[13] The ability to now carry out transformation experiments in the laboratory should facilitate molecular genetic analysis of this opportunistic pathogen.
In someone with a compromised immune system, particularly those with chronic liver disease, it can infect the bloodstream, causing a severe and life-threatening illness characterized by fever and chills, decreased blood pressure (septic shock), and blistering skin lesions.
While men have been shown to be more at risk from this infection than women, co-morbidities such as alcoholic cirrhosis and diseases affecting the endocrine system (diabetes, rheumatoid arthritis, etc.)
The capsular proteins the bacteria express, however, are capable of producing an immune response contributing to shock syndrome.
The optimal treatment is not known, but in one retrospective study of 93 people in Taiwan, the use of a third-generation cephalosporin and a tetracycline (e.g., ceftriaxone and doxycycline, respectively) was associated with an improved outcome.
[27] Prospective clinical trials are needed to confirm this finding, but in vitro data support the suggestion that this combination is synergistic against V. vulnificus.
Likewise, the American Medical Association and the Centers for Disease Control and Prevention (CDC) recommend treating the person with a quinolone or intravenous doxycycline with ceftazidime.
Key to the diagnosis and treatment were the early recognition of bullae in an immunocompromised person with liver cirrhosis and oyster ingestion within the previous 48 hours, and the request by the physician for STAT Gram staining and blood cultures for V.
If treatment with tetracycline or other cephalosporin antibiotics is initiated at the onset of symptoms and the full course followed, patients generally experience no long-term effects.
[27] People especially vulnerable are those with liver disease (especially cirrhosis and hepatitis) or immunocompromised states (some kinds of cancer, bone marrow suppression, HIV, diabetes, etc.).
In these cases, V. vulnificus usually enters the bloodstream, where it may cause fever and chills, septic shock (with sharply decreased blood pressure), and blistering skin lesions.
The consumption of contaminated raw oysters in those with chronic liver disease causes primary sepsis with a mortality rate of over 50%.
Females having had an oophorectomy experienced increased mortality rates, as estrogen has been shown experimentally to have a protective effect against V.
[35] Most deaths at that time were occurring due to fulminant sepsis, either in the area of oyster harvest and ingestion, or in tourists returning home.
Lack of disease recognition, and also of the risk factors, presentation, and cause, were and are major obstacles to good outcome and recovery.
[citation needed] Increasing seasonal temperatures and decreasing salinity levels seem to favor a greater concentration of Vibrio within filter-feeding shellfish of the U.S. Atlantic seaboard and the Gulf of Mexico, especially oysters (Crassostrea virginica).
The vast majority of people who develop sepsis from V. vulnificus became ill after they ate raw oysters; most of these cases have been men.
[2] In 2005, health officials clearly identified strains of V. vulnificus infections among evacuees from New Orleans due to the flooding there caused by Hurricane Katrina.