org/10.1086/315271
  66. Waage A, Halstensen A, Espevik T. Association between tumour necrosis factor in serum and fatal outcome in patients with meningococcal disease. Lancet 1987;14:355-357.
  67. Lee JY, Kim DM, Yun NR, et al. Tumor necrosis factor-$\alpha$ and mortality in patients infected with Vibrio vulnificus. Am J Trop Med Hyg 2011;84:426-428. https://doi.org/10.4269/ajtmh.2011.10-0310
  68. DuPont HL, Spink WW. Infections due to gram-negative organisms: an analysis of 860 patients with bacteremia at the University of Minnesota Medical Center, 1958-1966. Medicine (Baltimore) 1969;48:307-332. https://doi.org/10.1097/00005792-196907000-00003
  69. Vollberg CM, Herrera JL. Vibrio vulnificus infection: an important cause of septicemia in patients with cirrhosis. South Med J 1997;90:1040-1042. https://doi.org/10.1097/00007611-199710000-00014

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