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Signs and Symptoms of Vibrio vulnificus Infection

Healthy Patients

Healthy individuals infected by V. vulnificus from ingestion of raw/improperly cooked molluscan shellfish (oysters, clams, or mussels) often have no symptoms. A mild, self-limiting gastroenteritis may occur within 16 hours after ingestion with symptoms of nausea, vomiting, abdominal cramps, and diarrhea. Healthy patients may also develop a skin infection or cellulitis from an infected wound (see photo below). Septicemia and death occurring in an immunocompetent person as a result of V. vulnificus is rare^{1 2}.

High-Risk Patients

V. vulnificus bacteria cause severe, life-threatening wound infections and primary septicemia in immunocompromised patients with illnesses and conditions such as liver disease, hemochromatosis, hemolytic anemia, chronic renal failure, cancer, diabetes, HIV/AIDS, and/or disorders leading to low gastric acid. One Florida study estimates that adultswith liver disease who eat raw oysters are 80 times more likely to become ill with V. vulnificus and 200 times more likely to die from a V. vulnificus infection (when compared to a population without liver disease).²

Health care professionals should suspect V. vulnificus infection in persons with a history of ingestion of raw or undercooked shellfish or in wound infections following exposure to seawater, particularly in the Gulf of Mexico and southern U.S. In high-risk patients, septicemia usually occurs 24 to 48 hours after ingestion, but may occur up to seven days after ingestion.^{1 2} Signs and symptoms of V. vulnificus septicemia include: hemorrhagic bullous skin lesions on the extremities or trunk (see photo below), fever, chills, nausea, vomiting, diarrhea, abdominal pain, intense lower extremity pain, thrombocytopenia, leukopenia, and hypotension.^{3 4 5 6}

Infected skin lesions occur 24 to 48 hours after exposure to seawater and consist of erythema, edema, bullous lesions, ulcers, and may rapidly progress to necrotizing fasciitis (see photo below) and sepsis.^{2 6}

References

1. American Medical Association, Centers for Disease Control and Prevention, U.S. Food and Drug Administration.  2001. Diagnosis and management of foodborne illnesses, a primer for physicians.
2. Centers for Disease Control and Prevention.  Vibrio vulnificus infections associated with raw oyster consumption - Florida, 1981-1992. MMWR.  1993:42(21); 405-407.
3. Daniels, N.A. and A. Shafaie. 2000. A review of pathogenic Vibrio infections for clinicians. J Infect Med. 17(10):665-685.
4. Martin, G, A.M. Wright and K. Banakaim. 2000. A case of fatal food-borne septicemia: can family physicians provide prevention? J Am Board Fam Pract. 13:197-200.
5. Kumamato, K.S.,  and D. J. Vukich. 1998. Clinical infections of Vibrio vulnificus: a case report and review of the literature. J Emerg Med. 16:61-66.
6. Morris, J.G. 2003. Vibrio vulnificus infections. UpToDate. (www.uptodate.com).