A comprehensive review of Vibrio vulnificus: An important cause of severe sepsis and skin and soft-tissue infection

International Journal of Infectious Diseases

Volumn 15, Issue 3, 2011, Pages

  Horseman, Michael A ^a,b,c   Surani, Salim ^c,d,e  

^a TEXAS A AND M HEALTH SCIENCE CENTER   (United States)

^b Mays Cancer Center at UT Health San Antonio   (United States)

^c Christus Spohn Hospital Corpus Christi Memorial   (United States)

^d BAYLOR COLLEGE OF MEDICINE   (United States)

^e SCOTT AND WHITE MEMORIAL HOSPITAL   (United States)

Author keywords

Doxycycline; Gastroenteritis; Risk factors; Severe sepsis; Vibrio vulnificus; Wound infection

Indexed keywords

AMIKACIN; AMINOGLYCOSIDE; CEFOTAXIME; CEFTAZIDIME; CEFTRIAXONE; CHLORAMPHENICOL; CILASTATIN PLUS IMIPENEM; CIPROFLOXACIN; CLINDAMYCIN; COTRIMOXAZOLE; CYTOTOXIN; DOXYCYCLINE; ERTAPENEM; GENTAMICIN; LEVOFLOXACIN; LIPOPOLYSACCHARIDE; MINOCYCLINE; MOXIFLOXACIN; NORADRENALIN; PIPERACILLIN PLUS TAZOBACTAM; POLYSACCHARIDE; VANCOMYCIN; VIRULENCE FACTOR;

ADULT; ANTIBIOTIC SENSITIVITY; CASE REPORT; CHRONIC LIVER DISEASE; CLINICAL FEATURE; DIABETES MELLITUS; DISEASE SEVERITY; DRUG DOSE TITRATION; FASCIITIS; FLAGELLUM; GANGRENE; GASTROENTERITIS; HEMOSIDEROSIS; HIGH RISK POPULATION; HUMAN; IMMUNE DEFICIENCY; INFECTION RISK; KIDNEY FAILURE; MALE; MORTALITY; NONHUMAN; RAW FOOD; REVIEW; SEPSIS; SKIN INFECTION; SOFT TISSUE INFECTION; STOMACH ACID; VIBRIO VULNIFICUS; VIBRIO VULNIFICUS INFECTION; WOUND INFECTION;

ANIMALS; ANTI-BACTERIAL AGENTS; BACTEREMIA; CEFTAZIDIME; DOXYCYCLINE; DRUG THERAPY, COMBINATION; HUMANS; MALE; MIDDLE AGED; RISK FACTORS; SKIN DISEASES, INFECTIOUS; SOFT TISSUE INFECTIONS; VIBRIO INFECTIONS; VIBRIO VULNIFICUS;

EID: 79952105809     PISSN: 12019712     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.ijid.2010.11.003     Document Type: Review

References (97)

1. Klontz K.C., Lieb S., Schreiber M., Janowski H.T., Baldy L.M., Gunn R.A. Syndromes of Vibrio vulnificus infections. Clinical and epidemiologic features in Florida cases, 1981-1987. Ann Intern Med 1988, 109:318-323.
2. Dechet A.M., Yu P.A., 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.
3. Jones M.K., Oliver J.D. Vibrio vulnificus: disease and pathogenesis. Infect Immun 2009, 77:1723-1733.
4. Shapiro R.L., Altekruse S., Hutwagner L., Bishop R., Hammond R., Wilson S., 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.
5. Tacket C.O., Brenner F., Blake P.A. Clinical features and an epidemiological study of Vibrio vulnificus infections. J Infect Dis 1984, 149:558-561.
6. Oliver J.D. Wound infections caused by Vibrio vulnificus and other marine bacteria. Epidemiol Infect 2005, 133:383-391.
7. Strom M.S., Paranjpye R.N. Epidemiology and pathogenesis of Vibrio vulnificus. Microbes Infect 2000, 2:177-188.
8. Motes M.L., DePaola A., Cook D.W., Veazey J.E., Hunsuler J.C., Garthright W.E., 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.
9. Zaidenstein R., Sadik C., Lerner L., Valinsky L., Kopelowitz J., Yishai R., et al. Clinical characteristics and molecular subtyping of Vibrio vulnificus illnesses, Israel. Emerg Infect Dis 2008, 14:1875-1882.
10. Hlady W.G., Klontz K.C. The epidemiology of Vibrio infections in Florida, 1981-1993. J Infect Dis 1996, 173:1176-1183.
11. Blake P.A., Merson M.H., Weaver R.E., Hollis D.G., Heublein P.C. Disease caused by a marine Vibrio. Clinical characteristics and epidemiology. N Engl J Med 1979, 300:1-5.
12. World Health Organization. Risk assessment of Vibrio vulnificus in raw oysters: interpretative summary and technical report. Geneva: World Health Organization; 2005.
13. Centers for Disease Control and Prevention. Vibrio vulnificus general information: What can be done to improve safety of oysters? Atlanta, GA: CDC; 2009. Available at: (accessed June 5, 2010). http://www.cdc.gov/nczved/divisions/dfbmd/diseases/vibriov/.
14. Janda J.M., Powers C., Bryant R.G., Abbott S.L. Current perspectives on the epidemiology and pathogenesis of clinically significant Vibrio spp. Clin Microbiol Rev 1988, 1:245-267.
15. Centers for Disease Control and Prevention. Summary of human Vibrio cases reported to CDC, 2007. Atlanta, GA: CDC; 2007. Available at: (accessed June 10, 2010). http://www.cdc.gov/nationalsurveillance/PDFs/CSTEVibrio2007.pdf.
16. Morris J.G. Cholera and other types of vibriosis: a story of human pandemics and oysters on the half shell. Clin Infect Dis 2003, 37:272-280.
17. Johnston J.M., Becker S.F., McFarland L.M. Vibrio vulnificus. Man and the sea. JAMA 1985, 253:2850-2853.
18. Barton J.C., Acton R.T. Hemochromatosis and Vibrio vulnificus wound infections. J Clin Gastroenterol 2009, 43:890-893.
19. Brennt C.E., Wright A.C., Dutta S.K., Morris J.G. Growth of Vibrio vulnificus in serum from alcoholics: association with high transferrin iron saturation. J Infect Dis 1991, 164:1030-1032.
20. Centers for Disease Control and Prevention. Vibrio vulnificus infections associated with raw oyster consumption-Florida, 1981-1992. MMWR Morb Mortal Wkly Rep 1993; 42:405-7.
21. Powell J.L., Strauss K.A., Wiley C., Zhan M., Morris J.G. Inflammatory cytokine response to Vibrio vulnificus elicited by peripheral blood mononuclear cells from chronic alcohol users is associated with biomarkers of cellular oxidative stress. Infect Immun 2003, 71:4212-4216.
22. Gulig PA, Bourdage KL, Starks AM. Molecular pathogenesis of Vibrio vulnificus. J Microbiol 2005; 43 Spec No:118-31.
23. Kim J.S., Choi S.H., Lee J.K. Lysine decarboxylase expression by Vibrio vulnificus is induced by SoxR in response to superoxide stress. J Bacteriol 2006, 188:8586-8592.
24. Kang I.H., Kim J.S., Lee J.K. The virulence of Vibrio vulnificus is affected by the cellular level of superoxide dismutase activity. J Microbiol Biotechnol 2007, 17:1399-1402.
25. Kim J.S., Sung M.H., Kho D.H., Lee J.K. Induction of manganese-containing superoxide dismutase is required for acid tolerance in Vibrio vulnificus. J Bacteriol 2005, 187:5984-5995.
26. Koo J., DePaola A., Marshall D.L. Effect of simulated gastric fluid and bile on survival of Vibrio vulnificus and Vibrio vulnificus phage. J Food Prot 2000, 63:1665-1669.
27. Rhee J.E., Rhee J.H., Ryu P.Y., Choi S.H. Identification of the cadBA operon from Vibrio vulnificus and its influence on survival to acid stress. FEMS Microbiol Lett 2002, 208:245-251.
28. Musher D.M., Hansen M.V., Goree A., Gyorkey F., Chapman A.J., Baughn R.E. Emergence of bactericidal and opsonizing antibody to Vibrio vulnificus following bacterial infection. J Clin Microbiol 1986, 23:411-415.
29. Shin S.H., Shin D.H., Ryu P.Y., Chung S.S., Rhee J.H. Proinflammatory cytokine profile in Vibrio vulnificus septicemic patient's sera. FEMS Immunol Med Microbiol 2002, 33:133-138.
30. Powell J.L., Wright A.C., Wasserman S.S., Hone D.M., Morris J.G. 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.
31. Kashimoto T., Ueno S., Hayashi H., Hanajima M., Yoshioka K., Yoshida K., et al. Depletion of lymphocytes, but not neutrophils, via apoptosis in a murine model of Vibrio vulnificus infection. J Med Microbiol 2005, 54(Pt 1):15-22.
32. Lee S.E., Kim S.Y., Jeong B.C., Kim Y.R., Bae S.J., Ahn O.S, et al. A bacterial flagellin, Vibrio vulnificus FlaB, has a strong mucosal adjuvant activity to induce protective immunity. Infect Immun 2006, 74:694-702.
33. Goo S.Y., Ham Y.S., Kim W.H., Lee K.H., Park S.J. Vibrio vulnificus IlpA-induced cytokine production is mediated by Toll-like receptor 2. J Biol Chem 2007, 282:27647-27658.
34. Hor L.I., Chang T.T., Wang S.T. Survival of Vibrio vulnificus in whole blood from patients with chronic liver diseases: association with phagocytosis by neutrophils and serum ferritin levels. J Infect Dis 1999, 179:275-278.
35. Kashimoto T., Ueno S., Hanajima M., Hayashi H., Akeda Y., Miyoshi S., et al. Vibrio vulnificus induces macrophage apoptosis in vitro and in vivo. Infect Immun 2003, 71:533-535.
36. Tsuchiya T., Mitsuo E., Hayashi N., Hikita Y., Nakao H., Yamamoto S., et al. Vibrio vulnificus damages macrophages during the early phase of infection. Infect Immun 2007, 75:4592-4596.
37. Wright A.C., Simpson L.M., Oliver J.D. Role of iron in the pathogenesis of Vibrio vulnificus infections. Infect Immun 1981, 34:503-507.
38. Hor L.I., Chang Y.K., Chang C.C., Lei H.Y., Ou J.T. Mechanism of high susceptibility of iron-overloaded mouse to Vibrio vulnificus infection. Microbiol Immunol 2000, 44:871-878.
39. Kim C.M., Park Y.J., Shin S.H. A widespread deferoxamine-mediated iron-uptake system in Vibrio vulnificus. J Infect Dis 2007, 196:1537-1545.
40. Daly A.L., Velazquez L.A., Bradley S.F., Kauffman C.A. Mucormycosis: association with deferoxamine therapy. Am J Med 1989, 87:468-471.
41. Adamkiewicz T.V., Berkovitch C., Krishnan C., Poisonelli C., Kermack D., Olivieri N.F. Infection due to Yersinia enterocolitica in a series of patients with β-thalassemia: incidence and predisposing factors. Clin Infect Dis 1998, 27:1362-1366.
42. Neupane G.P., Kim D.M. Comparison of the effects of deferasirox, deferiprone, and deferoxamine on the growth and virulence of Vibrio vulnificus. Transfusion 2009, 49:1762-1769.
43. Kim C.M., Park Y.J., Choi M.H., Sun H.Y., Shin S.H. Ferrophilic characteristics of Vibrio vulnificus and potential usefulness of iron chelation therapy. J Infect Dis 2007, 195:90-98.
44. Neupane G.P., Kim D.M. In vitro time-kill activities of ciprofloxacin alone and in combination with the iron chelator deferasirox against Vibrio vulnificus. Eur J Clin Microbiol Infect Dis 2010, 29:407-410.
45. Litwin C.M., Byrne B.L. Cloning and characterization of an outer membrane protein of Vibrio vulnificus required for heme utilization: regulation of expression and determination of the gene sequence. Infect Immun 1998, 66:3134-3141.
46. Gray L.D., Kreger A.S. Mouse skin damage caused by cytolysin from Vibrio vulnificus and by V. vulnificus infection. J Infect Dis 1987, 155:236-241.
47. Kim H.R., Rho H.W., Jeong M.H., Park J.W., Kim J.S., Park B.H., et al. Hemolytic mechanism of cytolysin produced from V. vulnificus. Life Sci 1993, 53:571-577.
48. Wright A.C., Morris J.G. The extracellular cytolysin of Vibrio vulnificus: inactivation and relationship to virulence in mice. Infect Immun 1991, 59:192-197.
49. Fan J.J., Shao C.P., Ho Y.C., Yu C.K., Hor L.I. Isolation and characterization of a Vibrio vulnificus mutant deficient in both extracellular metalloprotease and cytolysin. Infect Immun 2001, 69:5943-5948.
50. Lee S.E., Ryu P.Y., Kim S.Y., Kim Y.R., Koh J.T., Kim O.J., et al. Production of Vibrio vulnificus hemolysin in vivo and its pathogenic significance. Biochem Biophys Res Commun 2004, 324:86-91.
51. Miyoshi N., Miyoshi S., Sugiyama K., Suzuki Y., Furuta H., Shinoda S. Activation of the plasma kallikrein-kinin system by Vibrio vulnificus protease. Infect Immun 1987, 55:1936-1939.
52. Maruo K., Akaike T., Ono T., Maeda H. Involvement of bradykinin generation in intravascular dissemination of Vibrio vulnificus and prevention of invasion by a bradykinin antagonist. Infect Immun 1998, 66:866-869.
53. Kim Y.R., Lee S.E., Kook H., Yeom J.A., Na H.S., Kim S.Y., et al. Vibrio vulnificus RTX toxin kills host cells only after contact of the bacteria with host cells. Cell Microbiol 2008, 10:848-862.
54. Chung K.J., Cho E.J., Kim M.K., Kim J.R., Kim S.H., Yang H.Y., et al. RtxA1-induced expression of the small GTPase Rac2 plays a key role in the pathogenicity of Vibrio vulnificus. J Infect Dis 2010, 201:97-105.
55. Lee J.H., Kim M.W., Kim B.S., Kim S.M., Lee B.C., Kim T.S., et al. Identification and characterization of the Vibrio vulnificus rtxA essential for cytotoxicity in vitro and virulence in mice. J Microbiol 2007, 45:146-152.
56. Merkel S.M., Alexander S., Zufall E., Oliver J.D., Huet-Hudson Y.M. Essential role for estrogen in protection against Vibrio vulnificus-induced endotoxic shock. Infect Immun 2001, 69:6119-6122.
57. Paranjpye R.N., Strom M.S. A Vibrio vulnificus type IV pilin contributes to biofilm formation, adherence to epithelial cells, and virulence. Infect Immun 2005, 73:1411-1422.
58. Goo S.Y., Lee H.J., Kim W.H., Han K.L., Park D.K., Kim S.M., et al. Identification of OmpU of Vibrio vulnificus as a fibronectin-binding protein and its role in bacterial pathogenesis. Infect Immun 2006, 74:5586-5594.
59. Lee J.H., Rho J.B., Park K.J., Kim C.B., Han Y.S., Choi S.H., et al. Role of flagellum and motility in pathogenesis of Vibrio vulnificus. Infect Immun 2004, 72:4905-4910.
60. Wongpaitoon V., Sathapatayavongs B., Prachaktam R., Bunyaratvej S., Kurathong S. Spontaneous Vibrio vulnificus peritonitis and primary sepsis in two patients with alcoholic cirrhosis. Am J Gastroenterol 1985, 80:706-708.
61. Kelly M.T., Avery D.M. Lactose-positive Vibrio in seawater: a cause of pneumonia and septicemia in a drowning victim. J Clin Microbiol 1980, 11:278-280.
62. Tison D.L., Kelly M.T. Vibrio vulnificus endometritis. J Clin Microbiol 1984, 20:185-186.
63. Katz B.Z. Vibrio vulnificus meningitis in a boy with thalassemia after eating raw oysters. Pediatrics 1988, 82:784-786.
64. Johnson R.W., Arnett F.C. A fatal case of Vibrio vulnificus presenting as septic arthritis. Arch Intern Med 2001, 161:2616-2618.
65. Vartian C.V., Septimus E.J. Osteomyelitis caused by Vibrio vulnificus. J Infect Dis 1990, 161:363.
66. Jung S.I., Shin D.H., Park K.H., Shin J.H., Seo M.S. Vibrio vulnificus endophthalmitis occurring after ingestion of raw seafood. J Infect 2005, 51:e281-e283.
67. Penland R.L., Boniuk M., Wilhelmus K.R. Vibrio ocular infections on the U.S. Gulf Coast. Cornea 2000, 19:26-29.
68. 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.
69. Haq S.M., Dayal H.H. 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.
70. Paik K.W., Moon B., Park C.W., Kim K.T., Ji M.S., Choi S.K., et al. Clinical characteristics of ninety-two cases of Vibrio vulnificus infections. Korean J Infect Dis 1995, 27:355-365.
71. Choi H.J., Lee D.K., Lee M.W., Choi J.H., Moon K.C., Koh J.K. Vibrio vulnificus septicemia presenting as purpura fulminans. J Dermatol 2005, 32:48-51.
72. Wang S.M., Liu C.C., Chiou Y.Y., Yang H.B., Chen C.T. Vibrio vulnificus infection complicated by acute respiratory distress syndrome in a child with nephrotic syndrome. Pediatr Pulmonol 2000, 29:400-403.
73. Kuo Y.L., Shieh S.J., Chiu H.Y., Lee J.W. Necrotizing fasciitis caused by Vibrio vulnificus: epidemiology, clinical findings, treatment and prevention. Eur J Clin Microbiol Infect Dis 2007, 26:785-792.
74. Vinh D.C., Mubareka S., Fatoye B., Plourde P., Orr P. Vibrio vulnificus septicemia after handling Tilapia species fish: a Canadian case report and review. Can J Infect Dis Med Microbiol 2006, 17:129-132.
75. Tang H.J., Chang M.C., Ko W.C., Huang K.Y., Lee C.L., Chuang Y.C. In vitro and in vivo activities of newer fluoroquinolones against Vibrio vulnificus. Antimicrob Agents Chemother 2002, 46:3580-3584.
76. Han F., Walker R.D., Janes M.E., 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.
77. Chuang Y.C., Liu J.W., Ko W.C., Lin K.Y., Wu J.J., Huang K.Y. In vitro synergism between cefotaxime and minocycline against Vibrio vulnificus. Antimicrob Agents Chemother 1997, 41:2214-2217.
78. Muldrew K.L., Miller R.R., Kressin M., Tang Y.W., Stratton C. Necrotizing fasciitis from Vibrio vulnificus in a patient with undiagnosed hepatitis and cirrhosis. J Clin Microbiol 2007, 45:1058-1062.
79. Torres L., Escobar S., Lopez A.I., Marco M.L., Pobo V. Wound infection due to Vibrio vulnificus in Spain. Eur J Clin Microbiol Infect Dis 2002, 21:537-538.
80. French G.L., Woo M.L., Hui Y.W., Chan K.Y. Antimicrobial susceptibilities of halophilic vibrios. J Antimicrob Chemother 1989, 24:183-194.
81. de Araujo M.R., Aquino C., Scaramal E., Ciola C.S., Schettino G., Machado M.C. Vibrio vulnificus infection in Sao Paulo, Brazil: case report and literature review. Braz J Infect Dis 2007, 11:302-305.
82. Centers for Disease Control and Prevention. Vibrio vulnificus general information: How is V. vulnificus treated? Atlanta, GA: CDC; 2009. Available at: (accessed June 5, 2010). http://www.cdc.gov/nczved/divisions/dfbmd/diseases/vibriov/.
83. Hsueh P.R., Lin C.Y., Tang H.J., Lee H.C., Liu J.W., Liu Y.C., et al. Vibrio vulnificus in Taiwan. Emerg Infect Dis 2004, 10:1363-1368.
84. Park K.H., Jung S.I., Jung Y.S., Shin J.H., Hwang J.H. Marine bacteria as a leading cause of necrotizing fasciitis in coastal areas of South Korea. Am J Trop Med Hyg 2009, 80:646-650.
85. Halow K.D., Harner R.C., Fontenelle L.J. Primary skin infections secondary to Vibrio vulnificus: the role of operative intervention. J Am Coll Surg 1996, 183:329-334.
86. Wang J., Corson K., Mader J. Hyperbaric oxygen as adjunctive therapy in Vibrio vulnificus septicemia and cellulitis. Undersea Hyperb Med 2004, 31:179-181.
87. Centers for Disease Control and Prevention. Vibrio vulnificus general information: How can I learn about V. vulnificus? Atlanta, GA: CDC; 2009. Available at: (accessed June 10, 2010). http://www.cdc.gov/nczved/divisions/dfbmd/diseases/vibriov/.
88. MarylandInfo.Com. Food and drink: How to shuck oysters. Maryland, USA: MarylandInfo.Com. Available at: (accessed June 10, 2010). http://www.marylandinfo.com/sponsorships/how_to_shuck_oysters.html.
89. Silver Point Oysters. How to shuck a live oyster the easy way? Oregon, USA: Silver Point Oysters; 2004. Available at: (accessed June 10, 2010). http://www.silverpointoysters.com/easyshuck.html.
90. Ulusarac O., Carter E. Varied clinical presentations of Vibrio vulnificus infections: a report of four unusual cases and review of the literature. South Med J 2004, 97:163-168.
91. Chuang Y.C., Yuan C.Y., Liu C.Y., Lan C.K., Huang A.H. Vibrio vulnificus infection in Taiwan: report of 28 cases and review of clinical manifestations and treatment. Clin Infect Dis 1992, 15:271-276.
92. Joynt G.M., Gomersall C.D., Lyon D.J. Severe necrotising fasciitis of the extremities caused by Vibrionaceae: experience of a Hong Kong tertiary hospital. Hong Kong Med J 1999, 5:63-68.
93. Tacket C.O., Barrett T.J., Mann J.M., Roberts M.A., Blake P.A. Wound infections caused by Vibrio vulnificus, a marine Vibrio, in inland areas of the United States. J Clin Microbiol 1984, 19:197-199.
94. Kim J.J., Yoon K.J., Yoon H.S., Chong Y., Lee S.Y., Chon C.Y., et al. Vibrio vulnificus septicemia: report of four cases. Yonsei Med J 1986, 27:307-313.
95. Barton J.C., Coghlan M.E., Reymann M.T., Ozbirn T.W., Acton R.T. Vibrio vulnificus infection in a hemodialysis patient receiving intravenous iron therapy. Clin Infect Dis 2003, 37:e63-e67.
96. Inoue H. Vibrio vulnificus infection of the hand. J Orthop Sci 2006, 11:85-87.
97. Kikawa K., Yamasaki K., Sujiura T., Myose H., Chinen M., Tsutsumi K., et al. A successfully treated case of Vibrio vulnificus septicemia with shock. Jpn J Med 1990, 29:313-319.