Hemochromatosis and Vibrio vulnificus Wound Infections

Introduction: Vibrio vulnificus infection, an uncommon but life-threatening illness, manifests as two main types, primary septicemia and primary wound infections. Little information regarding the seasonality of V. vulnificus infections in tropical areas and prognostic factors of primary V. vulnificus wound infections is available. Methodology: This retrospective study was conducted to include 159 V. vulnificus-infected admissions at our institution in southern Taiwan, 63 with primary septicemia (Group 1) and 96 with primary wound infections (Group 2), from 1999 to 2008, for analysis. Results: The case-fatality rate was 24%. Eighty-eight percent of these cases occurred during April to November. During December to March, patients in Group 2 were less likely to have acquired the infection compared with those in Group 1. Group 1 was more likely to have comorbidities and a higher case-fatality rate compared to Group 2. In multivariate analysis, hemorrhagic bullous skin lesions/necrotizing fasciitis (P=0.024), lesions involving two or more limbs (P=0.043), and shock on admission (P=0.015) were related to an increased mortality risk, while surgery < 24 hours after admission (P=0.001) was related to a decreased mortality risk in Group 1; however, hemorrhagic bullous skin lesions/necrotizing fasciitis (P=0.045) was the only prognostic factor in Group 2. Conclusion: The presence of hemorrhagic bullous lesion/necrotizing fasciitis is the main prognostic factor for primary septicemia or primary wound infections caused by V. vulnificus. Persons with an underlying immunocompromised status should avoid consuming raw/undercooked seafood or exposing wounds to seawater and should wear clothing during handling of seafood/fishing, especially in warmer months.

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Molecular and Physical Factors That Influence Attachment of Vibrio vulnificus to Chitin

Applied and Environmental Microbiology ◽

10.1128/aem.00753-15 ◽

2015 ◽

Vol 81 (18) ◽

pp. 6158-6165 ◽

Cited By ~ 13

Author(s):

Tiffany C. Williams ◽

Mesrop Ayrapetyan ◽

James D. Oliver

Keyword(s):

Quorum Sensing ◽

Vibrio Vulnificus ◽

The United States ◽

Type Iv Pili ◽

Negative Regulator ◽

Physical Factors ◽

Wound Infections ◽

Environmental Persistence ◽

Content Type ◽

Type Iv

ABSTRACTThe human pathogenVibrio vulnificusis the leading cause of seafood-related deaths in the United States. Strains are genotyped on the basis of alleles that correlate with isolation source, with clinical (C)-genotype strains being more often implicated in disease and environmental (E)-genotype strains being more frequently isolated from oysters and estuarine waters. Previously, we have shown that the ecologically distinct C- and E-genotype strains ofV. vulnificusdisplay different degrees of chitin attachment, with C-genotype strains exhibiting reduced attachment relative to their E-genotype strain counterparts. We identified type IV pili to be part of the molecular basis for this observed genotypic variance, as E-genotype strains exhibit higher levels of expression of these genes than C-genotype strains. Here, we used a C-genotype quorum-sensing (QS) mutant to demonstrate that quorum sensing is a negative regulator of type IV pilus expression, which results in decreased chitin attachment. Furthermore, calcium depletion reduced E-genotype strain attachment to chitin, which suggests that calcium is necessary for proper functioning of the type IV pili in E-genotype strains. We also found that starvation or dormancy can alter the efficiency of chitin attachment, which has significant implications for the environmental persistence ofV. vulnificus. With the increasing incidence of wound infections caused byV. vulnificus, we investigated a subset of E-genotype strains isolated from human wound infections and discovered that they attached to chitin in a manner more similar to that of C-genotype strains. This study enhances our understanding of the molecular and physical factors that mediate chitin attachment inV. vulnificus, providing insight into the mechanisms that facilitate the persistence of this pathogen in its native environment.

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Vibrio vulnificus

Infection Control ◽

10.1017/s0195941700066625 ◽

1987 ◽

Vol 8 (10) ◽

pp. 430-433 ◽

Cited By ~ 7

Author(s):

Hilda Ratner

Keyword(s):

Cerebrospinal Fluid ◽

Vibrio Parahaemolyticus ◽

Vibrio Vulnificus ◽

Halophilic Bacterium ◽

Blood Cultures ◽

Vibrio Species ◽

Wound Infections ◽

Marine Vibrio ◽

Ferment Lactose ◽

Tract Infections

The importance of vibrio species other than Vibrio cholerae has only recently been appreciated. Vibrio parahaemolyticus has usually been associated with gastrointestinal tract infections although it may be a rare cause of soft tissue infection and septicemia. V alginolyticus is a rare cause of marine wound infections, otitis, and sepsis, and has not been associated with outbreaks of gastroenteritis. In 1976 Hollis et al1 described the characteristics of 38 isolates of a halophilic bacterium isolated from blood cultures (20), cerebrospinal fluid (2), and wound infections (16). Originally called Beneckea vulnifica, this organism was reassigned to the genus Vibrio and named V vulnificus by Farmer. It is a salt-requiring, marine vibrio that can be distinguished from other vibrio species by its ability to ferment lactose. V vulnificus is a particularly virulent organism that typically produces either primary septicemia that occurs after ingestion of raw shellfish, especially in patients with chronic liver disease, or a fulminating wound infection that occurs after exposure to seawater or handling of shellfish.

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Bactericidal Effects of Toluidine Blue-Mediated Photodynamic Action on Vibrio vulnificus

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.49.3.895-902.2005 ◽

2005 ◽

Vol 49 (3) ◽

pp. 895-902 ◽

Cited By ~ 75

Author(s):

Tak-Wah Wong ◽

Yin-Yi Wang ◽

Hamm-Ming Sheu ◽

Yin-Ching Chuang

Keyword(s):

Toluidine Blue ◽

Vibrio Vulnificus ◽

Opportunistic Infections ◽

Red Light ◽

Lethal Dose ◽

Wound Infections ◽

Bactericidal Effects ◽

Lower Light ◽

Photodynamic Reaction

ABSTRACT Vibrio vulnificus is a gram-negative, highly invasive bacterium responsible for human opportunistic infections. We studied the antibacterial effects of toluidine blue O (TBO)-mediated photodynamic therapy (PDT) for V. vulnificus wound infections in mice. Fifty-three percent (10 of 19) of mice treated with 100 μg of TBO per ml and exposed to broad-spectrum red light (150 J/cm2 at 80 mW/cm2) survived, even though systemic septicemia had been established with a bacterial inoculum 100 times the 50% lethal dose. In vitro, the bacteria were killed after exposure to a lower light dose (100 J/cm2 at 80 mW/cm2) in the presence of low-dose TBO (0.1 μg/ml). PDT severely damaged the cell wall and reduced cell motility and virulence. Cell-killing effects were dependent on the TBO concentration and light doses and were mediated partly through the reactive oxygen species generated during the photodynamic reaction. Our study has demonstrated that PDT can cure mice with otherwise fatal V. vulnificus wound infections. These promising results suggest the potential of this regimen as a possible alternative to antibiotics in future clinical applications.

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TolCV1 Has Multifaceted Roles During Vibrio vulnificus Infection

Frontiers in Cellular and Infection Microbiology ◽

10.3389/fcimb.2021.673222 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yue Gong ◽

Rui Hong Guo ◽

Joon Haeng Rhee ◽

Young Ran Kim

Keyword(s):

Escherichia Coli ◽

Western Blot ◽

Bile Salt ◽

Vibrio Vulnificus ◽

Salt Resistance ◽

Wound Infections ◽

Time Points ◽

Host Signal ◽

Fatal Septicemia ◽

Vulnificus Infection

RtxA1 is a major cytotoxin of Vibrio vulnificus (V. vulnificus) causing fatal septicemia and necrotic wound infections. Our previous work has shown that RpoS regulates the expression and secretion of V. vulnificus RtxA1 toxin. This study was conducted to further investigate the potential mechanisms of RpoS on RtxA1 secretion. First, V. vulnificus TolCV1 and TolCV2 proteins, two Escherichia coli TolC homologs, were measured at various time points by Western blotting. The expression of TolCV1 was increased time-dependently, whereas that of TolCV2 was decreased. Expression of both TolCV1 and TolCV2 was significantly downregulated in an rpoS deletion mutation. Subsequently, we explored the roles of TolCV1 and TolCV2 in V. vulnificus pathogenesis. Western blot analysis showed that RtxA1 toxin was exported by TolCV1, not TolCV2, which was consistent with the cytotoxicity results. Furthermore, the expression of TolCV1 and TolCV2 was increased after treatment of the host signal bile salt and the growth of tolCV1 mutant was totally abolished in the presence of bile salt. A tolCV1 mutation resulted in significant reduction of V. vulnificus induced-virulence in mice. Taken together, TolCV1 plays key roles in RtxA1 secretion, bile salt resistance, and mice lethality of V. vulnificus, suggesting that TolCV1 could be an attractive target for the design of new medicines to treat V. vulnificus infections.

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Vibrio vulnificus Wound Infections From the Mississippi Gulf Coastal Waters

Southern Medical Journal ◽

10.1097/00007611-199505000-00004 ◽

1995 ◽

Vol 88 (5) ◽

pp. 531-533 ◽

Cited By ~ 21

Author(s):

ALAN D. PENMAN ◽

DOUGLAS C. LANIER ◽

WILLIAM T. AVARA ◽

KENNETH E. CANANT ◽

JOHN W. DeGROOTE ◽

...

Keyword(s):

Coastal Waters ◽

Vibrio Vulnificus ◽

Wound Infections

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Genetic Characterization of Vibrio vulnificus Strains from Tilapia Aquaculture in Bangladesh

Applied and Environmental Microbiology ◽

10.1128/aem.00636-10 ◽

2010 ◽

Vol 76 (14) ◽

pp. 4890-4895 ◽

Cited By ~ 30

Author(s):

Zahid H. Mahmud ◽

Anita C. Wright ◽

Shankar C. Mandal ◽

Jianli Dai ◽

Melissa K. Jones ◽

...

Keyword(s):

Vibrio Vulnificus ◽

Genetic Characterization ◽

Phylogenetic Analyses ◽

Wound Infections ◽

Freshwater Aquaculture

ABSTRACT Outbreaks of Vibrio vulnificus wound infections in Israel were previously attributed to tilapia aquaculture. In this study, V. vulnificus was frequently isolated from coastal but not freshwater aquaculture in Bangladesh. Phylogenetic analyses showed that strains from Bangladesh differed remarkably from isolates commonly recovered elsewhere from fish or oysters and were more closely related to strains of clinical origin.

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Wound infections caused by Vibrio vulnificus and other marine bacteria

Epidemiology and Infection ◽

10.1017/s0950268805003894 ◽

2005 ◽

Vol 133 (3) ◽

pp. 383-391 ◽

Cited By ~ 208

Author(s):

J. D. OLIVER

Keyword(s):

Vibrio Vulnificus ◽

Elevated Serum ◽

Foodborne Pathogen ◽

Bacterial Pathogen ◽

Case Fatality ◽

The United States ◽

Wound Infections ◽

Fatality Rate ◽

Erysipelothrix Rhusiopathiae ◽

Marine Vibrios

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 Aeromonas hydrophila.

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