Wednesday, October 4, 2023
| Characteristic | V. alginolyticus | V. parahaemolyticus | V. cholerae non-O1/O139 | V. vulnificus | Other species |
|---|---|---|---|---|---|
| Total patients | 23 (100) | 20 (100) | 10 (100) | 7 (100) | 7 (100) |
| Demographics | |||||
| Age, y, median (SD) | 50 (+26.7) | 53 (+22.8) | 69 (+19.7) | 66 (+11.5) | 40 (+24.8) |
| Sex | |||||
| M | 19 (83) | 15 (75) | 7 (70) | 7 (100) | 6 (86) |
| F | 4 (17) | 5 (25) | 3 (30) | 0 | 1 (14) |
| Underlying condition | |||||
| Heart failure | 8 (35) | 6 (30) | 5 (50) | 4 (57) | 1 (14) |
| Neoplasia | 1 (4) | 5 (25) | 4 (40) | 0 (0) | 1 (14) |
| Diabetes | 2 (9) | 3 (15) | 1 (10) | 1 (14) | 1 (14) |
| Kidney failure | 2 (9) | 1 (5) | 1 (10) | 0 | 3 (43) |
| Immune disease | 2 (9) | 2 (10) | 1 (10) | 0 | 2 (29) |
| Hemopathy | 1 (4) | 1 (5) | 1 (10) | 1 (14) | 1 (14) |
| Liver disease | 1 (4) | 1 (5) | 2 (20) | 1 (14) | 0 |
| Alcohol use disorder | 2 (9) | 1 (5) | 2 (20) | 2 (29) | 0 |
| Preexisting wound | 3 (13) | 0 | 0 | 3 (43) | 0 |
| Digestive surgery | 2 (9) | 2 (10) | 1 (10) | 0 | 1 (14) |
| Time to symptom onset, d, median (SD) | 2.4 (+2.0) | 1.3 (+0.9) | 3 (+4.4) | 5.6 (+8.1) | 1 (+0.0) |
| Infection type | |||||
| Acute | 14 (61) | 19 (95) | 10 (100) | 7 (100) | 5 (71) |
| Chronic | 9 (39) | 1 (5) | 0 | 0 | 2 (29) |
| Outcome | |||||
| Recovered | 21 (91) | 17 (85) | 8 (80) | 6 (86) | 7 (100) |
| Died | 2 (9) | 3 (15) | 2 (20) | 1 (14) | 0 |
Table 1. Clinical characteristics of patients with Vibrio infection, by species, Bay of Biscay, France, 2001–2019*
*Values are no. (%) except as indicated.
| Antibiotic | V. alginolyticus | V. parahaemolyticus | V. cholerae non-O1/O139 | V. vulnificus | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| S | I | R | S | I | R | S | I | R | S | I | R | ||||
| Amoxicillin | 1 | 0 | 15 | 1 | 6 | 7 | 2 | 2 | 3 | 5 | 0 | 0 | |||
| Ticarcillin | 5 | 0 | 10 | 2 | 2 | 9 | 5 | 0 | 1 | 5 | 0 | 0 | |||
| First-generation cephalosporin | 10 | 4 | 0 | 13 | 1 | 0 | 4 | 1 | 0 | 4 | 1 | 0 | |||
Table 2. Available drug-susceptibility test results for the main antibiotics used to treat Vibrio infections, by species, Bay of Biscay, France, 2001–2019*
*Data are no. of cases. I, intermediate; R, resistant; S, susceptible.
| Characteristic | No sepsis, n = 42 | Septic shock, n = 13 | p value | ||||
|---|---|---|---|---|---|---|---|
| No. | % (95% CI) | No. | % (95% CI) | ||||
| Patient sex | |||||||
| M | 35 | 83 (72–95) | 10 | 77 (54–100) | 0.685 | ||
| F | 7 | 17 (5–28) | 3 | 23 (0.2–46) | |||
| Underlying conditions | |||||||
| Heart failure | 18 | 43 (28–58) | 6 | 46 (19–73) | Referent | ||
| Neoplasia | 6 | 14 (4–25) | 4 | 31 (6–56) | 0.223 | ||
| Diabetes | 7 | 17 (5–28) | 1 | 8 (0–22) | 0.664 | ||
| Kidney failure | 5 | 12 (2–22) | 2 | 15 (0–35) | 0.664 | ||
| Immune disease | 5 | 12 (2–22) | 2 | 15 (0–35) | 0.664 | ||
| Hemopathy | 3 | 7 (0–15) | 2 | 15 (0–35) | 0.582 | ||
| Liver disease | 2 | 5 (0–11) | 3 | 23 (0–46) | 0.318 | ||
| Alcohol use disorder | 3 | 7 (0–15) | 4 | 31 (6–56) | 0.102 | ||
| Preexisting wound | 6 | 14 (4–25) | 0 | 0 (0–0) | 0.317 | ||
| Digestive surgery | 4 | 10 (1–18) | 2 | 15 (0–35) | 0.618 | ||
| Species | |||||||
| V. alginolyticus | 10 | 24 (11–37) | 4 | 31 (6–56) | |||
| V. parahaemolyticus | 14 | 33 (19–48) | 5 | 38 (12–65) | |||
| V. cholerae non-O1/O139 | 8 | 19 (7–31) | 2 | 15 (0–35) | |||
| V. vulnificus | 6 | 14 (4–25) | 1 | 8 (0–22) | |||
| Other Vibrio species | 4 | 10 (1–18) | 1 | 8 (0–22) | |||
| Outcome | |||||||
| Recovered | 40 | 95 (89–100) | 7 | 54 (27–81) | 0.001 | ||
| Died | 2 | 5 (0–11) | 6 | 46 (19–73) | |||
Table 3. Clinical characteristics and outcome of patients with and without septic shock after acute Vibrio infection, Bay of Biscay, France, 2001–2019*
*Median patient age ( + SD) was 60 ( + 21.4) for no sepsis and 61 ( + 15.3) for septic shock.
Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 1.00 ABIM MOC points
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Noncholera vibriosis is a rare, opportunistic bacterial infection caused by Vibrio spp. other than V. cholerae O1/O139 and diagnosed mainly during the hot summer months in patients after seaside activities. Detailed knowledge of circulating pathogenic strains and heterogeneities in infection outcomes and disease dynamics may help in patient management. We conducted a multicenter case-series study documenting Vibrio infections in 67 patients from 8 hospitals in the Bay of Biscay, France, over a 19-year period. Infections were mainly caused by V. alginolyticus (34%), V. parahaemolyticus (30%), non-O1/O139 V. cholerae (15%), and V. vulnificus (10%). Drug-susceptibility testing revealed intermediate and resistant strains to penicillins and first-generation cephalosporins. The acute infections (e.g., those involving digestive disorder, cellulitis, osteitis, pneumonia, and endocarditis) led to a life-threatening event (septic shock), amputation, or death in 36% of patients. Physicians may need to add vibriosis to their list of infections to assess in patients with associated risk factors.
Some opportunistic pathogens associated with marine environments are already known but until now have caused rare infectious diseases. Among those pathogens are Vibrio spp. other than the well-known V. cholerae belonging to serogroups O1 and O139, which causes cholera. Vibrio spp. are gram negative, curved, rod-shaped bacteria that are natural inhabitants of the aquatic environment [1]. Vibrio infections can be very severe or even fatal; they cause gastroenteritis, severe bacterial cellulitis, or necrotizing fasciitis and can lead to septic shock. Infections are more common in patients with multiple underlying conditions, including liver disease, heart failure, diabetes, liver cirrhosis, alcohol abuse, and immunocompromising conditions [2–5]. Vibrio spp. can also cause mild diseases, such as chronic ear infections, which are more likely to affect younger patients [6]. Humans acquire Vibrio infections after eating contaminated raw seafood, especially oysters, or after exposing an injury to the marine environment [7]. Infections occur mainly during the hot summer months, which is probably attributable to higher water temperatures [8,9] and to increased seawater-related activities.
Because vibriosis is a relatively rare disease and is not reported in most national surveillance systems, the global incidence rate of Vibrio spp. infections other than V. cholerae O1/O139 is underestimated. In the United States, where those infections are notifiable, a marked seasonal distribution and an increasing incidence rate have been observed [10–12]. Because of their rarity, Vibrio infections are very poorly known and therefore probably underdiagnosed. Delays in therapeutic management and, in particular, in the prescription of a targeted antibiotic regimen have been documented [13]. Our study aimed to make an inventory of Vibrio infections diagnosed in hospitals in the Bay of Biscay on the west coast of France and to describe the clinical and epidemiologic characteristics of the patients and their therapeutic management.
