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Reagents for serogrouping Vibrio cholerae isolates are available in all state health department laboratories in the U.S. Commercially available rapid test kits are useful in epidemic settings but do not yield an isolate for antimicrobial susceptibility testing and subtyping, and should not be used for routine diagnosis …The diagnosis can be confirmed by isolation of V. cholerae from stool cultures performed on specific selective media. Rapid tests such as stool dipsticks or darkfield microscopy can support the diagnosis in settings where stool culture is not readily available. (See ‘Diagnostic studies’ below.)Even with the most sophisticated and high-tech equipment or rapid presumptive detection methods that use differential media such as MacConkey agar and thiosulfate-citrate-bile salts-sucrose (TCBS) agar, more than 2 days is needed for the definitive identification of V. vulnificus from blood or tissue samples.
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This video presentation by Dr. David Sack provides easy-to-follow instructions on the use of the Crystal VC dipstick test to test a fecal specimen for the presence of vibrio cholera. The video covers direct and enriched tests.
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Vibrio Species Detection and Identification in Seafood
How to enrich, detect and entify the three main pathogenic species, Vibrio cholerae, V. parahaemolyticus and V. vulnificus, from seafood.
Source: www.rapidmicrobiology.com
Date Published: 12/7/2021
View: 6575
Which lab tests are performed in the diagnosis of Vibrio …
Which lab tests are performed in the diagnosis of Vibrio vulnificus infection? … Routine stool, wound, and blood cultures a in the diagnosis of V vulnificus …
Source: www.medscape.com
Date Published: 10/16/2022
View: 2766
Diagnosis and Treatment | Vibrio Illness (Vibriosis) | CDC
Clinicians may suspect vibriosis if a patient has watery diarrhea and has recently eaten raw or undercooked seafood. Vibriosis is diagnosed by Vibrio …
Source: www.cdc.gov
Date Published: 6/29/2022
View: 9066
A RAPID TEST FOR THE IDENTIFICATION OF VIBRIO … – jstor
A rap test to entify Vibrio choierae in stools has been developed. … technique, low cost and easy preparation, the test can be performed in a …
Source: www.jstor.org
Date Published: 12/24/2022
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Evidence of False Positivity for Vibrio Species Tested by …
These findings emphasize the need for improvements to testing platform specificity … However, Vibrio spp. can now be detected by several …
Source: academic.oup.com
Date Published: 4/12/2021
View: 9733
Vibrio spp. – Food | Public Health Ontario
For sampling, follow the instructions found in Public Health Inspector’s Gue to Environmental Microbiology Laboratory Testing. Shipping …
Source: www.publichealthontario.ca
Date Published: 11/19/2022
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Vibrio cholerae – American Society for Microbiology
and Plesiomonas shigelloes) that can cause gastrointestinal disease. The deoxycholate string test can be used to separate possible isolates of Vibrio spp.
Source: asm.org
Date Published: 9/22/2022
View: 914
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- Author: Johns Hopkins CCP
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- Date Published: Nov 28, 2016
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How do you confirm Vibrio cholerae?
The diagnosis can be confirmed by isolation of V. cholerae from stool cultures performed on specific selective media. Rapid tests such as stool dipsticks or darkfield microscopy can support the diagnosis in settings where stool culture is not readily available. (See ‘Diagnostic studies’ below.)
How do I know if I have Vibrio vulnificus?
Even with the most sophisticated and high-tech equipment or rapid presumptive detection methods that use differential media such as MacConkey agar and thiosulfate-citrate-bile salts-sucrose (TCBS) agar, more than 2 days is needed for the definitive identification of V. vulnificus from blood or tissue samples.
Does Vibrio go away on its own?
Most people with a mild case of vibriosis recover after about 3 days with no lasting effects. However, people with a Vibrio vulnificus infection can get seriously ill and need intensive care or limb amputation.
How do I get rid of my vibriosis?
What is the treatment for vibriosis? Treatment is not necessary in most cases. Drink plenty of liquids to replace fluids lost through diarrhea. Severe cases may require use of ciprofloxacin antibiotics and hospitalization.
Can you get tested for cholera?
Although signs and symptoms of severe cholera can be unmistakable in areas where it’s common, the only way to confirm a diagnosis is to identify the bacteria in a stool sample. Rapid cholera dipstick tests enable doctors in remote areas to quickly confirm a cholera diagnosis.
Does cholera go away on its own?
The symptoms of mild or uncomplicated cases of cholera resolve on their own (spontaneously) within 3 to 6 days of onset. The bacteria usually disappear from the gastrointestinal system within 2 weeks. Most people with cholera require the replacement of fluids that are lost due to prolonged diarrhea.
What are the chances of getting Vibrio vulnificus?
Only about 205 people in the United States will get an infection from Vibrio vulnificus — also called the “flesh-eating bacteria” — this year. People with certain underlying conditions may be more prone to contracting the infection. The bacteria can also cause symptoms when ingested, such as through raw oysters.
What antibiotic treats Vibrio?
Antibiotics are necessary to eradicate V vulnificus infection. Effective antibiotics may include tetracycline, third-generation cephalosporins, and imipenem.
How fast does Vibrio spread?
Signs and Symptoms: On the rare occasions when serious infection with Vibrio vulnificus occurs, illness typically begins within 1 to 3 days of exposure, but can occur as late as 7 days after exposure. Infections may start with redness, pain and swelling at the site of a wound or injury.
What foods is Vibrio found in?
You can get a Vibrio infection by eating raw or undercooked seafood, particularly oysters. You also can get an infection if you have an open wound that comes in contact with raw or undercooked seafood, their juices, or their drippings.
How long after eating raw oysters do you get sick?
Potentially life-threatening to most people, symptoms of Vibrio vulnificus infection occurs within 24 to 48 hours of ingestion and may include symptoms such as sudden chills, fever, nausea, vomiting, diarrhea, shock and skin lesions.
How is vibriosis diagnosed?
Infection is diagnosed when Vibrio bacteria are found in the stool, wound, or blood of a patient who has symptoms of vibriosis.
How long does it take for symptoms of Vibrio vulnificus?
Symptoms usually appear 12 to 24 hours after infection for most Vibrio organisms. For V. vulnificus, symptoms can take as long as 72 hours to appear.
How is Vibrio food poisoning treated?
If your stomach infection is mild, drinking plenty of fluids can help replace what was lost from diarrhea, the CDC says. Antibiotics may or may not fight vibriosis depending on which species of vibrio caused the infection.
Diagnosis and Detection
It is almost impossible to distinguish a single patient with cholera from a patient infected by another pathogen that causes acute watery diarrhea without testing a stool sample. A review of clinical features of multiple patients who are part of a suspected outbreak of acute watery diarrhea can be helpful in identifying cholera because of the rapid spread of the disease.
While management of patients with acute watery diarrhea is similar regardless of the illness, it is important to identify cholera because of the potential for a widespread outbreak.
Vibrio cholerae growing on thiosulphate citrate bile salt sucrose (TCBS) agar plates
How to Diagnose
Isolation and identification of Vibrio cholerae serogroup O1 or O139 by culture of a stool specimen remains the gold standard for the laboratory diagnosis of cholera.
Cary Blair media is ideal for transport, and the selective thiosulfate–citrate–bile salts agar (TCBS) is ideal for isolation and identification. Reagents for serogrouping Vibrio cholerae isolates are available in all state health department laboratories in the U.S. Commercially available rapid test kits are useful in epidemic settings but do not yield an isolate for antimicrobial susceptibility testing and subtyping, and should not be used for routine diagnosis.
In many countries where cholera is not uncommon, but access to diagnostic laboratory testing is difficult, WHO recommends the following clinical definition be used for suspected cholera cases.
Suspected cholera case
In areas where a cholera outbreak has not been declared: Any patient 2 years old or older presenting with acute watery diarrhea and severe dehydration or dying from acute watery diarrhea.
In areas where a cholera outbreak is declared: any person presenting with or dying from acute watery diarrhea.
WHO also recommends the following definition for confirmed cholera cases.
Confirmed cholera case
A suspected case with Vibrio cholerae O1 or O139 confirmed by culture or PCR and, in countries where cholera is not present or has been eliminated, the Vibrio cholerae O1 or O139 strain is demonstrated to be toxigenic.
Rapid Tests
In areas with limited or no laboratory testing, the Crystal® VC dipstick rapid test can provide an early warning to public health officials that an outbreak of cholera is occurring. However, the sensitivity and specificity of this test is not optimal. Therefore, it is recommended that fecal specimens that test positive for V. cholerae O1 and/or O139 by the Crystal® VC dipstick always be confirmed using traditional culture-based methods suitable for the isolation and identification of V. cholerae.
Electron micrograph of Vibrio cholerae
Detection in the U.S.
Cholera is a nationally reportable disease in the U.S. All isolates should be sent to CDC via state health department laboratories for cholera toxin-testing and subtyping.
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Questions and Answers
Questions and Answers
What are Vibrio bacteria?
Vibrio bacteria naturally live in certain coastal waters and are present in higher concentrations between May and October when water temperatures are warmer.
You can get a Vibrio infection from eating raw oysters. Find out why >
What is vibriosis?
About a dozen Vibrio species can cause human illness, known as vibriosis. The most common species causing human illness in the United States are Vibrio parahaemolyticus, Vibrio vulnificus, and Vibrio alginolyticus.
Note: This website focuses on vibriosis, not cholera, which is caused by other strains of Vibrio. To learn about cholera, visit CDC’s cholera website.
How do people get vibriosis?
Most people become infected by eating raw or undercooked shellfish, particularly oysters. Certain Vibrio species can also cause a skin infection when an open wound is exposed to salt water or brackish water. Brackish water is a mixture of fresh and salt water. It is often found where rivers meet the sea.
Find out steps you can take to prevent infection.
Who is more likely to get vibriosis?
People with compromised immune systems, especially those with chronic liver disease, are more likely to get vibriosis. Eating raw seafood, particularly oysters, and exposing open wounds to salt water or brackish water can increase a person’s chance for getting vibriosis.
Learn more about Vibrio and oysters.
During which months are people more likely to get vibriosis?
About 80% of infections occur between May and October when water temperatures are warmer.
How common is vibriosis?
CDC estimates that vibriosis causes 80,000 illnesses each year in the United States. About 52,000 of these illnesses are estimated to be the result of eating contaminated food.
The most commonly reported species, Vibrio parahaemolyticus, is estimated to cause 45,000 illnesses each year in the United States.
Is vibriosis a serious disease?
Most people with a mild case of vibriosis recover after about 3 days with no lasting effects. However, people with a Vibrio vulnificus infection can get seriously ill and need intensive care or limb amputation. About 1 in 5 people with this type of infection die, sometimes within a day or two of becoming ill.
Learn more about Vibrio vulnificus.
How can vibriosis be prevented?
To reduce your chance of getting vibriosis, don’t eat raw or undercooked shellfish, such as oysters. If you have a wound (including from a recent surgery, piercing, or tattoo), avoid contact with salt water or brackish water or cover the wound with a waterproof bandage if there’s a possibility it could come into contact with salt water or brackish water, raw seafood, or raw seafood juices.
Get more tips for preventing vibriosis.
How does CDC monitor vibriosis?
Vibriosis has been a nationally notifiable disease since 2007.
Health departments report cases to the Cholera and Other Vibrio Illness Surveillance (COVIS) system. COVIS was initiated by CDC, FDA, and four Gulf Coast states (Alabama, Florida, Louisiana, and Texas) in 1989. By the early 2000s, almost all states were voluntarily reporting.
Because Vibrio bacteria are not easily identified with routine testing, many cases are not reported.
Learn more about vibriosis surveillance.
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Vibriosis in Shellfish
What is vibriosis?
Vibriosis is an intestinal disease caused by small bacteria called vibrio. Vibrio are found in fish and shellfish living in saltwater and in rivers and streams where freshwater meets saltwater. Although there are several types of vibrio, Vibrio parahaemolyticus and related species are the most common in the northwest.
Where does vibrio come from?
Vibrio is found naturally in marine coastal waters, normally in low numbers that pose no problems. It multiplies rapidly in warm conditions, so fish and shellfish are more likely to be contaminated in the summer.
How is it spread?
Most cases occur from eating raw or undercooked fish or shellfish. However, even fully cooked food can be recontaminated if rinsed with seawater. Failure to keep shellfish cold after harvesting can contribute to the growth of the bacteria. Poor food handling practices during preparation or improper refrigeration of prepared seafood can also lead to illness. See Food Safety Tips for more information on safe food handling practices.
How can I prevent vibriosis?
Vibrio is destroyed by cooking shellfish to an internal temperature of 145° F for 15 seconds.
Eat only well-cooked shellfish, especially in summer months. Do not consider shellfish to be fully cooked when the shells just open — they need to cook longer to reach 145° F.
When harvesting:
Just before you leave, check for closures and advisories due to vibrio, biotoxins, and pollution at our Shellfish Safety Map, by contacting your local health department, or by calling our biotoxin hotline at 1-800-562-5632.
Harvest shellfish as soon as possible with the receding tide.
Don’t harvest shellfish that have been exposed to the sun for more than one hour (less in really hot weather).
Keep shellfish cold after harvesting.
More shellfish safety tips.
Who is at risk?
Anyone who eats raw or partially cooked fish or shellfish can become ill. People with compromised immune systems are especially at risk.
People taking antacids are more likely to get sick. Stomach acids help destroy bacteria, so when stomach acids are reduced, vibrio bacteria are more likely to pass through the stomach and into the intestine, where the illness occurs.
What are the symptoms?
Symptoms include diarrhea, abdominal cramps, nausea, vomiting, headache, fever, and chills. The illness is usually mild or moderate and runs its course in 2 to 3 days. In severe cases, hospitalization may be required.
How soon do symptoms appear?
Symptoms usually appear about 12-24 hours after consumption but can take as long as four days.
What is the treatment for vibriosis?
Treatment is not necessary in most cases. Drink plenty of liquids to replace fluids lost through diarrhea. Severe cases may require use of ciprofloxacin antibiotics and hospitalization.
What should I do if I think I have vibriosis?
If severe diarrhea or fever persists, contact your primary care provider. You should also report the illness to your local health department, or you can email us through our illness reporting address, [email protected].
What other marine vibrio organisms exist?
Several other marine vibrios found in Washington can cause intestinal illness, and symptoms from these infections are similar to those from Vibrio parahaemolyticus. One type of vibrio, Vibrio vulnificus, can cause serious infection and death in people with weakened immune systems. There have been no reports of V. vulnificus infection attributed to eating Washington State shellfish or contact with Washington marine waters. The first locally acquired V. vulnificus infections reported in Washington residents occurred in 2016 and 2017 (one case each year) and both were associated with handling farmed tilapia fish purchased from live freshwater tanks.
Are there any other illnesses associated with shellfish?
Yes. There are several types of biotoxins found in the northwest that can cause severe illness, and in extreme cases, death. Norovirus is also a concern. Some people can have an allergic reaction to shellfish.
More Resources
Print Version of this Webpage (PDF)
Vibrio Species Causing Vibriosis, CDC
Call the Shellfish Program at 360-236-3330 or Communicable Disease Epidemiology at 206-418-5500.
Vibrio Species Detection and Identification in Seafood
Updated: 22nd Oct 2019
Key Points
Three species, V. cholerae, V. parahaemolyticus and V. vulnificus, are important human pathogens and are potential contaminants in seafood.
Rapid kits now give one-day completion of enrichment and detection of pathogenic Vibrio species
Vibrio parahaemolyticus is the most common source of seafood-borne disease but Vibrio vulnifucs has been the most lethal cause.
Members of the genus Vibrio are all Gram-negative straight or curved rods, which do not form spores and are motile, usually by a single polar flagellum. Three species are considered to be important human pathogens – V. cholerae, V. parahaemolyticus and V. vulnificus. All three have the potential to be foodborne, and are most often associated with the consumption of raw, or undercooked, shellfish.
A number of other species have infrequently been isolated from the stools of people suffering from gastroenteritis and are considered to be occasional human pathogens. These include V. alginolyticus, V. fluvialis, V. furnissii, V. hollisae, V. metschnikovii and V. mimicus. These species are not generally regarded as significant foodborne pathogens.
All of the pathogenic species have been shown to withstand freezing temperatures whilst inhabiting seafood, which is of significant concern for the seafood industry. They are also able to tolerate high pH and salinity; factors which comprise the make-up of enrichment media when isolating Vibrio sp. from other natural flora. Most Vibrio spp. are oxidase and catalase positive and ferment glucose without gas production.
They occur naturally in freshwater and marine environments and are considered the natural microflora of these environments. However pathogenic strains of these species do arise either through a rise in temperatures or through polluted waters. Many of the pathogenic species, with the notable exception of Vibrio cholerae, are adapted to salt or brackish water habitats and are halophilic to some degree, being unable to grow in the absence of sodium chloride.
Vibrio cholerae
V. cholerae is the cause of outbreaks and epidemics of cholera, a serious and potentially fatal gastrointestinal infection, which is still a major health problem in parts of the developing world. Humans are the principal reservoir for V. cholerae and cholera is usually associated with poor hygiene and polluted water supplies, but it may also be foodborne.
Contamination of fruits, vegetables and other foods usually occurs via an infected food handler, or by the use of polluted water in food preparation. Not all strains of V. cholerae cause cholera and the main virulence factor involved in the disease is the cholera enterotoxin (CT). Strains causing classic epidemic cholera generally belong to one of two serogroups, O1 or O139, although other strains have been reported to cause occasional isolated cases of cholera-like disease.
Non-O1/O139 strains can cause a less severe form of diarrhoeal disease and are more common clinical isolates in developed countries. These isolates are typically related to consumption of contaminated shellfish, especially raw oysters. Non-O1/O139 V. cholerae strains are not uncommon in certain estuarine waters and may contaminate shellfish harvested from polluted sites.
V. cholerae will grow rapidly in temperature-abused processed foods and will also survive for extended periods in chilled and even frozen foods, but it does not survive desiccation for more than 48 hours. The cells are not heat-resistant and are readily destroyed by cooking and pasteurisation.
Vibrio parahaemolyticus
V. parahaemolyticus is the species most likely to be associated with foodborne disease in humans. It can cause mild to moderate gastrointestinal infections, which are usually self limiting and rarely fatal. It is not normally involved in epidemics or large outbreaks, but is an important source of foodborne disease, especially in Japan and other Asian countries.
Infection is almost always associated with consumption of seafood and V. parahaemolyticus is very common in marine coastal waters in tropical regions and in temperate regions during the warmer months of the year. There is also evidence that it may be becoming more common in colder waters during the summer, possibly as a consequence of rising sea temperatures. As with V. cholerae, not all strains of V. paraheamolyticus are capable of causing human disease. Pathogenicity is associated with a thermostable haemolysin, called the Kanagawa phenomenon. Almost all isolates from cases of food poisoning are Kanagawa positive strains.
V. paraheamolyticus is part of the normal microflora of coastal and estuarine waters in almost all temperate regions and may be present in comparatively high numbers when the water temperature is at its highest during the summer. At these times, shellfish may easily become contaminated, but fortunately most environmental isolates are Kanagawa negative and do not cause illness. The possibility of infection means that shellfish from high-risk waters should not be eaten raw.
Most cases of V. paraheamolyticus infection in Europe can be traced to imported seafood, but there is evidence to suggest that it is becoming more common in domestically harvested shellfish. V. paraheamolyticus differs from V.cholerae in that it is an obligate halophile and will not grow unless a salt concentration of at least 0.5% is present. In fact it will grow at salt levels as high as 10%. Like V. cholerae it will grow rapidly in temperature abused foods and survives chilled and frozen storage, but not drying or mild heat processes.
Vibrio vulnificus
V. vulnificus is the leading cause of death from a seafood-borne disease in the United States. Foodborne infections can take the form of gastroenteritis in healthy adults, but in vulnerable individuals the pathogen can cause primary septicaemia, which is very serious and has a mortality rate of more than 50%. Consumption of raw oysters is the primary source of this pathogen with a significant amount of incidents related to oysters from the Gulf of Mexico that are eaten raw. The state of California has implemented a law prohibtiing the sale of raw oysters from this region applicable to certain times of the year. Only about 90 cases of V. vulnificus infection are reported each year in the USA and major outbreaks have not been recorded, but the high death rate means that it is regarded as a serious pathogen.
Elsewhere, sporadic cases have been identified in Europe, Korea and Taiwan. Like V. parahaemolyticus, V. vulnificus is a common part of the natural microflora of coastal waters in tropical and temperate regions worldwide, especially during the summer months. This being so, given the low number of cases of human infection, it is likely that only certain strains are pathogenic to man. V. vulnificus is a halophile requiring at least 0.5% salt to grow and will tolerate levels of up to 5%. It will multiply in live oysters, but not at temperatures of less than 13oC. Like other species it resists low temperatures for some time, but is destroyed by cooking and is not resistant to desiccation.
Vibrio mimicus
V.mimicus is a foodborne pathogen and has been associated with diarrhea following the consumption of raw or undercooked seafood, primarily oysters. It was isolated from samples during a search for V. cholerae as they are both nonhalophilic. V. mimicus can be differentiated from its closely related pathogen by sucrose nonfermentation.
There is currently no standards set in the revised edition of ISO 21872: 2017 for the detection of V.mimicus as was in the original ISO 21872:2007 paper. The Microbiological Methods and Bacteriological Analytical Manual (BAM), under the authority of U.S Food and Drug Administration maintains a section dedicated to the detection of V. mimicus and so worthy of mention. The organism will appear as green colonies on thiosulfate citrate bile salts sucrose (TCBS) agar and will grow in most common media without added NaCl. Virulence is poorly characterized, but some strains have been found to possess the cholera toxin gene, produce demonstrable CT in a tissue culture assay, and the ctx gene can be detected by PCR amplification.
Methods
Storage and preparation of samples The majority of food samples examined for the presence of Vibrio species will be shellfish and other seafood. It is very unusual for other food categories to be routinely tested for these pathogens
Vibrio spp can grow very rapidly in seafood at ambient temperature and samples must be chilled to below 10oC immediately and then analysed as quickly as possible. However, the cells are easily damaged by rapid cooling and samples should not be cooled by direct contact with ice.
Sample preparation procedures for shellfish typically require pooling 10-12 individual animals. The pooled sample is then homogenised using a sterile high-speed blender. If sample dilutions are required they should be prepared with a diluent containing salt, such as phosphate buffered saline (PBS).
Traditional methods
The recently revised ISO standard for the horizontal method of detection of enteropathogenic Vibrio species in the food chain now includes V.vulnificus (Standard ISO 21872-1:2017 – Microbiology of food and animal feeding stuffs — Horizontal method for the detection of potentially enteropathogenic Vibrio spp). V.vulnificus was included in Part 2 of the original document and has now been included in the revised edition due to its high rate of death after infection.
The first stage in traditional detection methods exploits the ability of Vibrio spp to grow rapidly at relatively high pH values. Media containing sodium chloride and with a pH of about 8.6, such as alkaline saline peptone water (ASPW), are used for enrichment. Typically, a 6-hour preliminary enrichment (at 41.5oC for fresh products, or 37oC for frozen or salted products) is followed by a second enrichment in ASPW at 41.5oC (for V. cholerae and V. parahaemolyticus) or 37oC (for other species) for 18 hours.
The second enrichment culture is inoculated on to thiosulphate citrate bile salts sucrose (TCBS) agar and one other optional selective medium and incubated at 37oC for 24 hours. On TCBS agar, V. cholerae colonies are smooth and yellow, V. parahaemolyticus colonies appear blue-green and V. vulnificus colonies are green or yellow. Selective chromogenic agar media specifically designed for the differentiation of pathogenic Vibrio spp are also available. Examples include chromID™ Vibrio agar from bioMérieux and CHROMagar™ Vibrio.
A quantitative method for V. parahaemolyticus can be used for samples where significant numbers are expected. This applies a MPN technique based on enrichment of tenfold dilutions in ASPW, followed by plating onto selective agar.
A hydrophobic grid membrane filtration enumeration procedure (HGMF) has also been described.
Rapid methods
There are more rapid PCR based test kits for Vibrio spp. in foods becoming commercially available than was previously. It is now possible to complete both the enrichment and detection stage in one day. An example of this is the Bio-Rad iQ-Check Vibrio Real-Time PCR Detection Kit which was released onto the market last year. It can enrich and detect the three main pathogenic species of Vibrio in just eleven hours.
Another example of a commercially available PCR-based method for pathogenic Vibrio detection is the BAX® System Real-Time PCR Assay from Hygiena. Part of the well established family of BAX® System assays, the Vibrio assay is able to detect the three most important species, V. cholerae, V. parahaemolyticus and V. vulnificus in the same sample within 24 hours, including an 18-20 hour enrichment. It is designed for testing seafood samples, including shrimp, oysters, crabs and tuna and is capable of detecting 104 CFU/ml.
Confirmation and identification
Traditional methods There are well established confirmation and identification procedures for pathogenic Vibrio spp., especially for V. cholerae. Preliminary identification based on colony appearance on TCBS agar is traditionally confirmed using classical biochemical tests. Key tests are oxidase reaction and the presence or absence of lysine and ornithine decarboxylases and arginine dehydrolase. Media should be prepared with 2-3% sodium chloride to allow the growth of halophilic species.
V. cholerae isolates are further confirmed and characterised by serological agglutination testing, β haemolysis on blood agar and tests for cholera toxin production.
V. parahaemolyticus isolates can also be characterised by serological testing and by the Kanagawa test.
Rapid methods
As an alternative to the gold standard method of using TCBS agar, Hardy diagnostics have the HardyCHROM™ Vibrio, a one-plate-for-all that allows the differentiation between all species. Pathogenic species show up different colours from each other with the aid of fluorescent light and non-pathogenic species show no colour.
Biochemical confirmation can be accomplished using commercial identification systems such as the API 20E test strip from bioMérieux and Remel’s RapID™ NF PLUS System. However it is important to ensure that cultures are suspended in a saline medium to ensure the growth of halophilic species.
A number of molecular methods for confirmation have been developed, notably PCR assays for the identification of the three most important species. Labelled DNA probes can be used to confirm the pathogenicity of V. parahaemolyticus and V. vulnificus by detecting the genes for specific virulence factors, such as haemolysins, and a PCR method has been developed for cholera toxin, which is rarely present in V. cholerae isolates from food. Protocols for several of these methods are provided in Chapter 9 of the USFDA BAM and the revised Standard ISO 21872-1:2017 – Microbiology of food and animal feeding stuffs — Horizontal method for the detection of potentially enteropathogenic Vibrio spp
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Which lab tests are performed in the diagnosis of Vibrio vulnificus infection?
Author
Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society
Disclosure: Nothing to disclose.
Coauthor(s)
Cris Jagar, MD Staff Physician, Department of Psychiatry, Trinitas Regional Medical Center
Disclosure: Nothing to disclose.
Specialty Editor Board
David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for MOHS Surgery, Association of Military Dermatologists, Phi Beta Kappa
Disclosure: Nothing to disclose.
Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine
Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American College of Rheumatology
Disclosure: Received honoraria from UpToDate for author/editor; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for i inherited these trust accounts; I serve on a safety monitoring committee for Principia Biopharma for: Allergen; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble; Amgen; Gilead.
Chief Editor
Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.
Additional Contributors
Craig A Elmets, MD Professor and Chair, Department of Dermatology, Director, Chemoprevention Program Director, Comprehensive Cancer Center, UAB Skin Diseases Research Center, University of Alabama at Birmingham School of Medicine
Craig A Elmets, MD is a member of the following medical societies: American Academy of Dermatology, American Association of Immunologists, American College of Physicians, American Federation for Medical Research, Society for Investigative Dermatology
Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: University of Alabama at Birmingham; University of Alabama Health Services Foundation
Serve(d) as a speaker or a member of a speakers bureau for: Ferndale Laboratories
Received research grant from: NIH, Veterans Administration, California Grape Assn
Received consulting fee from Astellas for review panel membership; Received salary from Massachusetts Medical Society for employment; Received salary from UpToDate for employment. for: Astellas.
Diagnosis and Treatment
Diagnosis
A clinician may suspect vibriosis if a patient has watery diarrhea and has recently eaten raw or undercooked seafood, especially oysters, or when a wound infection occurs after exposure to seawater. Infection is diagnosed when Vibrio bacteria are found in the stool, wound, or blood of a patient who has symptoms of vibriosis.
Treatment
Treatment is not necessary in mild cases, but patients should drink plenty of liquids to replace fluids lost through diarrhea. Although there is no evidence that antibiotics decrease the severity or duration of illness, they are sometimes used in severe or prolonged illnesses.
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