What is the mortality and morbidity associated with Vibrio infections?

Updated: Jun 21, 2021
  • Author: Hoi Ho, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

According to CDC estimates, foodborne diseases cause approximately 48 million illnesses, 128,000 hospitalizations, [2]  and 3000 deaths annually in the United States. [1]

Foodborne noncholera Vibrio infections may occur at rate of 0.2-0.3 case per 100,000 population. In 2011, CDC estimates 4,500 cases of V parahaemolyticus infection annually, resulting in 129 hospitalizations and 5 deaths. Two hundred and seven cases of V vulnificus infection are estimated to occur annually, resulting in 200 hospitalizations and 77 deaths. [2]

Although Vibrio infections are not as common as Campylobacter, Salmonella, or Listeria infections, more patients with Vibrio infections die because of the high mortality rate (35-50%) associated with V vulnificus septicemia.

Among all foodborne diseases, V vulnificus infection is associated with the highest case fatality rate (39%).

Patients with cirrhosis who consumed raw oysters were 80 times more likely to develop V vulnificus infection and 200 times more likely to die of the infection than those without liver disease who consumed raw oysters. [31]  A 2017 case study reported V vulnificus cellulitis in a patient with a recent leg tattoo who was infected while swimming in the Gulf of Mexico. The patient had underlying chronic liver disease and died of Vibrio septic shock despite early identification of the infection and aggressive initial empiric treatment with doxycycline and ceftriaxone. [32]

A meta-analysis of 12 studies with 1157 patients wih V. vulnificus necrotizing skin and soft tissue infections (VNSSTI) revealed a mortality rate of 53.9% in patients with hepatic disease (HD), and 16.1% in non-HD patients. Patients with HD contracted VNSSTIs were more than twice as likely as non-HD patients to die (risk ratio, 2.61). [33]

Of the 75 cases of V vulnificus infection reported by the FDA between 2002 and 2007, it appears that the number of oysters consumed (one oyster vs more than 24 oysters) does not relate to the interval before symptom development (0-7 days) or patient outcomes (mortality, 33% vs 25%). [34]

A 10-year retrospective study reported that an APACHE II score of 20 or more on the first day of admission is an accurate and reliable predictor of ICU mortality among patients with V vulnificus necrotizing fasciitis (sensitivity, 97%; specificity, 86%; NPV, 98%. [35]

In a retrospective study of 34 patients with V vulnificus infection, the initial arterial pH levels obtained upon hospital admission were found to be an important and more accurate prognostic indicator than the APACHE II score. Regardless of whether emergency surgery was performed and appropriate antimicrobial drug therapy administered, all 9 patients with an admission arterial pH < 7.2 died, whereas all 18 patients who had an initial arterial pH ≥7.35 survived. A pH level < 7.35 was an accurate predictor of death (sensitivity, 100%; specificity, 83%; PPV, 84%; NPV, 100%). [36]

Regardless of pre-existing conditions, the mortality risk increases in patients with V vulnificus infection who are hospitalized more than 2 days after symptoms develop (odds ratio, 2.9). [37]

A delay in performing the first fasciotomy (>24 h) after development of clinical symptoms in patients with V vulnificus necrotizing fasciitis was associated with 5-fold increase in the mortality risk.


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