Disease caused by a marine Vibrio. Clinical characteristics and epidemiology

Activation of the plasma kallikrein-kinin system by Vibrio vulnificus protease

Vibrio vulnificus protease enhanced hypodermic vascular permeability when injected into the dorsal skin of a guinea pig. Enhancement of permeability was observed within 2 min, and the permeability-enhancing reaction terminated at about 10 min postinjection. The permeability-enhancing reaction was greatly augmented by simultaneous injection of a kininase II inhibitor, whereas the reaction was inhibited by soybean trypsin inhibitor, a well-known inhibitor of plasma kallikrein. Furthermore, in vitro activation of plasma prekallikrein to kallikrein by V. vulnificus protease was observed. These results indicate that V. vulnificus protease enhances vascular permeability through activation of the plasma kallikrein-kinin system which generates bradykinin, factor in edema formation.

Use of sodium dodecyl sulfate-polymyxin B-sucrose medium for isolation of Vibrio vulnificus from shellfish

The differential and selective sodium dodecyl sulfate-polymyxin B-sucrose medium (SPS) of Kitaura et al. (T. Kitaura, S. Doke, I. Azuma, M. Imaida, K. Miyano, K. Harada, and E. Yabuuchii, FEMS Microbiol. Lett. 17:205-209, 1983), which highlights alkylsulfatase activity, was evaluated for its potential use in the direct isolation and enumeration of Vibrio vulnificus from shellfish. V. vulnificus was detected by this method in six of nine shellfish samples collected from diverse geographic locales during the summer of 1986. Direct enumeration of V. vulnificus at 7.0 X 10(2) to 2.2 X 10(4) CFU/g of shellfish was achieved on SPS agar. All sample results were confirmed in parallel examinations by using conventional glucose-salt-Teepol (Shell Oil Co.) broth and alkaline peptone water enrichment with plating onto thiosulfate-citrate-bile salts-sucrose agar. Additionally, alkylsulfatase activity was evaluated in vitro for 97 strains representing 14 Vibrio spp. V. vulnificus and Vibrio cholerae-01 were the only species consistently found to possess this activity. The range of plating efficiencies for random V. vulnificus strains analyzed on SPS was 11 to 74% (mean, 39%). The use of SPS shows great promise for the study of shellfish and other environmental sources for V. vulnificus.

Bacteriology of the marine environment: implications for clinical therapy

Ocean water and tissue samples were obtained from a variety of sources with phylogenetic and geographic diversity. Purified bacterial colonies were isolated and identification procedures were performed. A total of 67 isolates were recovered. Thirty-eight isolates belonged to the genus Vibrio and included six species. Twenty-four non-fermentative bacteria and four Gram-positive isolates were recovered. Antibiotic susceptibility testing showed that while the non-fermentative marine bacteria generally were susceptible to the antibiotics tested, marine Vibrio species were relatively resistant to a wide variety of antimicrobials. Antibiotics effective against all species included imipenem, trimethoprim/sulfamethoxazole, and chloramphenicol. Further recommendations for treatment are based on sensitivity in culture. Some isolates failed to grow in the medium used for susceptibility testing. Because commercial test kits may not yield accurate identifications of bacteria, the acquisition of antimicrobial susceptibility data gains added importance.

Inhibitory effect of capsular antigen of Vibrio vulnificus on bactericidal activity of human serum

Opaque (Op) and translucent (Tr) colonial variants were isolated from Vibrio vulnificus strains. Op-type variants were more resistant than the isogenic Tr-type variants, but the survival rate of the Op-type variants varied with the strains. Antisera were prepared by immunizing rabbit with whole cells of Op and Tr variants of some strains, in which the difference of the sensitivity between Op and Tr cells was remarkable. Then agglutination tests with their living and heat-killed cells were carried out. The results suggested the presence of capsular antigen in Op cells and its absence in Tr cells, with the exception of the existence of a slight amount of capsular material in Tr variants of strain L-180. The thin capsular layer of Tr cells of strain L-180 was also demonstrated electron microscopically, but the layer was thinner than that of the isogenic Op cells. Results of determination of sugar content in the extracted capsular fraction also showed that Op to Tr transformation was due to loss of capsular antigen of the cells. These results confirmed the morphological studies previously reported which suggested the prevention of host defense system by the capsular material of the vibrio.

Vibrio vulnificus infection after raw oyster ingestion in a patient with liver disease and acquired immune deficiency syndrome-related complex

Sepsis, peritonitis, and gastroenteritis developed in a 45-yr-old homosexual man 1 day after ingestion of raw oysters. The patient had chronic active hepatitis and cirrhosis with hepatitis B virus and delta-infection. He also had persistent generalized lymphadenopathy associated with HTLV-III antibody positivity. Vibrio vulnificus was isolated from the patient's blood and peritoneal fluid as well as from the same batch of oysters at the restaurant where the patient had visited. To our knowledge, this is the first report relating direct microbiologic and clinical evidence that the infection is acquired through the gastrointestinal tract by consuming raw seafood containing the pathogen. This is also the first reported case of peritonitis associated with sepsis and gastroenteritis from this organism. Patients with liver disease and other immunocompromised states should be warned about such life-threatening infections and complications associated with the consumption of raw oysters or other undercooked seafoods.

Clinical and ecological characteristics of Vibrio vulnificus in the northeastern United States

Multiple seawater sites in the northeastern United States, particularly Long Island Sound, and shellfish from Long Island Sound were sampled from April to November for 3 successive yr, 1983-1985. Hospitals in coastal and metropolitan areas of Connecticut were surveyed for the same 3-yr period, Vibrio vulnificus can be found in these waters during the summer months. The appearance of these virulent bacteria in both seawater and shellfish are a function of the water temperature; no V. vulnificus could be isolated until the temperature was approximately 17 degrees C. Although the risk of infection is small, as shown by isolation of this organism from patients, certain high-risk groups exist. Consumption of raw shell fish during the summer months should be discouraged in people with liver disease or patients on immunosuppressive therapy.

Correlation between virulence and colony morphology in Vibrio vulnificus

Of 38 isolates of Vibrio vulnificus examined, all avirulent strains produced only translucent colonies. All virulent strains, with the exception of biogroup 2 (eel pathogens), exhibited both opaque and translucent colonies. Isogenic morphotypes were examined for a variety of phenotypic and virulence traits. Only the ability to utilize transferrin-bound iron and the presence of a surface polysaccharide were found to correlate with colony opacity and virulence.

Purification and characterization of Vibrio vulnificus protease

A protease was purified from a strain of Vibrio vulnificus isolated from the blood of a septicemic human. The vibrio was cultured in bacto peptone-yeast extract medium, and the protease was purified by a purification procedure including ultrafiltration of the culture supernatant with an Amicon YM 5 membrane, diethylaminoethyl-Sephacel column chromatography, Sephacryl S-200 column chromatography and fast protein liquid chromatography on Mono Q column. The protease preparation revealed homogeneity on polyacrylamide gel electrophoresis and about 30,000-fold purification was achieved, with a yield of about 30%. The isoelectric point of the purified V. vulnificus protease was about 5.80 and its molecular weight was ca. 45,000 by sodium dodecyl sulfate polyacrylamide gel electrophoresis. The optimum pH of the protease activity was 8.0. The V. vulnificus protease was inhibited by a metalloprotease inhibitor and zinc ion and/or ferrous ion were essential for its enzyme activity. No cysteine residue was detected in the V. vulnificus protease. The protease had caseinolytic, elastolytic and collagenolytic activities.

Identification of environmental Vibrio vulnificus isolates with a DNA probe for the cytotoxin-hemolysin gene

We screened 44 lactose-positive Vibrio strains isolated from the marine environment for homology with a 3.2-kilobase DNA fragment encoding the Vibrio vulnificus cytotoxin-hemolysin gene. All 29 marine isolates identified as V. vulnificus on the basis of numerical taxonomy and DNA-DNA hybridization studies hybridized with the cytotoxin gene probe, as did all V. vulnificus reference strains. Homologous gene sequences were identified in no other lactose-positive marine vibrio isolates nor in 10 other Vibrio species.

Bioluminescence in a strain of the human pathogenic bacterium Vibrio vulnificus

We report the existence of a bioluminescent strain of the human pathogen Vibrio vulnificus. The isolate was obtained from blood following a fatal wound infection and thus represents the first description of an infection caused by a luminescent bacterium.

Fulminant community-acquired infectious diseases: diagnostic problems

The processes presented here do not represent an all-inclusive list of fulminant infectious diseases. Some of the more common acute, overwhelming infections of the central nervous system and lungs are covered elsewhere in this issue. We have selected less common, potentially catastrophic syndromes that might be recognized earlier if certain historical clues, physical findings, or laboratory abnormalities are appreciated. Specific and effective therapy is available for most of the diseases we have chosen. Meningitis due to Naegleria fowleri, a free-living ameba that may invade the central nervous system through the cribriform plate in persons swimming in brackish water, and hemorrhagic mediastinitis due to inhalation of Bacillus anthracis, which is acquired in occupational exposure to goat's hair, wool, or an animal with anthrax, are other examples but are lacking in proven effective therapy. Although most physicians quickly consider exotic and overwhelming infections in the severely compromised patient, fewer recognize this risk in the diabetic, cirrhotic, or healthy person with a unique occupational or travel history. During the present epidemic of AIDS, previous exposure to the HTLV-3 virus must be considered in all severely ill patients. The proper use of new diagnostic tests may permit the physician to intercede effectively if these life-threatening diseases are suspected.

Plasmid carriage in Vibrio vulnificus and other lactose-fermenting marine vibrios

A total of 42 clinical and environmental isolates of Vibrio vulnificus were examined for plasmid carriage. Of these, only five (12%) harbored plasmids, which were of various molecular weights. In contrast, 20 of 32 (62.5%) unidentified lactose-fermenting Vibrio spp. were found to possess plasmids with masses of 2.1 to 150 megadaltons. In these isolates, multiple plasmids were common, with an average of 2.25 plasmids per plasmid-containing strain. Attempts to demonstrate a correlation with the plasmids identified in the various Vibrio spp. and a variety of phenotypic traits, production of several enzymes potentially involved in virulence, cytotoxicity for Chinese hamster ovary cells, and mouse lethality were unsuccessful. A correlation was observed, however, between the presence of a 6.5-megadalton plasmid and resistance to pteridine 0/129. It was concluded that V. vulnificus, unlike most other Vibrio spp., shows a general lack of these extrachromosomal elements.

Production of extracellular enzymes and cytotoxicity by Vibrio vulnificus

Thirty-three strains of Vibrio vulnificus of clinical and environmental origin were examined for production of 12 extracellular enzymes of potential importance to the virulence of this bacterium. Strains of Vibrio vulnificus were consistent in their production of protease, mucinase, lipase, chondroitinase, hyaluronidase, DNase, sulfatase, and hemolysin. No differences between clinical and environmental isolates were noted. Although none of the enzymes appeared to correlate with the ability of these strains to produce lethality in mice, the production of hemolysin and of a protease with activity against native serum albumin may be significant in the pathogenesis of the potentially fatal infections produced by this organism. The production of several of these exoenzymes also appeared to correlate with pathogenicity in the seven other Vibrio species examined. Culture filtrates of all virulent strains of Vibrio vulnificus were cytotoxic for Chinese hamster ovary cells, whereas those of the strains of Vibrio parahaemolyticus and Vibrio alginolyticus examined lacked this activity.

Virulence of Vibrio vulnificus strains from marine environments

Vibrio vulnificus strains isolated from geographically diverse marine sources were compared with clinical isolates for phenotype and in vitro and in vivo production of virulence factors. There were no differences between environmental and clinical strains on the basis of biochemical characteristics or antimicrobial susceptibility patterns. Cytolysin and cytotoxin titers produced by environmental strains were generally comparable to those of clinical strains. Of 29 environmental isolates tested, 25 were pathogenic for mice. These data show that environmental V. vulnificus strains are phenotypically indistinguishable from clinical isolates and that approximately 90% of the environmental strains tested produced in vitro virulence factors and in vivo pathogenicity for mice comparable to those produced by clinical V. vulnificus isolates.

Emergence of bactericidal and opsonizing antibody to Vibrio vulnificus following bacterial infection

Virulent isolates of Vibrio vulnificus resist the bactericidal and opsonizing effects of normal human serum, in contrast to environmental isolates, which are highly serum susceptible. Immune responses to bacteremic V. vulnificus infections in human subjects have not been characterized. Serum from a patient who survived sepsis caused by V. vulnificus had substantial bactericidal and opsonizing immunoglobulin G (IgG) for his own bloodstream isolate. Killing was mediated by the classical complement pathway, whereas opsonization was effected by either the classical or the alternative pathway. IgG that reacted strongly with 55-, 58-, and 68-kilodalton outer membrane proteins was present in the patient's convalescent-phase serum but was absent from normal human serum. These findings suggest that humoral immunity to V. vulnificus, mediated by bactericidal and opsonizing antibody, emerges during infection and may be due, in part, to IgG directed against identifiable outer membrane proteins.

Composition of major outer membrane proteins of Vibrio vulnificus isolates: effect of different growth media and iron deficiency

The outer membrane proteins of Vibrio vulnificus including isolates from humans, seawater and an asari clam were examined by sodium dodecyl sulfate (SDS)-polyacrylamide gel electrophoresis. A major outer membrane protein with an apparent molecular weight of 48,000 (48K protein) was common to all the strains grown in 3% NaCl-nutrient broth; however this 48K protein was not produced in any of the strains grown in chemically defined medium. Other major outer membrane proteins with molecular weights ranging from 33,000 to 40,000 varied in number, relative amount and molecular weight depending on the strain. One to three new outer membrane proteins with molecular weights ranging from 74,000 to 85,000 were produced in the cells grown in iron-deficient medium. The 48K protein and one or two major proteins with molecular weights ranging from 35,000 to 37,000 in the cells grown in 3% NaCl-nutrient broth were not solubilized by 2% SDS at 60 C for 30 min and were resistant to trypsin, indicating that they are porins. On the other hand, in cells grown in chemically defined medium, one or two major outer membrane proteins with molecular weights ranging from 33,000 to 40,000 might be porins.

Gastroenteritis in patients with stool isolates of Vibrio vulnificus

Vibrio vulnificus, a marine Vibrio associated with severe extraintestinal infections, has not been previously implicated as a cause of infectious diarrhea. Three patients were identified with diarrheal illness from whom this organism was the sole pathogen recovered from cultured stool specimens. All three had eaten raw oysters within one week of becoming ill. These patients were all taking medication that reduces gastric acidity, two were heavy drinkers of alcohol, and one had unrecognized colon cancer; these factors may have predisposed to the development of disease. Clinicians should consider that V. vulnificus may be a cause of gastroenteritis in patients who have consumed raw oysters.

Cloning of the cytotoxin-hemolysin gene of Vibrio vulnificus

Genes encoding the cytotoxin-hemolysin of Vibrio vulnificus were cloned in Escherichia coli by using the lytic cloning vector, lambda 1059. Subcloning in plasmid pBR325 resulted in the isolation of a 3.2-kilobase DNA fragment containing the cytotoxin gene. By using this fragment as a DNA probe, homologous gene sequences were detected in all 54 V. vulnificus strains studied; homologous sequences were present in none of 96 isolates from 29 other bacterial species.

Uptake and clearance of Vibrio vulnificus from Gulf coast oysters (Crassostrea virginica)

Oysters collected in late winter, when they were free of Vibrio vulnificus, were exposed in the organism in the laboratory. The oysters effectively concentrated the bacteria from seawater, but when the inoculum was removed, the bacteria were rapidly cleared from the oyster tissues. These results suggest that V. vulnificus may be found in oysters as a result of filtration of the bacteria from seawater rather than active multiplication of the bacteria in the oysters.

Identification of Vibrio vulnificus by indirect immunofluorescence

A rapid, sensitive, and specific indirect immunofluorescence (IIF) procedure is described for identifying Vibrio vulnificus. Reference antisera were prepared by vaccinating rabbits with surface antigen preparations of V. vulnificus, and the antisera were examined for the ability to react with and serologically group 85 isolates of V. vulnificus grown in heart infusion broth, and to detect V. vulnificus in tissue specimens from mice experimentally infected with a virulent isolate of the bacterium. The antisera detected 100% of the V. vulnificus isolates examined and gave false-positive results in approximately 0.9% of 445 IIF tests performed with non-V. vulnificus clinical isolates. V. vulnificus also was detected in frozen tissue sections from infected mice; however, the most easily observed positive results were obtained by examining V. vulnificus from lesion specimens and blood cultured briefly in heart infusion broth. The bacteria in 2-hr-old cultures of local lesions fluoresced brilliantly and were easily detectable. The IIF procedure could be of value in rapidly diagnosing fulminating and potentially fatal human disease caused by V. vulnificus.

Vibrio vulnificus resists phagocytosis in the absence of serum opsonins

Invasive disease caused by Vibrio vulnificus may result partially from resistance to phagocytic host defense mechanisms. The present studies show that V. vulnificus resists phagocytosis by murine peritoneal macrophages in the absence of serum opsonins and extracellular bacterial products, apparently through the anti-phagocytic properties of the bacterial surface.

Some properties of Vibrio vulnificus hemolysin

Some properties of hemolysin produced by Vibrio vulnificus were investigated. The hemolysin was heat labile, and the hemolytic activity was inhibited by adding cholesterol or divalent cations. Cholesterol inhibited the temperature-independent hemolysin-binding step, suggesting that cholesterol made up the binding site of the cell membrane, whereas the divalent cations inhibited the temperature-dependent membrane-degradation step. However, the V. vulnificus hemolysin was stable to oxygen and sulfhydryl reagents and was not inactivated by antiserum against streptolysin O, suggesting that the V. vulnificus hemolysin differs from oxygen-labile hemolysins which bind to cholesterol. The V. vulnificus hemolysin seems to be one of the exceptional cholesterol-binding hemolysins.

Vibrio vulnificus septicemia

A 33-year-old Japanese male, who had a three year history of biopsy-proved liver cirrhosis, was admitted to the hospital on June, 24, 1983 with a sudden onset of fever (38.6 degrees C), chills, generalized pain, nausea, anorexia, weakness, and eruption over the entire body. The patient went into shock and died about 7 hours after admission. Blood cultures before death were positive for V. vulnificus. Postmortem microscopic examination revealed "necrotizing vasculitis" in the small and large intestines, stomach, and skin, and also showed marked toxic epidermal necrolysis. This case matches the primary septicemia caused by V. vulnificus described by Blake et al. In addition, this case suggests that the septicemia was acquired through the gastrointestinal tract, especially the small intestine, because the V. vulnificus was isolated from blood and numerous Gram-negative bacilli around the submucosal vessels were observed in the area with acute necrotizing vasculitis.

Isolation and characterization of two hemolytic phenotypes of Vibrio damsela associated with a fatal wound infection

Two hemolytic phenotypes of Vibrio damsela, isolated from the tissue of a patient with a fatal wound infection, were characterized. The patient had underlying disease, and the wound was associated with an injury inflicted during the handling of a catfish. The phenotypes were morphologically and biochemically similar except for their lecithinase, lipase, and hemolytic activities. When grown on rabbit blood agar, one phenotype (LZ) produced a large zone of hemolysis (10 mm) around the colony, whereas the other type (SZ) produced only a small zone (1 to 2 mm). On sheep blood agar, the differences in hemolytic activity were more subtle. By a modified CAMP test in which V. damsela was streaked perpendicularly to Staphylococcus aureus, it was determined that a factor elaborated by the LZ phenotype (but not the SZ phenotype) protected sheep erythrocytes from the hemolysis normally caused by S. aureus toxins. Cell-free filtrates of broth cultures of each phenotype had the same effects on erythrocytes as did the organisms themselves.

Relation of capsular materials and colony opacity to virulence of Vibrio vulnificus

Colonies which varied in opacity were isolated from the four strains of Vibrio vulnificus. Opaque and translucent colonial types of the strains were distinguished from the corresponding parent strains. Variation in the opacity of colonies formed by each strain was accompanied by variation of capsular material formation, which was clarified by electron microscopy of the organisms stained with ruthenium red. The opaque-type colonies of the strains had capsular materials. On the other hand, three translucent-type colonies had no observable capsular materials, and one had incomplete capsular materials, in contrast to the corresponding opaque type. The corresponding opaque and translucent types of the strains were compared for points of virulence in mice and guinea pigs. By having capsular materials, the bacterial strains acquired resistance to serum bactericidal action, antiphagocytic activity, high lethality for mice, and strong invasiveness in the subcutaneous tissue of guinea pigs. Capsular materials of V. vulnificus were considered to be important for the expression of virulence.

Demonstration of a common antigen in sonicated cells for identification of Vibrio vulnificus serotypes

Ouchterlony immunodiffusion of sonicated Vibrio vulnificus cells illustrated a single major precipitation line with antiserum prepared from whole cells of the same species. Antigenic analysis by two-dimensional immunoelectrophoresis verified the presence of a single dominant precipitation line. Tandem two-dimensional immunoelectrophoretic analyses of V. vulnificus antigens from various strains revealed one fused precipitation line of identity. No fused precipitation lines were seen with other Vibrio species tested. This dominant antigen, designated VVA, was not dialyzable, lost antigenicity by heating at 100 degrees C but not at 70 degrees C, and was precipitated by 70%, but not by 50%, saturated ammonium sulfate. VVA was not present in concentrated (20X) spent culture medium. VVA is possibly an intracellular protein specific to V. vulnificus species and may be useful in the serological identification of this important human pathogen.

Necrotising fasciitis caused by Vibrio vulnificus

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.

Bacteriology of the teeth from a great white shark: potential medical implications for shark bite victims

Bacteria were cultured for the first time from the teeth of a great white shark (Carcharodon carcharias). Isolates included Vibrio alginolyticus, Vibrio fluvialis, Vibrio parahaemolyticus, and other genera. All are common in the marine environment and some may be associated with wound infections in humans. Shark bite lacerations may serve as a source of these potentially infectious bacteria, particularly Vibrio spp., and should be treated immediately. Antibiotic susceptibility patterns are shown for representatives of Vibrio isolates and indicate that a variety of new agents may be appropriate chemotherapy for shark bite victims.

Vibrio hand infections: a case report and review of the literature

A case of Vibrio vulnificus infection of the hand is presented. The role of Vibrio species as primary pathogens in infections associated with exposure to a marine environment is discussed.

Extracellular phospholipase A2 and lysophospholipase produced by Vibrio vulnificus

Phospholipase A2 and lysophospholipase activities were detected in the culture supernatant fluids of a virulent strain of Vibrio vulnificus. The phospholipase A2 was inactivated by heating at 56 degrees C for 30 min, had an apparent molecular weight of greater than or equal to 80,000 (estimated by gel filtration with Sephadex G-75), and a pI of ca. 5.0. Phospholipid hydrolysis was unaffected by Ca2+ or ethylene glycol-bis(beta-aminoethyl ether)-N,N-tetraacetic acid and was optimal at pH 5.0 to 5.5. The lysophospholipase was not affected by heating at 56 degrees C for 30 min but was inactivated at 100 degrees C and had an apparent molecular weight of greater than or equal to 80,000 and a pI of ca. 4.0. The enzymes were detected coincidentally with a previously described extracellular cytolysin of V. vulnificus; however, they were physically separable from the toxin (which did not possess phospholipase A, C, or D activity) by gel filtration with Sephadex G-75.

Role of heme compounds and haptoglobin in Vibrio vulnificus pathogenicity

An induced peritonitis model was employed in mice to determine whether heme-containing molecules enhance the lethality of infections by Vibrio vulnificus. The lethality of intraperitoneal (ip) inocula of the bacteria was increased by concurrent injections (ip) of hemoglobin, methemoglobin, or hematin, but not by myoglobin. Similar results were obtained in mice with phenylhydrazine-induced hemoglobinemia, in which after ip injections of V. vulnificus, a direct correlation between lethality and levels of plasma hemoglobin was observed. In vitro studies indicated that the growth of V. vulnificus, which was limited in an iron-poor medium, was enhanced by the addition of hemoglobin in a manner similar to an inorganic iron source, ferric ammonium citrate. These results suggest that V. vulnificus is capable of extracting iron from hemoglobin for use as a nutrilite, thereby promoting growth and increased lethality in the in vivo models. Further studies with human serum cultures demonstrated that the growth of V. vulnificus was not decreased when hemoglobin added to the serum was completely complexed with haptoglobin; these results are in opposition to those with cultures of Escherichia coli. These results are discussed relative to the capacity of V. vulnificus to produce fatal human infections.

Wound infections caused by Vibrio vulnificus, a marine vibrio, in inland areas of the United States

Vibrio vulnificus is a halophilic marine vibrio which may produce infection in wounds exposed to seawater or raw shellfish. The Centers for Disease Control has received two isolates from wounds exposed to inland waters, a New Mexico creek and an Oklahoma reservoir. Halophilic organisms were recovered from both the creek and the reservoir, and the water in both sites was found to be brackish. Both clinical isolates of V. vulnificus grew in salt concentrations as low as those found in the creek and reservoir. These cases illustrate the potential for pathogenic halophilic Vibrio species to live in brackish inland waters and produce infections in patients living in inland areas of the United States.

Comparative studies and laboratory diagnosis of Vibrio vulnificus, an invasive Vibrio sp

Vibrio vulnificus was isolated from a bacteremic patient. This strain, together with other isolates of V. vulnificus, was compared with V. alginolyticus, V. fluvialis, and V. parahaemolyticus with regard to growth characteristics on enteric agar media (enabling isolation and identification) and production of exoenzymes which could correlate with invasive potential. V. vulnificus grew well on MacConkey. Endo, xylose-lysine deoxycholate, and Hektoen enteric agar plates. Because V. vulnificus colonies resembled those of lactose-fermenting strains of the family Enterobacteriaceae, however, isolation of this vibrio from mixed specimens or stools may require the use of thiosulfate-citrate-bile salts-sucrose agar. V. vulnificus produced numerous exoenzymes (protease, DNase, lipase, and esterase) but not elastase or lecithinase. Although differences in exoenzyme production were observed among the four vibrio species, no single exoenzyme could be linked to the invasive potential of V. vulnificus.

Vibrio vulnificus septicaemia

A patient, who had been receiving treatment for refractory anaemia with excess of myeloblasts for three years, developed septic shock due to Vibrio vulnificus septicaemia. The infection was believed to have been introduced with the ingestion of raw oysters. This organism is comparatively rare, but it can cause serious infection, and is known to be capable of very rapid tissue invasion.

Infections in the alcoholic

Serious infections appear to occur more frequently in alcoholic patients. However, whether this is due to the effects of alcohol per se or to the other frequent complications of alcoholism--nutritional deficiencies, cirrhosis, and poor hygiene--has not been determined. The host factors that may underlie an increased frequency of infection in alcoholics and the clinical infectious syndromes associated with alcoholism are described.

Differential complement activation and susceptibility to human serum bactericidal action by Vibrio species

The ability of Vibrio vulnificus to resist human serum bactericidal action and to activate human complement was compared with similar cultures of Vibrio cholerae and Vibrio parahaemolyticus. Both V. vulnificus and V. parahaemolyticus had similar survival rates in sera and were much more resistant to killing than was V. cholerae. In contrast, V. vulnificus activated significantly less serum complement than did V. cholerae and V. parahaemolyticus. The relative ability of V. vulnificus to survive in serum and activate less complement than other Vibrio spp. tested may be related to its ability to cause chronic tissue infections and septicemias.

Bacterial flora of marine penetrating injuries

Bacteriologic and clinical features of 28 cases of traumatic marine injuries are described. The most common bacterial isolates were normal skin bacteria, Staphylococcus aureus and, in 11% of cases, Vibrio alginolyticus. All injuries responded to local wound care, and only half received antibiotic therapy.