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Why is vibrio vulnificus so bad for people with liver disease?

🤯The answer could blow your mind!🤯

Join me for a #tweetorial:
Act 1: Epi of v. vulnificus: What’s the deal with oysters?!
Act 2: Mechanism

#cirrhosis #livertwitter #idtwitter
First, a poll:

what is it about liver disease that makes vibrio vulnificus so bad for people with liver disease?
Who is Vibrio vulnificus?

1⃣Halophile=Needs salt 2 live. i.e. lives in sea
2⃣Makes a 'chitinase', embeds in mollusks

Infections caused:
3⃣Open wound in sea water: cellulitis
4⃣Raw oysters: deadly bacteremia

5⃣Fortunately Rare. 0.8 infections/100000ppl


1⃣Vulnificus cases track with oyster production
2⃣Oysters from warm water are the riskiest
3⃣Cool job alert🚨: @CDCgov Epidemic intelligence service officers went 🚪-to-🚪investigating vulnificus cases. This is how the oyster connection was made.

All studies show: the patients most likely to be affected have cirrhosis, alcohol use disorder and hemochromatosis.

What do these people have in common?

Take-home point:
Alcohol-use disorder, #cirrhosis, and #hemochromatosis are each independently associated with iron-overload & high transferrin saturations...and low hepcidin levels

See below for the evidence in a throwback #tweetorial


Vibrio & Iron

1⃣🦠 need our iron 2 live. 🦠 r smart & make 'siderophores' 2 grab our iron
2⃣We may have EVOLVED the anemia of chronic inflammation 2 defend us from 🦠 by⬆️hepcidin!
3⃣Vulnificus makes vulnibactin which liberates iron from saturated transferrin

Vulnificus is uniquely dangerous to people with iron-saturated transferrin

1⃣Normal plasma actually kills vulnificus
2⃣High hepcidin protects against vulnificus infection

And who has low hepcidin? hemochromatosis, alcohol use disorder, many w/#cirrhosis

Poll again:

What is the connection between liver disease and the pathogenesis of vibrio vulnificus infection?

To summarize:
Vibrio Vulnificus is a deadly infection:
🦠 Carried by 🦪🦪
🦠 Impacts people with liver disease
🦠 'cause they may have high Tsats
🦠 'cause the 🦠 gets iron from transferrin

So tell your patients with high Tsats: No 🦪!

This concludes a #tweetorial on how (and for whom) vibrio vulnificus impacts health. I learned a lot about the intersection of iron metabolism, evolution, and infections. And I hope you did too.
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