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The frequency of Vibrio vulnificus infection is very rare and there are many questions regarding its epidemiology in Japan. To investigate the clinical course and epidemiology of V. vulnificus infection in Japan, we performed a retrospective questionnaire survey in which 1693 hospitals from all over Japan were surveyed, including advanced life saving emergency centers and dermatology institutions. Of the 1693 hospitals, we received answers from 1045. Ninety-four cases were confirmed as V. vulnificus infections during 1999 and 2003. Sixty-eight (72.3%) of the 94 patients had the septic type infection with a mortality rate of 75.0% (51/68 patients died). The prognosis of patients with the septic type was worse than that of the wound type (P < 0.001). V. vulnificus infections occurred from June to November and none occurred in winter. Many infections occurred in western Japan with the majority of infections (50/94) occurring in Kyushu. In particular, 43 infections occurred in marine coastal areas of the Ariake and Yatsushiro Seas, which have many tidelands. Seventy-seven of 89 patients (86.5%) had liver function impairment as an underlying disease, and 53 (59.6%) had liver cirrhosis, of whom nine (10.1%) suffered from liver cancer. The incidence of V. vulnificus infection was different according to districts. Geographic and climatic factors also contributed to the occurrence of V. vulnificus infection.
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PMID:Epidemiological survey of Vibrio vulnificus infection in Japan between 1999 and 2003. 1834 55

We report a case of rapidly progressive necrotizing soft tissue infection and sepsis followed by a patient's death. We suspected Vibrio vulnificus infection because the patient's underlying disease was cirrhosis and the course extremely rapid. No microbe had been detected at death. We extracted DNA from a blood culture bottle. SYBR green I real-time PCR was conducted but could not detect V. vulnificus vvh in the DNA sample. Aeromonas hydrophila was cultured and identified in blood and necrotized tissue samples. Real-time PCR was conducted to detect A. hydrophila ahh1, AHCYTOEN and aerA in the DNA sample extracted from the blood culture bottle and an isolated necrotized tissue strain, but only ahh1 was positive. High-mortality in necrotizing soft tissue infections makes it is crucial to quickly detect V. vulnificus and A. hydrophila. We found real-time PCR for vvh, ahh1, AHCYTOEN, and aerA useful in detecting V. vulnificus and A. hydrophila in necrotizing soft tissue infections.
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PMID:[Real-time PCR in rapid diagnosis of Aeromonas hydrophila necrotizing soft tissue infections]. 2003 24

Vibrio vulnificus infection can result in necrotizing fasciitis and sepsis and is associated with high mortality. Most patients infected with this microbe have liver dysfunction as an underlying disease. However, because of the sporadic nature of outbreaks and unidentified cases, extensive evaluation of clinical features and identification of factors affecting prognosis have not been performed. We retrospectively analyzed 37 cases in Japan from 1984 to 2008 to review clinical features and to identify risk factors associated with prognosis. Statistical differences between clinical features (patient's characteristics, initial clinical laboratory data, symptoms upon admission, and other risk indicators) and prognosis were analyzed by use of the chi(2) test or the Mann-Whitney U test. Multivariate logistic regression analysis was also performed to assess factors which potentially affect hospital mortality. The mortality rate was 64.9%. An underlying liver disease was observed in 91.6% of the patients. The presence of liver cirrhosis tended to be related to hospital mortality; however, statistical significance was not achieved. Advanced age, lower platelet counts, and the presence of extensive skin lesions at onset affected outcomes with statistical significance. The prognosis of this disease is poor, because septic shock and necrotizing fasciitis often develop within a few days. Early diagnosis and treatment are needed to improve the prognosis of V. vulnificus infection.
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PMID:Clinical features of Vibrio vulnificus infections in the coastal areas of the Ariake Sea, Japan. 2022 50

A 73-year-old man with advanced lung cancer ate raw fish the day before being admitted to our hospital with severe abdominal pain, fever and vomiting. Soon afterward he fell into shock and disseminated intravenous coagulation. A CT scan revealed invagination and emergency surgery was performed. On the first day after surgery, Vibrio vulnificus was cultured from his ascites and blood. The infection was controlled by antibiotic treatment and he was discharged 23 days after the surgery. Vibrio vulnificus infection is an opportunistic infection that develops mostly in patients with liver cirrhosis within two days after eating raw seafood or having the injured skin exposed to sea water in the summer. Mortality is 70%, and more than half of these patients die within 72 hours of onset. Early diagnosis and treatment are very important. In addition, the public should be educated to protect immuno-compromised individuals from this infection.
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PMID:[A case of Vibrio vulnificus infection presenting with invagination]. 2071 28

Vibrio vulnificus infection can cause necrotizing fasciitis and sepsis and can develop within a few days despite intensive care. The mortality rate is up to 60% in vulnerable people. Most patients infected with this microbe have chronic liver disease, especially liver cirrhosis or cancer, as an underlying disease. V. vulnificus infection is opportunistic, and there is an urgent need to develop an anti- V. vulnificus vaccine. Thus, it is important to identify immunogenic antigens. We collected human sera from three subject groups: patients with V. vulnificus infection, patients with chronic liver disease but without V. vulnificus infection, and healthy volunteers with normal liver function. Immunoblots of cytosolic and membrane proteins of seven strains of V. vulnificus and one of V. parahaemolyticus were performed with sera from these groups. Although we could not demonstrate differences in antibody response between the groups, all sera showed a strong antibody response to a 62-kDa protein that was common to all strains examined. Immunoblots of Escherichia coli and Klebsiella pneumoniae also showed strong antibody response to this 62-kDa protein, and the possibility of cross-reaction cannot be denied. We identified this 62-kDa protein as an immunogenic antigen of V. vulnificus for humans.
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PMID:Identification of 62-kDa protein as an immunogenic antigen of Vibrio vulnificus for humans. 2404 Jun 94

We herein report on a case of Vibrio vulnificus infection that was improved by conservative treatment in Kagoshima, Japan. A 75-year-old Japanese woman with liver cirrhosis presented to our hospital with shaking chill and right lower leg pain. Her blood culture was positive for V. vulnificus, and bullae had newly appeared on the right leg. Further history taking revealed that she had eaten some raw seafood before admission. She recovered following administration of antibiotics and small incisions in the lesion. West Japan (especially, the northern parts of Kyushu island) is well known as an endemic area of V. vulnificus infection: however, some cases had been reported in other areas in Japan. When clinicians treat cellulitis with risk factors, we should consider the possibility of V. vulnificus infection, even in a non-endemic area. Taking blood culture and early administration of appropriate antibiotics may contribute to conservative cure of some case of V. vulnificus infection.
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PMID:[A Case of Vibrio vulnificus Infection Improved with Conservative Treatment in Kagoshima]. 3027 4


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