From the Guidelines
Individuals with haemochromatosis and iron overload are at a significantly increased risk of severe Vibrio vulnificus infections, and should avoid direct handling and consumption of raw or undercooked shellfish and wound exposition to seawater, especially in geographical regions where the pathogen is common 1.
Risk Factors for Vibrio vulnificus Infections
The risk of Vibrio vulnificus infections is particularly high in individuals with certain underlying conditions, including:
- Liver disease
- Immunocompromised conditions
- Diabetes
- Chronic kidney disease
- Iron overload conditions like hemochromatosis These individuals should take precautions to avoid exposure to the pathogen, such as avoiding raw or undercooked seafood and wearing protective clothing when entering saltwater environments.
Prevention and Treatment
To prevent Vibrio vulnificus infections, individuals with high-risk conditions should:
- Avoid eating raw or undercooked seafood, especially oysters
- Wear protective clothing when entering saltwater environments
- Avoid exposing open wounds to saltwater
- Seek prompt medical attention if exposure occurs Early antibiotic treatment with doxycycline plus a third-generation cephalosporin is recommended for suspected Vibrio vulnificus infections 1.
Importance of Hepcidin in Vibrio vulnificus Infections
Hepcidin plays a crucial role in the host defense against Vibrio vulnificus, and hepcidin deficiency and high levels of circulatory iron can increase the risk of severe infections 1.
Clinical Guidelines
Clinical guidelines recommend that patients with haemochromatosis and iron overload should be advised to avoid or reduce alcohol consumption, as it can increase the risk of liver disease and other complications 1.
From the Research
Vibrio vulnificus Risk Factors
- Chronic liver disease is a significant risk factor for Vibrio vulnificus infection, as it increases the susceptibility to primary sepsis 2, 3, 4, 5
- Immunodeficiency is also a risk factor, making individuals more prone to severe infections 2, 6, 5
- Iron storage disorders, end-stage renal disease, and diabetes mellitus are additional risk factors for Vibrio vulnificus infection 2
- Consumption of raw or undercooked oysters, particularly those harvested from the Gulf Coast, is a significant risk factor for primary sepsis 2, 3, 6, 4
- Exposure of open wounds to warm seawater with high concentrations of V. vulnificus can lead to necrotizing wound infections 2, 6, 4, 5
Clinical Presentations and Outcomes
- Primary sepsis is a severe clinical presentation of Vibrio vulnificus infection, with a high mortality rate exceeding 50% 2, 3, 6, 4
- Wound infections can range from mild to severe, with severe cases characterized by necrotizing skin and soft-tissue infection, including fasciitis and gangrene 2, 6, 4, 5
- The presence of hemorrhagic bullous skin lesions/necrotizing fasciitis is a significant prognostic factor for increased mortality risk 5
- Early diagnosis, aggressive antibiotic therapy, and supportive care are crucial for improving patient outcomes 2, 3, 6, 4, 5