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Background
Vibrios are bacteria, probably best known as the causative agent of cholera (Vibrio cholera). However, there are several halophilic or sea-loving Vibrio bacteria that may cause devastating disease in humans.
OUTLINE
LABORATORY/
RADIOLOGICCHARACTERIZATION FLUOROGENIC
- Development of a simple and rapid fluorogenic procedure for identification of vibrionaceae family members.
Richards GP, Watson MA, Parveen S.
USDA, ARS, Delaware State University, 1200 N. DuPont Hwy., James W. W. Baker Center, Dover, DE 19901, USA.
Appl Environ Microbiol. 2005 Jul;71(7):3524-7. Abstract quote
We describe a simple colony overlay procedure for peptidases (COPP) for the rapid fluorogenic detection and quantification of Vibrionaceae from seawater, shellfish, sewage, and clinical samples. The assay detects phosphoglucose isomerase with a lysyl aminopeptidase activity that is produced by Vibrionaceae family members.
Overnight cultures are overlaid for 10 min with membranes containing a synthetic substrate, and the membranes are examined for fluorescent foci under UV illumination. Fluorescent foci were produced by all the Vibrionaceae tested, including Vibrio spp., Aeromonas spp., and Plesiomonas spp. Fluorescence was not produced by non-Vibrionaceae pathogens. Vibrio cholerae strains O1, O139, O22, and O155 were strongly positive. Seawater and oysters were assayed, and 87 of 93 (93.5%) of the positive isolates were identified biochemically as Vibrionaceae, principally Vibrio vulnificus, Vibrio parahaemolyticus, Aeromonas hydrophila, Photobacterium damselae, and Shewanella putrefaciens. None of 50 nonfluorescent isolates were Vibrionaceae. No Vibrionaceae were detected in soil, and only A. hydrophila was detected in sewage.
The COPP technique may be particularly valuable in environmental and food-testing laboratories and for monitoring water quality in the aquaculture industry.PCR
- Development of a quantitative real-time polymerase chain reaction targeted to the toxR for detection of Vibrio vulnificus.
Takahashi H, Hara-Kudo Y, Miyasaka J, Kumagai S, Konuma H.
Division of Microbiology, National Institute of Health Sciences, 1-18-1 Kamiyoga, Setagaya-ku, Tokyo 158-8501, Japan.
J Microbiol Methods. 2005 Apr;61(1):77-85. Abstract quote
The TaqMan assay, a quantitative real-time polymerase chain reaction (PCR), was developed to target the ToxR gene (toxR) of Vibrio vulnificus. The toxR of V. vulnificus was cloned and sequenced. Based on these results, we designed specific primers and a probe for use in the quantitative PCR assay.
Twenty-nine strains of V. vulnificus that were obtained from various sources produced a single PCR product. The amount of final amplification product and threshold cycle number were the same among the strains. We used the method to detect V. vulnificus in seawater and oyster samples.
We developed standard curves to quantitate V. vulnificus numbers using the PCR from seawater and oyster samples. The standard curves were not different from that of the pure culture of V. vulnificus. We found the assay was very sensitive detecting as few as 10 microbes per milliliter of seawater and oyster homogenate. Moreover, we evaluated the TaqMan assay to detect V. vulnificus in seawater samples. The numbers of V. vulnificus counted by the TaqMan assay were similar to those by a culture method in almost samples. The TaqMan assay was performed within 2 h compared to days using the culture method.
The results indicate the TaqMan assay method used in this study was rapid, effective and quantitative for monitoring V. vulnificus contamination in seawater and seafoods such as oysters.Direct identification of Vibrio vulnificus in clinical specimens by nested PCR.
Lee SE, Kim SY, Kim SJ, Kim HS, Shin JH, Choi SH, Chung SS, Rhee JH.
Department of Microbiology, Chonnam National University Medical School, Chonnam National University, Kwangju 501-190, Republic of Korea.
J Clin Microbiol 1998 Oct;36(10):2887-92 Abstract quote
This study was performed to establish optimal nested PCR conditions and a high-yield DNA extraction method for the direct identification of Vibrio vulnificus in clinical specimens.
We designed two sets of primers targeting the V. vulnificus hemolysin/cytolysin gene. The target of the first primer set (P1-P2; sense, 5'-GAC-TAT-CGC-ATC-AAC-AAC-CG-3', and antisense, 5'-AGG-TAG-CGA-GTA-TTA-CTG-CC-3', respectively) is a 704-bp DNA fragment. The second set (P3-P4; sense, 5'-GCT-ATT-TCA-CCG-CCG-CTC-AC-3', and antisense, 5'-CCG-CAG-AGC-CGT-AAA-CCG-AA-3', respectively) amplifies an internal 222-bp DNA fragment. We developed a direct DNA extraction method that involved boiling the specimen pellet in a 1 mM EDTA-0.5% Triton X-100 solution. The new DNA extraction method was more sensitive and reproducible than other conventional methods. The DNA extraction method guaranteed sensitivity as well, even when V. vulnificus cells were mixed with other bacteria such as Escherichia coli or Staphylococcus aureus.
The nested PCR method could detect as little as 1 fg of chromosomal DNA and single CFU of V. vulnificus. We applied the nested PCR protocol to a total of 39 serum specimens and bulla aspirates from septicemic patients. Seventeen (94.4%) of the 18 V. vulnificus culture-positive specimens were positive by the nested PCR. Eight (42.1%) of the 19 culture-negative samples gave positive nested PCR results.
GROSS APPEARANCE/
CLINICAL VARIANTSCHARACTERIZATION General Clinical infections of Vibrio vulnificus: a case report and review of the literature.
Kumamoto KS, Vukich DJ.
Division of Emergency Medicine, University of Florida Health Science Center at Jacksonville, 32209-6511, USA.
J Emerg Med 1998 Jan-Feb;16(1):61-6 Abstract quote
Vibrio vulnificus is a marine Gram-negative bacillus that is recognized as a cause of fulminant primary septicemia and wound infections. One of the most common bacteria in seawater, V. vulnificus is concentrated in ocean filter feeders (e.g., oysters and clams). Primary septicemia can occur in patients, typically with underlying liver disease, who have acquired the organism through the gastrointestinal tract after recent consumption of raw shellfish.
Characterized by fevers, chills, and bullous skin lesions, V. vulnificus septicemia is associated with a mortality greater than 50%. With septic shock, mortality approaches 100%. Wound infections are seen after injury to the skin in a marine environment or from exposure of preexisting wounds to seawater.
Because of the high morbidity and mortality associated with V. vulnificus infections, effective treatment includes preventive measures to educate high-risk individuals, early search for and recognition of the disease, aggressive antibiotic therapy, supportive care, and, in the case of wound infections, aggressive debridement.
Review of this subject was prompted by a case of V. vulnificus primary septicemia and fulminant septic shock in a patient with the unusual presentation of pain in the lower extremities.
VARIANTS ENDOMETRITIS Vibrio vulnificus endometritis.
Tison DL, Kelly MT.
J Clin Microbiol 1984 Aug;20(2):185-6 Abstract quote
Vibrio vulnificus most frequently causes wound infections contracted after exposure to seawater or primary septicemias resulting from the consumption of raw oysters.
We report a case of endometritis caused by V. vulnificus. The infection was apparently acquired during the act of sexual intercourse in seawater in an area in which V. vulnificus has been frequently isolated.
The efficacy of treatment with an antimicrobial regimen which included tetracycline is discussed.
NECROTIZING FASCIITIS Necrotising fasciitis caused by Vibrio vulnificus.
Woo ML, Patrick WG, Simon MT, French GL.
J Clin Pathol 1984 Nov;37(11):1301-4 Abstract quote
A case of necrotising fasciitis caused by Vibrio vulnificus is described. The need for early recognition and aggressive surgical treatment are highlighted, and the necrotising infections due to V vulnificus described in the published work are reviewed.
OVARIES
Diagn Microbiol Infect Dis. 2005 Feb;51(2):131-3. Abstract quote
Vibrio vulnificus is a Gram-negative bacterium that causes an aggressive infection with high mortality, especially in patients with liver disease.
Wound infections due to V. vulnificus occur via direct contamination of cutaneous tissues and can include the uterus.
We report a case of V. vulnificus tubo-ovarian infection from an unusual method of acquisition in the Gulf of Mexico.PURPURA FULMINANS
J Dermatol. 2005 Jan;32(1):48-51. Abstract quote
We present a case of Vibrio vulnificus septicemia presenting as purpura fulminans, which can often result in a catastrophic course.
This case had a fortunate outcome due to immediate and intensive empirical antibiotic treatment and the relatively healthy condition of the patient.
We focused on the prognostic factors for the relatively good outcome in this patient.SEPTIC ARTHRITIS A fatal case of Vibrio vulnificus presenting as septic arthritis.
Johnson RW, Arnett FC.
Division of Rheumatology and Clinical Immunogenetics, University of Texas-Houston Medical School, 6431 Fannin, MSB 5.260, Houston, TX 77030, USA.
Arch Intern Med 2001 Nov 26;161(21):2616-8 Abstract quote
Vibrio vulnificus is an invasive gram-negative bacillus that may cause necrotizing cellulitis, bacteremia, and/or sepsis. Although V vulnificus infection is uncommon, it is frequently fatal and is usually attributed to ingestion of raw shellfish or traumatic exposure to a marine environment; patients are also often found to have a hepatic disorder (cirrhosis, alcohol abuse, or hemochromatosis) or an immunocompromised health status, and most commonly present with septicemia or a wound infection.
We describe a patient who presented with septic arthritis as the first clinical manifestation of a V vulnificus infection. The organism was subsequently identified in a synovial fluid aspirate.
WOUND INFECTION
- Wound infections caused by Vibrio vulnificus and other marine bacteria.
Oliver JD.
Department of Biology, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA.
Epidemiol Infect. 2005 Jun;133(3):383-91. Abstract quote
Infections caused by Vibrio vulnificus were first reported in 1979 by Blake et al. of the US Centers for Disease Control. At that time described as a 'rare, unnamed halophilic lactose-fermenting Vibrio species', V. vulnificus has emerged as the most virulent foodborne pathogen in the United States with a hospitalization rate of 0.910 and a case-fatality rate of 0.390. It is in addition a significant cause of potentially life-threatening wound infections.
Infections following ingestion of raw or undercooked seafood, commonly raw oysters, can lead to a primary septicaemia with a fatality rate of 50-60%. An unusual symptom, occurring in 69% of 274 cases reviewed by Oliver, is the development of secondary lesions, typically on the extremities, which are generally severe (often a necrotizing fasciitis) and require tissue debridement or amputation. These cases occur almost exclusively in males over the age of 50 years. Interestingly, this gender specificity has been found to be due to the female hormone oestrogen, which in some manner provides protection against the lethal V. vulnificus endotoxin. Further, most cases occur in persons with certain underlying diseases which are either immunocompromising or which lead to elevated serum iron levels (e.g. liver cirrhosis, chronic hepatitis, haemochromatosis). V. vulnificus infections resulting in primary septicaemia have been extensively studied, and the subject of several reviews.
This review concentrates on the wound infections caused by this marine bacterial pathogen, including the more recently described biotypes 2 and 3, with brief discussions of those caused by other marine vibrios, and the increasingly reported wound/skin infections caused by Mycobacterium marinum, Erysipelothrix rhusiopathiae, and Aeromnonas hydrophila.Clinical, epidemiological, and microbiological features of Vibrio vulnificus biogroup 3 causing outbreaks of wound infection and bacteraemia in Israel. Israel Vibrio Study Group.
Bisharat N, Agmon V, Finkelstein R, Raz R, Ben-Dror G, Lerner L, Soboh S, Colodner R, Cameron DN, Wykstra DL, Swerdlow DL, Farmer JJ
3rd. Infectious Diseases Unit, Ha'Emek Medical Center, Afula, Israel
Lancet 1999 Oct 23;354(9188):1421-4 Abstract quote
BACKGROUND: Vibrio vulnificus is a gram-negative bacterium that causes septicaemia and wound infection. Cases occur sporadically, and no previous outbreaks due to a common source or a clonal strain have been reported. In the summer and autumn of 1996 and 1997, an outbreak of invasive V. vulnificus infection occurred in Israel in people who had recently handled fresh, whole fish purchased from artificial fish-ponds.
METHODS: We reviewed clinical and epidemiological information, and undertook an environmental investigation to assess disease characteristics, modes of transmission, phenotypic characteristics of the bacterium, and fish-marketing policy. The clonal nature of 19 isolates was studied by biotyping, pulsed-field gel electrophoresis, and restriction-fragment length polymorphism (RFLP) analysis of a PCR fragment.
FINDINGS: During 1996-97, 62 cases of wound infection and bacteraemia occurred. 57 patients developed cellulitis, four had necrotising fasciitis, and one developed osteomyelitis. In all cases, the fish were cultivated in inland fish-ponds. In the summer of 1996, fish-pond managers initiated a new marketing policy, in which fish were sold alive instead of being packed in ice. Phenotypically, the isolates had five atypical biochemical test results. The isolates were non-typeable by pulsed-field gel electrophoresis, and all had the same PCR-RFLP pattern which had not been seen previously.
INTERPRETATION: The cause of the outbreak was a new strain of V. vulnificus, classified as biogroup 3. A new fish-marketing policy that began in 1996 may have exposed susceptible people to the organism.
Lower extremity manifestations of Vibrio vulnificus infection.
Laughlin TJ, Lavery LA.
University of Texas Health Science Center, Department of Orthopedics/Podiatry Section, San Antonio 78234, USA.
J Foot Ankle Surg 1995 Jul-Aug;34(4):354-7 Abstract quote
Vibrio vulnificus is a potentially lethal marine bacterium that has not been previously described in podiatric literature. A review of the microorganism's characteristics, susceptible patient population, and lower extremity manifestations of infection is presented. V. vulnificus is found as part of the normal flora of the Gulf of Mexico, Atlantic, and Pacific coastal waters and is often isolated from the filter feeding shellfish of these regions.
Its pathogenicity is generally reserved for the immunocompromised host, and is specifically related to disease states which exhibit high serum iron levels. V. vulnificus infections present in two distinct clinical syndromes: primary sepsis secondary to raw oyster ingestion, or localized infection from wound exposure to V. vulnificus-inhabited salt water. Both syndromes demonstrate characteristic skin lesions of the trunk and extremities that present as hemorrhagic bullae and progress to necrotic ulcerations.
Although V. vulnificus infection is rare, its extreme virulence in patients suffering from a chronic disease process and its manifestation of characteristic lower-extremity lesions require the podiatric physician to be able to recognize and treat such a condition.
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Last Updated August 8, 2005
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