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Tanveer M, Ntakiyisumba E, Won G. Prevalence and risk factors of seafood-borne Vibrio vulnificus in Asia: a systematic review with meta-analysis and meta-regression. Front Microbiol 2024; 15:1363560. [PMID: 38511007 PMCID: PMC10951106 DOI: 10.3389/fmicb.2024.1363560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
Vibrio vulnificus is a free-living marine bacterium associated with the contamination of fish and shellfish-the most consumed seafood in Asia. Owing to its potentially lethal clinical consequences, the consumption of seafood contaminated with V. vulnificus has become a growing public health concern. This systematic review with meta-analysis and meta-regression aimed to integrate data on the prevalence of seafood-borne V. vulnificus specifically in Asia and assess the potential risk factors that can influence the outcomes. A comprehensive literature search of four electronic databases yielded 279 relevant studies, among which 38 fulfilled the inclusion criteria. These selected studies were subjected to risk-of-bias assessment and data extraction by three independent researchers. A meta-analysis of the eligible studies estimated the overall prevalence of seafood-borne V. vulnificus in Asia to be 10.47% [95% confidence interval (CI): 6.8-15.8%], with bivalve shellfish, such as oysters, mussels, clams, and cockles being the most contaminated seafood. The highest prevalence was reported in Japan, where 47.6% of the seafood samples tested positive for V. vulnificus. The subgroup and meta-regression analyses identified three potential covariates-detection method, publication year, and country-associated with between-study heterogeneity. Furthermore, data visualization displayed the variations in V. vulnificus prevalence across the studies, associated with differences in sample type, sample size, and sampling stage. This study provides valuable insights into the prevalence of V. vulnificus in fish and shellfish across the entire Asian continent and highlights the potential factors that cause variation in the prevalence rates among the studies. These findings underscore the importance of enhancing hygiene measures throughout the seafood supply chain to mitigate V. vulnificus infection risks and ensure the safety of consumers.
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Affiliation(s)
| | | | - Gayeon Won
- College of Veterinary Medicine and Bio-Safety Research Institute, Jeonbuk National University, Iksan, Republic of Korea
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Kim JS, Lee EG, Chun BC. Epidemiologic Characteristics and Case Fatality Rate of Vibrio vulnificus Infection: Analysis of 761 Cases From 2003 to 2016 in Korea. J Korean Med Sci 2022; 37:e79. [PMID: 35257530 PMCID: PMC8901877 DOI: 10.3346/jkms.2022.37.e79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 02/07/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Vibrio vulnificus infection is a highly fatal disease resulting from the consumption of raw or undercooked seafood and exposure to seawater containing the organism. It has been a nationally notifiable disease since 2000 in Korea. The aims of this study were to assess the trends in the incidence of V. vulnificus infection and its case fatality rate and to determine the epidemiologic characteristics to effectively prevent infection and lower mortality. METHODS We analyzed the incidence trends of V. vulnificus infection by year, month, and region in 913 cases reported to the Korea Centers for Disease Control and Prevention (KCDC, currently Korea Disease Control and Prevention Agency) by the National Infectious Disease Surveillance System from 2001 to 2016. We analyzed the number of patients with V. vulnificus infection who were under the National Health Insurance Service (NHIS) and whose coastal seawater temperature data were provided by the Korea Oceanographic Data Center of the National Institute of Fisheries Science. Epidemiological investigations were followed up and analyzed for 761 patients from 2003 to 2016. A total of 152 patients who were not followed up were excluded from the analysis. The case fatality rate was analyzed for 325 cases reported to the KCDC from 2011 to 2016. RESULTS The mean incidence of V. vulnificus infection was 0.12 per 100,000 people, and the highest incidence was reported in September (41.1%) during the study period. The incidence rate per 100,000 people was the highest in Jeonnam (8.23). The number of patients who claimed to the NHIS was the highest in September (105 patients). The average seawater temperature was the highest at 24.1°C in August, and the average seawater temperature from August to October, when many cases occurred, was 22.4°C. The male-to-female ratio was 6:1, and 96.4% of the patients were aged ≥ 40 years. Of the patients, 96.1% had underlying diseases, the most common of which was liver cirrhosis (56.3%). The case fatality rate was 48.9%. CONCLUSION The occurrence of V. vulnificus infection showed distinct seasonality, with a large number of cases occurring in the months when the seawater temperature was high; there were also distinct geographical characteristics. The incidence of V. vulnificus infection and mortality rates have not decreased for decades, and it is still an important public health problem with a high fatality rate.
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Affiliation(s)
- Jung Sook Kim
- Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Eun Gyu Lee
- Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Byung Chul Chun
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
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Kim J, Chun BC. Effect of Seawater Temperature Increase on the Occurrence of Coastal Vibrio vulnificus Cases: Korean National Surveillance Data from 2003 to 2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094439. [PMID: 33922061 PMCID: PMC8122616 DOI: 10.3390/ijerph18094439] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/15/2021] [Accepted: 04/20/2021] [Indexed: 12/19/2022]
Abstract
The purpose of this study was to assess the association between seawater temperature and Vibrio vulnificus cases in coastal regions of Korea. All V. vulnificus cases in coastal regions notified to the Korea Disease Control and Prevention Agency between 2003 and 2016 were included in this work. Data for seawater temperature on the south, west, and east coast during the study period were provided by the Korea Oceanographic Data Center of the National Institute of Fisheries Science. We used a generalized additive model and performed a negative binomial regression analysis. In total, 383 notified cases were analyzed (west coast: 196 cases, south coast: 162, and east coast: 25). The maximum seawater temperature was the most significant predictor of V. vulnificus cases on the south and east coasts (relative risk according to the 1 °C increase in seawater temperature (RR) = 1.35 (95% confidence interval (CI): 1.19–1.53) and 1.30 (95% CI: 1.06–1.59), respectively). However, the mean seawater temperature was the most significant predictor for the west coast (RR = 1.34 (95% CI: 1.20–1.51)). These results indicate that continuously monitoring seawater temperature increase in each coastal area is crucial to prevent V. vulnificus infections and protect high-risk groups, such as persons with liver disease.
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Affiliation(s)
- Jungsook Kim
- Korea Disease Control and Prevention Agency, Cheongju 28159, Korea;
- Department of Public Health, Korea University Graduate School, Seoul 02841, Korea
| | - Byung Chul Chun
- Department of Public Health, Korea University Graduate School, Seoul 02841, Korea
- Department of Preventive Medicine, Korea University College of Medicine, Seoul 02841, Korea
- Correspondence: ; Tel.: +82-2-2286-1169
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Hepatic disease and the risk of mortality of Vibrio vulnificus necrotizing skin and soft tissue infections: A systematic review and meta-analysis. PLoS One 2019; 14:e0223513. [PMID: 31652263 PMCID: PMC6814278 DOI: 10.1371/journal.pone.0223513] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/22/2019] [Indexed: 12/14/2022] Open
Abstract
Background Vibrio vulnificus necrotizing skin and soft tissue infections (VNSSTIs) are associated with a high mortality rate that varies remarkably with host susceptibility. Hepatic disease (HD) is considered the key risk factor for high VNSSTIs incidence and mortality; however, there is limited evidence in the literature to support this observation. Methodology We examined all reported cases of VNSSTIs and associated mortality rates between 1966 and mid-2018. The PubMed, Medline and Cochrane Library databases were systematically searched for observational studies on patients with VNSSTIs. Twelve studies with 1157 total patients with VNSSTIs were included in the analysis. From the pooled dataset, nearly half (46.8%) of the patients with VNSSTIs had HD. The mortality rate in HD patients with VNSSTIs was 53.9% (n = 292/542), which was considerably higher than the mortality rate of 16.1% (n = 99/615) in non-HD patients. Patients with HD contracted VNSSTIs were found to be two or more times (RR = 2.61, 95% CI = 2.14–3.19) as likely to die compared with those without HD. Besides, liver cirrhosis (LC), the end-stage HD, was confirmed to be a significant risk factor, with risk ratios of 1.84 (95% CI 1.21–2.79) and 2.00 (95% CI 1.41–2.85) when compared to non-LC and non-HD, respectively. Conclusions HD with or without LC can be associated with infections and complications from V. vulnificus. Clinicians should aggressively approach care and management of acutely and/or critically ill patients with VNSSTIs.
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Epidemiology, pathogenetic mechanism, clinical characteristics, and treatment of Vibrio vulnificus infection: a case report and literature review. Eur J Clin Microbiol Infect Dis 2019; 38:1999-2004. [PMID: 31325061 DOI: 10.1007/s10096-019-03629-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/02/2019] [Indexed: 12/17/2022]
Abstract
Vibrio vulnificus is a Gram-negative bacterium that belongs to the Vibrionaceae family. It represents a deadly opportunistic human pathogen which grows in water with the proper temperature and salinity, and is mostly acquired from seafood eating or direct contact. In susceptible individuals, a traumatic infection could be fatal, causing severe wound infection and even septic shock, and may require amputation. Global warming plays an important role in the geographical area expanding of Vibrio disease. The pathogenesis of Vibrio vulnificus-associated sepsis is very complex, including iron intake, cell injury, and adhesion-related protein and virulence regulation. Vibrio vulnificus infection mainly manifests clinical subtypes such as primary sepsis, traumatic infection, and gastroenteritis, with rapid symptom progression and signs of multiple organ dysfunction syndrome (MODS). It is important to assess these pathogenetic mechanisms in order to select more appropriate measures to prevent and treat Vibrio vulnificus infections, including antibiotic usage and surgical intervention. In this work, we report a typical case of successful treatment of necrotizing fasciitis caused by Vibrio vulnificus, and review the epidemiology, pathogenetic mechanism, clinical characteristics, and treatment of Vibrio vulnificus infection.
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Bonnin-Jusserand M, Copin S, Le Bris C, Brauge T, Gay M, Brisabois A, Grard T, Midelet-Bourdin G. Vibrio species involved in seafood-borne outbreaks (Vibrio cholerae, V. parahaemolyticus and V. vulnificus): Review of microbiological versus recent molecular detection methods in seafood products. Crit Rev Food Sci Nutr 2017; 59:597-610. [DOI: 10.1080/10408398.2017.1384715] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Maryse Bonnin-Jusserand
- Univ. Littoral Côte d'Opale, convention ANSES, EA 7394 – ICV – Institut Charles Viollette, Boulogne-sur-Mer, France
- INRA, France
- Univ. Lille, Lille, France
- ISA, Lille, France
- Univ. Artois, Arras, France
| | - Stéphanie Copin
- French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Laboratory for Food Safety, Boulevard du Bassin Napoléon, Boulogne-sur-Mer, France
| | - Cédric Le Bris
- Univ. Littoral Côte d'Opale, convention ANSES, EA 7394 – ICV – Institut Charles Viollette, Boulogne-sur-Mer, France
| | - Thomas Brauge
- French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Laboratory for Food Safety, Boulevard du Bassin Napoléon, Boulogne-sur-Mer, France
| | - Mélanie Gay
- French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Laboratory for Food Safety, Boulevard du Bassin Napoléon, Boulogne-sur-Mer, France
| | - Anne Brisabois
- French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Laboratory for Food Safety, Boulevard du Bassin Napoléon, Boulogne-sur-Mer, France
| | - Thierry Grard
- Univ. Littoral Côte d'Opale, convention ANSES, EA 7394 – ICV – Institut Charles Viollette, Boulogne-sur-Mer, France
| | - Graziella Midelet-Bourdin
- French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Laboratory for Food Safety, Boulevard du Bassin Napoléon, Boulogne-sur-Mer, France
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Gavin HE, Satchell KJF. Surface hypothermia predicts murine mortality in the intragastric Vibrio vulnificus infection model. BMC Microbiol 2017; 17:136. [PMID: 28629317 PMCID: PMC5477130 DOI: 10.1186/s12866-017-1045-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/09/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The Gram-negative bacterium Vibrio vulnificus can cause severe disease in humans who consume undercooked, contaminated seafood. To study food-borne V. vulnificus disease in the laboratory, mouse virulence studies predominantly use death as the primary experimental endpoint because behaviorally based moribund status does not consistently predict lethality. This study assessed ventral surface temperature (VST) and its association with mouse survival during V. vulnificus virulence studies as an efficacious, humane alternative. METHODS VST of mice intragastrically inoculated with V. vulnificus was measured every 2-h for 24 h and data for minimal VST analyzed for prediction of lethal outcome. RESULTS In contrast to the relatively stable VST of mock-infected control animals, mice infected with V. vulnificus exhibited hypothermia with minima occurring 8 to 12 h post-inoculation. The minimum VST of mice that proceeded to death was significantly lower than that of surviving mice. VST ≤ 23.5 °C was predictive of subsequent death with a sensitivity of 68% and specificity of 95%. CONCLUSIONS Use of VST ≤ 23.5 °C as an experimental endpoint during V. vulnificus infection has potential to reduce suffering of nearly 70% of mice for a mean of 10 h per mouse, without compromising experimental efficacy. Temperature cutoff of 23.5 °C exhibited 93% positive and 77% negative predictive value. For future V. vulnificus virulence studies requiring only binary comparison (e.g., LD50 assays), we find that VST can be applied as a humane endpoint. However, use of VST is not recommended when detailed survival kinetics are desired.
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Affiliation(s)
- Hannah E. Gavin
- Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave, Ward 6-205, Chicago, IL 60611 USA
| | - Karla J. F. Satchell
- Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave, Ward 6-205, Chicago, IL 60611 USA
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Heng SP, Letchumanan V, Deng CY, Ab Mutalib NS, Khan TM, Chuah LH, Chan KG, Goh BH, Pusparajah P, Lee LH. Vibrio vulnificus: An Environmental and Clinical Burden. Front Microbiol 2017; 8:997. [PMID: 28620366 PMCID: PMC5449762 DOI: 10.3389/fmicb.2017.00997] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/17/2017] [Indexed: 12/14/2022] Open
Abstract
Vibrio vulnificus is a Gram negative, rod shaped bacterium that belongs to the family Vibrionaceae. It is a deadly, opportunistic human pathogen which is responsible for the majority of seafood-associated deaths worldwide. V. vulnificus infection can be fatal as it may cause severe wound infections potentially requiring amputation or lead to sepsis in susceptible individuals. Treatment is increasingly challenging as V. vulnificus has begun to develop resistance against certain antibiotics due to their indiscriminate use. This article aims to provide insight into the antibiotic resistance of V. vulnificus in different parts of the world as well as an overall review of its clinical manifestations, treatment, and prevention. Understanding the organism's antibiotic resistance profile is vital in order to select appropriate treatment and initiate appropriate prevention measures to treat and control V. vulnificus infections, which should eventually help lower the mortality rate associated with this pathogen worldwide.
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Affiliation(s)
- Sing-Peng Heng
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University MalaysiaBandar Sunway, Malaysia
| | - Vengadesh Letchumanan
- Division of Genetics and Molecular Biology, Faculty of Science, Institute of Biological Sciences, University of MalayaKuala Lumpur, Malaysia
- Novel Bacteria and Drug Discovery Research Group, School of Pharmacy, Monash University MalaysiaBandar Sunway, Malaysia
| | - Chuan-Yan Deng
- Zhanjiang Evergreen South Ocean Science and Technology CorporationGuangdong, China
| | - Nurul-Syakima Ab Mutalib
- UKM Medical Centre, UKM Medical Molecular Biology Institute, Universiti Kebangsaan MalaysiaKuala Lumpur, Malaysia
| | - Tahir M. Khan
- Novel Bacteria and Drug Discovery Research Group, School of Pharmacy, Monash University MalaysiaBandar Sunway, Malaysia
- Department of Pharmacy, Absyn University PeshawarPeshawar, Pakistan
| | - Lay-Hong Chuah
- Novel Bacteria and Drug Discovery Research Group, School of Pharmacy, Monash University MalaysiaBandar Sunway, Malaysia
| | - Kok-Gan Chan
- Division of Genetics and Molecular Biology, Faculty of Science, Institute of Biological Sciences, University of MalayaKuala Lumpur, Malaysia
| | - Bey-Hing Goh
- Novel Bacteria and Drug Discovery Research Group, School of Pharmacy, Monash University MalaysiaBandar Sunway, Malaysia
- Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of PhayaoPhayao, Thailand
| | - Priyia Pusparajah
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University MalaysiaBandar Sunway, Malaysia
| | - Learn-Han Lee
- Novel Bacteria and Drug Discovery Research Group, School of Pharmacy, Monash University MalaysiaBandar Sunway, Malaysia
- Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of PhayaoPhayao, Thailand
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Gavin HE, Beubier NT, Satchell KJF. The Effector Domain Region of the Vibrio vulnificus MARTX Toxin Confers Biphasic Epithelial Barrier Disruption and Is Essential for Systemic Spread from the Intestine. PLoS Pathog 2017; 13:e1006119. [PMID: 28060924 PMCID: PMC5218395 DOI: 10.1371/journal.ppat.1006119] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 12/12/2016] [Indexed: 12/14/2022] Open
Abstract
Vibrio vulnificus causes highly lethal bacterial infections in which the Multifunctional Autoprocessing Repeats-in-Toxins (MARTX) toxin product of the rtxA1 gene is a key virulence factor. MARTX toxins are secreted proteins up to 5208 amino acids in size. Conserved MARTX N- and C-terminal repeat regions work in concert to form pores in eukaryotic cell membranes, through which the toxin's central region of modular effector domains is translocated. Upon inositol hexakisphosphate-induced activation of the of the MARTX cysteine protease domain (CPD) in the eukaryotic cytosol, effector domains are released from the holotoxin by autoproteolytic activity. We previously reported that the native MARTX toxin effector domain repertoire is dispensable for epithelial cellular necrosis in vitro, but essential for cell rounding and apoptosis prior to necrotic cell death. Here we use an intragastric mouse model to demonstrate that the effector domain region is required for bacterial virulence during intragastric infection. The MARTX effector domain region is essential for bacterial dissemination from the intestine, but dissemination occurs in the absence of overt intestinal tissue pathology. We employ an in vitro model of V. vulnificus interaction with polarized colonic epithelial cells to show that the MARTX effector domain region induces rapid intestinal barrier dysfunction and increased paracellular permeability prior to onset of cell lysis. Together, these results negate the inherent assumption that observations of necrosis in vitro directly predict bacterial virulence, and indicate a paradigm shift in our conceptual understanding of MARTX toxin function during intestinal infection. Results implicate the MARTX effector domain region in mediating early bacterial dissemination from the intestine to distal organs-a key step in V. vulnificus foodborne pathogenesis-even before onset of overt intestinal pathology.
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Affiliation(s)
- Hannah E. Gavin
- Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Nike T. Beubier
- Department of Pathology, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, IL, United States of America
| | - Karla J. F. Satchell
- Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
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Abstract
Vibrio vulnificus, carrying a 50% fatality rate, is the most deadly of the foodborne pathogens. It occurs in estuarine and coastal waters and it is found in especially high numbers in oysters and other molluscan shellfish. The biology of V. vulnificus, including its ecology, pathogenesis, and molecular genetics, has been described in numerous reviews. This article provides a brief summary of some of the key aspects of this important human pathogen, including information on biotypes and genotypes, virulence factors, risk factor requirements and the role of iron in disease, association with oysters, geographic distribution, importance of salinity and water temperature, increasing incidence associated with global warming. This article includes some of our findings as presented at the "Vibrios in the Environment 2010" conference held in Biloxi, MS.
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Huang KC, Weng HH, Yang TY, Chang TS, Huang TW, Lee MS. Distribution of Fatal Vibrio Vulnificus Necrotizing Skin and Soft-Tissue Infections: A Systematic Review and Meta-Analysis. Medicine (Baltimore) 2016; 95:e2627. [PMID: 26844475 PMCID: PMC4748892 DOI: 10.1097/md.0000000000002627] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/17/2015] [Accepted: 01/05/2016] [Indexed: 12/14/2022] Open
Abstract
Vibrio vulnificus necrotizing skin and soft tissue infections (VNSSTIs), which have increased significantly over the past few decades, are still highly lethal and disabling diseases despite advancing antibiotic and infection control practices. We, therefore, examined the spatiotemporal distribution of worldwide reported episodes and associated mortality rates of VNSSTIs between 1966 and 2014. The PubMed and Cochrane Library databases were systematically searched for observational studies on patients with VNSSTIs. The primary outcome was all-cause mortality. We did random-effects meta-analysis to obtain estimates for primary outcomes; the estimates are presented as means plus a 95% confidence interval (CI). Data from the selected studies were also extracted and pooled for correlation analyses.Nineteen studies of 2227 total patients with VNSSTIs were analyzed. More than 95% of the episodes occurred in the subtropical western Pacific and Atlantic coastal regions of the northern hemisphere. While the number of cases and the number of deaths were not correlated with the study period (rs = 0.476 and 0.310, P = 0.233 and 0.456, respectively), the 5-year mortality rate was significantly negatively correlated with them (rs = -0.905, P = 0.002). Even so, the pooled estimate of total mortality rates from the random-effects meta-analysis was as high as 37.2% (95% CI: 0.265-0.479).These data suggest that VNSSTIs are always an important public health problem and will become more critical and urgent because of global warming. Knowing the current distribution of VNSSTIs will help focus education, policy measures, early clinical diagnosis, and appropriate medical and surgical treatment for them.
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Affiliation(s)
- Kuo-Chin Huang
- From the College of Medicine, Chang Gung University, Taoyuan (K-CH, H-HW, T-SC, T-WH, MSL); Department of Orthopaedic Surgery (K-CH, T-YY, T-WH); Department of Diagnostic Radiology (H-HW); Department of Gastroenterology, Chang Gung Memorial Hospital, Chaiyi (T-SC); and Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan (MSL)
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Genotypic Diversity and Population Structure of Vibrio vulnificus Strains Isolated in Taiwan and Korea as Determined by Multilocus Sequence Typing. PLoS One 2015; 10:e0142657. [PMID: 26599487 PMCID: PMC4658092 DOI: 10.1371/journal.pone.0142657] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 10/26/2015] [Indexed: 12/18/2022] Open
Abstract
The genetic diversity and population structure of Vibrio vulnificus isolates from Korea and Taiwan were investigated using PCR-based assays targeting putative virulence-related genes and multilocus sequence typing (MLST). BOX-PCR genomic fingerprinting identified 52 unique genotypes in 84 environmental and clinical V. vulnificus isolates. The majority (> 50%) of strains had pathogenic genotypes for all loci tested; moreover, many environmental strains had pathogenic genotypes. Although significant (p < 0.05) inter-relationships among the genotypes were observed, the association between genotype and strain source (environmental or clinical) was not significant, indicating that genotypic characteristics alone are not sufficient to predict the isolation source or the virulence of a given V. vulnificus strain and vice versa. MLST revealed 23–35 allelic types per locus analyzed, resulting in a total of 44 unique sequence types (STs). Two major monophyletic groups (lineages A and B) corresponding to the two known lineages of V. vulnificus were observed; lineage A had six STs that were exclusively environmental, whereas lineage B had STs from both environmental and clinical sources. Pathogenic and nonpathogenic genotypes predominated in MLST lineages B and A, respectively. In addition, V. vulnificus was shown to be in linkage disequilibrium (p < 0.05), although two different recombination tests (PHI and Sawyer’s tests) detected significant evidence of recombination. Tajima’s D test also indicated that V. vulnificus might be comprised of recently sub-divided lineages. These results suggested that the two lineages revealed by MLST correspond to two distinct ecotypes of V. vulnificus.
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Lee TH, Chung KM. Development and characterization of a catalytically inactive cysteine protease domain of RtxA1/MARTXVv as a potential vaccine for Vibrio vulnificus. Microbiol Immunol 2015; 59:555-61. [PMID: 26177798 DOI: 10.1111/1348-0421.12284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/01/2015] [Accepted: 07/12/2015] [Indexed: 01/22/2023]
Abstract
Recent studies have defined several virulence factors as vaccine candidates against Vibrio vulnificus. However, most of these factors have the potential to cause pathogenic effects in the vaccinees or induce incomplete protection. To overcome these drawbacks, a catalytically inactive form, CPDVv (C3725S), of the well-conserved cysteine protease domain (CPD) of V. vulnificus multifunctional autoprocessing repeats-in-toxin (MARTXVv /RtxA1) was recombinantly generated and characterized. Notably, active and passive immunization with CPDVv (C3725S) conferred protective immunity against V. vulnificus strains. These results may provide a novel framework for developing safe and efficient subunit vaccines and/or therapeutics against V. vulnificus that target the CPD of MARTX toxins.
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Affiliation(s)
| | - Kyung Min Chung
- Department of Microbiology and Immunology.,Institute for Medical Science, Chonbuk National University Medical School, Jeonju, Jeonbuk, 561-756, Korea
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14
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Miyoshi SI. Extracellular proteolytic enzymes produced by human pathogenic vibrio species. Front Microbiol 2013; 4:339. [PMID: 24302921 PMCID: PMC3831164 DOI: 10.3389/fmicb.2013.00339] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/26/2013] [Indexed: 12/19/2022] Open
Abstract
Bacteria in the genus Vibrio produce extracellular proteolytic enzymes to obtain nutrients via digestion of various protein substrates. However, the enzymes secreted by human pathogenic species have been documented to modulate the bacterial virulence. Several species including Vibrio cholerae and V. vulnificus are known to produce thermolysin-like metalloproteases termed vibriolysin. The vibriolysin from V. vulnificus, a causative agent of serious systemic infection, is a major toxic factor eliciting the secondary skin damage characterized by formation of the hemorrhagic brae. The vibriolysin from intestinal pathogens may play indirect roles in pathogenicity because it can activate protein toxins and hemagglutinin by the limited proteolysis and can affect the bacterial attachment to or detachment from the intestinal surface by degradation of the mucus layer. Two species causing wound infections, V. alginolyticus and V. parahaemolyticus, produce another metalloproteases so-called collagenases. Although the detailed pathological roles have not been studied, the collagenase is potent to accelerate the bacterial dissemination through digestion of the protein components of the extracellular matrix. Some species produce cymotrypsin-like serine proteases, which may also affect the bacterial virulence potential. The intestinal pathogens produce sufficient amounts of the metalloprotease at the small intestinal temperature; however, the metalloprotease production by extra-intestinal pathogens is much higher around the body surface temperature. On the other hand, the serine protease is expressed only in the absence of the metalloprotease.
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Affiliation(s)
- Shin-Ichi Miyoshi
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Okayama, Japan
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Kuo SH, Tsai CF, Li CR, Tsai SJ, Chao WN, Chan KS, Lee YT, Wong RH, Chen CC, Chen SC. Rapid Emergency Medicine Score as a main predictor of mortality in Vibrio vulnificus–related patients. Am J Emerg Med 2013; 31:1037-41. [DOI: 10.1016/j.ajem.2013.03.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 02/06/2013] [Accepted: 03/16/2013] [Indexed: 12/17/2022] Open
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Yokochi N, Tanaka S, Matsumoto K, Oishi H, Tashiro Y, Yoshikane Y, Nakashima M, Kanda K, Kobayashi G. Distribution of virulence markers among Vibrio vulnificus isolates of clinical and environmental origin and regional characteristics in Japan. PLoS One 2013; 8:e55219. [PMID: 23383115 PMCID: PMC3559389 DOI: 10.1371/journal.pone.0055219] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 12/20/2012] [Indexed: 12/20/2022] Open
Abstract
Background Vibrio vulnificus is an opportunistic human pathogen that is widely distributed in estuarine environments and is capable of causing necrotizing fasciitis and sepsis. In Japan, based on epidemiological research, the incidences of V. vulnificus were concentrated in Kyusyu, mainly in coastal areas of the Ariake Sea. To examine the virulence potential, various genotyping methods have recently been developed. This study aimed to investigate the distribution of virulence markers among V. vulnificus isolates of clinical and environmental origin in three coastal areas with different infection incidences and to determine whether these isolates have the siderophore encoding gene viuB. Methodology/Principal Findings We examined the distribution of genotypes of the 16S ribosomal ribonucleic acid (rRNA) gene, vvhA, vcg, and capsular polysaccharide (CPS), and the presence of viuB in 156 isolates collected from patients and environmental samples in Japan. The environmental samples were collected from three coastal areas: the Ariake Sea, Ise & Mikawa Bay, and Karatsu Bay. The results showed disparity in the ratios of genotypes depending on the sample origins. V. vulnificus isolates obtained from patients were classified into the clinical type for all genotypes. In the environmental isolates, the ratios of the clinical type for genotypes of the 16S rRNA gene, vvhA, and vcg were in the order of the Ariake Sea>Ise & Mikawa Bay>Karatsu Bay. Meanwhile, CPS analysis showed no significant difference. Most isolates possessed viuB. Conclusions Many V. vulnificus belonging to the clinical type existed in the Ariake Sea. Three coastal areas with different infection incidences showed distinct ratios of genotypes. This may indicate that the distribution of clinical isolates correlates with the incidence of V. vulnificus infection.
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Affiliation(s)
- Nana Yokochi
- Department of Applied Biochemistry and Food Science, Faculty of Agriculture, Saga University, Saga, Japan
| | - Shigemitsu Tanaka
- Biomaterials and Commodity Chemicals Research Division, Osaka Municipal Technical Research Institute, Osaka, Japan
| | - Kouichi Matsumoto
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Hirotaka Oishi
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yukihiro Tashiro
- Institute of Advanced Study, Kyusyu University, Higashi-ku, Fukuoka, Japan
| | - Yu Yoshikane
- Tosa Food Business Creator Project Team, Kochi University, Nankoku, Kochi, Japan
| | - Mikio Nakashima
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Kohzo Kanda
- Department of Applied Biochemistry and Food Science, Faculty of Agriculture, Saga University, Saga, Japan
| | - Genta Kobayashi
- Department of Applied Biochemistry and Food Science, Faculty of Agriculture, Saga University, Saga, Japan
- * E-mail:
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Kuo Chou TN, Chao WN, Yang C, Wong RH, Ueng KC, Chen SC. Predictors of mortality in skin and soft-tissue infections caused by Vibrio vulnificus. World J Surg 2011; 34:1669-75. [PMID: 20151130 DOI: 10.1007/s00268-010-0455-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Vibrio vulnificus infection can progress rapidly in skin or soft tissue, and it is potentially life-threatening. The purpose of the present study was to explore the predictors of mortality in patients with V. vulnificus infections of skin or soft tissue. METHODS The medical records of 119 consecutive patients aged > or =18 years, hospitalized for V. vulnificus infections of skin or soft tissue between January 2000 and December 2007 were reviewed. Co-morbidities, clinical manifestations, laboratory studies, treatments, and outcomes were analyzed. Multiple logistic regression with the exact method was performed. RESULTS The mean age of the patients was 63.7 +/- 12.0 years. Twenty-four patients died, yielding an overall case fatality rate of 20%. Of the 24 deaths, 20 (83%) occurred within 72 h after hospital admission. Of 119 patients, 45 patients had primary septicemia, and 74 patients had wound infection. Multivariate analysis revealed that the following factors were associated with mortality: hemorrhagic bullous skin lesions/necrotizing fasciitis (p = 0.003), primary septicemia (p = 0.042), a greater organ dysfunction and/or infection score (p = 0.005), absence of leukocytosis (p = 0.0001), and hypoalbuminemia (p = 0.003). Treatment with surgical intervention plus antibiotics (p = 0.038) and surgical intervention within 24 h after admission (p = 0.017) were protective factors. CONCLUSIONS This study demonstrates that the presence of hemorrhagic bullous skin lesions/necrotizing fasciitis, primary septicemia, a greater severity-of-illness, absence of leukocytosis, and hypoalbuminemia were the significant risk factors for mortality in these patients. Moreover, patients treated with surgery plus antibiotics, especially those receiving a prompt surgical evaluation within 24 h after hospital admission, may have a better prognosis.
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Affiliation(s)
- Tsai-Nung Kuo Chou
- Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., Taichung, 40201, Taiwan
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Clinical outcomes and prognostic factors for patients with Vibrio vulnificus infections requiring intensive care: a 10-yr retrospective study. Crit Care Med 2010; 38:1984-90. [PMID: 20657269 DOI: 10.1097/ccm.0b013e3181eeda2c] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Vibrio vulnificus infection is uncommon but potentially life-threatening. The aim of this study was to evaluate clinical outcomes and prognostic factors for patients with V. vulnificus infections admitted to an intensive care unit. DESIGN Retrospective study. SETTING Multidisciplinary intensive care unit in a 2300-bed teaching hospital. PATIENTS Eighty-five adult patients (≥ 18 yrs) with V. vulnificus infections who required intensive care were enrolled and reviewed during a 10-yr period. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Thirty-four of the 85 patients died, giving an intensive care unit mortality rate of 40%. The mean Acute Physiology and Chronic Health Evaluation II score on intensive care unit admission was 18.4 (95% confidence interval, 17.1-19.8). The most common underlying disease was hepatic disease (48%) followed by diabetes mellitus (22%). Multivariate analysis showed that risk factors for intensive care unit mortality were the presence of hemorrhagic bullous skin lesions/necrotizing fasciitis (relative risk, 2.4; 95% confidence interval, 1.3-4.5; p = .006), skin/soft tissue infections involving two or more limbs (relative risk, 2.5; 95% confidence interval, 1.1-5.7; p = .025), and higher Acute Physiology and Chronic Health Evaluation II scores on intensive care unit admission (relative risk, 1.2; 95% confidence interval, 1.1-1.3; p = .0001). In contrast, surgical treatment < 24 hrs after arrival was inversely associated with intensive care unit mortality (relative risk, 0.35; 95% confidence interval, 0.15-0.79; p = .012). In addition, the area under the receiver operating characteristic curve for Acute Physiology and Chronic Health Evaluation II for predicting intensive care unit mortality was 0.945 (95% confidence interval, 0.873-0.983; p = .0001). An optimal cutoff Acute Physiology and Chronic Health Evaluation II score of ≥ 20 had a sensitivity of 97% and a specificity of 86% with a 41.4-fold increased risk of fatality (p = .0003). CONCLUSIONS This study found that V. vulnificus-infected patients with hemorrhagic bullous skin lesions/necrotizing fasciitis, skin/soft tissue infections involving two or more limbs, or higher Acute Physiology and Chronic Health Evaluation II scores have high risks of intensive care unit mortality. However, patients receiving prompt surgical treatments within 24 hrs after admission have better prognoses.
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Kashimoto T. [Current status and future prospects in a pathogenic study of Vibrio vulnificus]. Nihon Saikingaku Zasshi 2010; 65:369-78. [PMID: 20808058 DOI: 10.3412/jsb.65.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Takashige Kashimoto
- Laboratory of Veterinary Public Health, Kitasato University School of Veterinary Medicine, Higashi, Towada-shi, Aomori
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Chou TNK, Lee YT, Lai YY, Chao WN, Yang C, Chen CC, Wang PH, Lin DB, Wong RH, Chen SC. Prognostic factors for primary septicemia and wound infection caused by Vibrio vulnificus. Am J Emerg Med 2010; 28:424-31. [DOI: 10.1016/j.ajem.2008.12.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 12/29/2008] [Accepted: 12/30/2008] [Indexed: 12/17/2022] Open
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Austin B. Vibrios as causal agents of zoonoses. Vet Microbiol 2010; 140:310-7. [DOI: 10.1016/j.vetmic.2009.03.015] [Citation(s) in RCA: 275] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 02/09/2009] [Accepted: 03/02/2009] [Indexed: 01/01/2023]
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MORIMOTO K, HANAOKA K, NAKAMURA R, ISHIKAWA T, SHINODA S. Vibrio vulnificusinfection: A case infected by contaminated fishing gear. J Dermatol 2009; 36:620-1. [DOI: 10.1111/j.1346-8138.2009.00715.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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