marvin
08-18-2004, 02:19 PM
Warning- looooooong post- but worth reading.....
VIBRIO VULNIFICUS - USA (TEXAS)
*******************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
[1]
Date: Sat 14 Aug 2004
From: John Hardee <tsu@nwlink.com>
Source: Houston Chronicle [edited]
<http://www.chron.com/cs/CDA/ssistory.mpl/health/2735560>
Man loses battle with Gulf bacteria
-----------------------------------
A Houston dentist has lost his month long battle with a bacterium
that invaded a cut on his leg while he was fishing near Port
O'Connor, officials said on Fri 13 Aug 2004. The man, 52, died late
on Thu 12 Aug in a Victoria hospital, where he had been undergoing
treatment since 17 Jul, 2 days after he was exposed to the saltwater
bacteria _Vibrio vulnificus_. His is the 7th vibrio-related death in
Texas in 2004, officials said. At least 12 Texans have been injured
by the cholera-like bacteria as well, according to the Texas
Department of Health.
Another man on the fishing-contest outing was infected by a different
strain of the bacterium. He was released from the Victoria hospital
on Mon 9 Aug 2004, after more than 3 weeks of treatment, including
several surgical procedures to remove tainted flesh. Officials
attributed his survival to swift medical treatment after exposure.
The dentist apparently got a minor cut on his leg, on 15 Jul, when he
slipped on a dock. The following day, the leg became swollen, and he
sought treatment in Port Lavaca. By the 2nd day he was critically
ill, a spokesman at Citizens Medical Center in Victoria said.
"By the time he got here, vibrios had already infiltrated his blood
system, and he was in shock, which itself can be deadly," CMC
spokeswoman Melissa Purl said. Within days, both legs were amputated,
and he sank into a coma, she said. The dentist was one of several
Houston-area residents stricken by the bacteria in Gulf waters this
summer [2004]. A Bay City man, who went fishing in the Laguna Madre,
and a Dayton man, who vacationed in Freeport, were successfully
treated, in late July 2004, for infection with the bacteria.
Health experts said the bacteria are common in the Gulf, and, most
prevalent in coastal and bay waters in warmer months. The bacteria
can be ingested via contaminated seafood, such as oysters, or
absorbed through skin wounds, but don't penetrate healthy skin. The
Centers for Disease Control and Prevention (CDC), which has recorded
vibrio-related illnesses and deaths since 1988, said cases are rare,
but underreported. A typical year brings 16 deaths along the Gulf
Coast states, CDC said.
The Texas Department of Health reported on Fri 13 Aug that, so far
this year, there have been 31 illnesses caused by vibriosis,
including the 7 deaths, 4 of which were attributed to eating
contaminated oysters. Experts say those who enter coastal waters
should make note of skin cuts and check them later for redness or
swelling. If caught quickly, illness caused by the bacteria is
controllable with antibiotics.
[byline: John W Gonzalez]
--
John Hardee
Portland Oregon
<tsu@nwlink.com>
******
[2]
Date: Thu 29 Jul 2004
From: ProMED-mail <promed@promedmail.org>
Source: Houston Chronicle [edited]
<http://www.chron.com/cs/CDA/ssistory.mpl/sports/2707587>
Infections hit Texas coast fishermen
------------------------------------
A recent outbreak of rare, but potentially dangerous, bacterial
infections has some coastal fishermen scared to go near the water.
Experts say there is reason for concern, and opportunity to increase
awareness, but no cause for panic. _Vibrio vulnificus_, and its many
relatives, are naturally occurring bacteria found in warm saltwater
throughout much of the world.
CDC's Division of Bacterial and Mycotic Diseases notes that "an
average of 50 culture-confirmed cases, 45 hospitalizations, and 16
deaths" occur annually along the Gulf Coast. Nationally, the numbers
roughly double across the board. These bacteria are most often
responsible for illnesses and deaths from consumption of contaminated
seafood, but fishermen often contract the bacteria through open
wounds.
The Texas Department of Health issued a release, on 22 Jul 2004, that
documented 20 confirmed cases of these infections this year [2004],
including 3 deaths. "At least 2 (of the infections) were associated
with exposure of cuts, or open wounds, to coastal saltwater,"
according to the release.
TDH spokeswoman Emily Palmer amended that report on Wed 28 Jul 2004,
noting that 11 cases of wound-related Vibrio infections in Texas have
now been confirmed since June 2004. In 2003, there were 14
wound-related infections statewide among 43 total cases, 7 of which
were fatal.
Among the latest to make the unfortunate list of infected patients
are 3 fishing guides. The man most recently stricken was on high
personal alert for the disease, after word of earlier diagnoses hit
the coastal community. He, therefore, knew to seek medical attention
at the 1st serious hint of infection. A Port O'Connor guide, he had
worked for 10 consecutive days. When he got home, his left ankle felt
tender, "like a slight sprain." The next morning, he felt queasy and
skipped breakfast. Wading with clients a few hours later, he became
light-headed and passed out. A face full of bay water brought him
quickly back to consciousness, and the fishing guide knew that he was
in trouble.
Back in the boat, he summoned other guides to retrieve his customers,
then called for a family member to meet him at the dock. When he
removed his wading boots, he noticed a black spot "about the size of
a quarter" below the sore ankle. "In the time it took us to get from
the dock to the emergency room (about an hour)," he said, "that dot
about doubled in size."
The patient was met at DeTar Hospital Navarro by Dr Brian F Burns, a
plastic surgeon who also is treating 2 other victims of V.
vulnificus_ infection at Citizens Medical Center in Victoria, TX.
"While Dr Burns drew a circle around (the infected area), and
explained what he was going to do," the guide said, "I could see a
redness going up my leg." The infected tissue was removed, the
patient was administered antibiotics, and he improved. This man is
luckiest, thus far, of Texas waders stricken this summer [2004] by
the bacteria. Burns said that early detection, and treatment, saved
him from severe complications, and, probably spared his life.
Doctors at CMC were forced this week [last week of July 2004] to
amputate both legs of a Houston man, who also has suffered organ
failure since infection early in July 2004, and, who remained in
critical condition on Wed 28 Jul 2004. He waited just a couple of
days after the initial infection, friends say, before seeing a
doctor. Another man, who contracted the infection around the same
time, and in the same area, has lost most of the tissue between the
ankle and knee of one leg. On Wed 28 Jul 2004, he was listed as
stable but remained in intensive care at CMC.
A 4th man, another fishing guide, was hospitalized this week [last
week of July 2004] with _V. vulnificus_ infection in his right leg.
He already has undergone 2 surgeries to remove damaged tissue. "On
Friday, [9 Jul 2004], I cut my leg on the trailer, but didn't think
anything of it," the patient said from his hospital room in Bay City.
"I fished the next 5 days. It got worse and worse. By the next
Friday, I was bedridden. My fever got to 104 (degrees)."
_V. vulnificus_ also found its way into the arm of a Rockport guide
this month [July 2004]. His said that his temperature was 104.7
degrees [Fahrenheit; 40.4 degrees Celsius], when paramedics checked
him at the dock, "and he was drinking a cold drink when they took
it." This patient has undergone surgery, and skin grafting, to repair
his arm. He's improving, his wife said, but he won't able to work
again for weeks.
Dr James Oliver, a PhD at the University of North Carolina in
Charlotte, has studied the _Vibrio_ family for nearly 3 decades. He
was surprised by the number of wound-related cases in Texas over such
a short time and over such a small area. Matt Richardson, an
epidemiologist at TDH in Austin, confirmed that _V. vulnificus_ is
the "absolute worst of the marine bacteria" on a list that includes
many other family members, as well as a slow-growing, but
tough-to-kill, germ called atypical mycobacteria. He advised all
coastal anglers to be cautious but said that it won't attack
unbroken, healthy skin. People in generally good health who are
exposed to this bacterium through wounds usually experience only mild
symptoms that do not persist. Ingestion by healthy people, reports
CDC, may cause vomiting, diarrhea, and abdominal pain.
Common-sense precautions should be adequate to avoid life-threatening
infection. Keep an antibacterial soap and generous supply of fresh
water nearby. If the skin is broken, clean and flush the area at the
1st opportunity. Should the site worsen, or other indications such as
redness, fever, lethargy, or flu-like symptoms appear, go straight to
the emergency room. "Vibrio infections can be successfully treated
with antibiotics if treated early," according to the TDH. The CDC's
recommendation is for "doxycycline or a 3rd-generation cephalosporin
(such as ceftazidime)."
[byline: Doug Pike]
******
[3]
Date: Sat 14 Jul 2004
From: Stephen M Apatow <s.m.apatow@humanitarian.net>
The following information provides an excellent overview of the
challenges associated with warm weather, along the Gulf of Mexico,
providing a suitable niche for microbial growth and existence,
including bacterial genera of clinical importance (_V. vulnificus_,
_V. cholerae_, _V. parahaemolyticus_, _V. mimicus_, _Aeromonas_,
_Plesiomonas_), as well as discussion of economic issues:
Microbes and Marine Biotechnology: Pathogen Detection in Shellfish,
Asim K Bej, Department of Biology, University of Alabama at
Birmingham <http://dhp.disl.org/PDFs/SAME-2003.pdf>
Economic value of marine resources:
1. Contributes about 1/3 of the USA gross national products (GNP).
2. Seafood industry is one of the primary contributors to this GNP.
3. Gulf of Mexico coastal water is rich in seafood, due to the warm
weather, and is a major resource for the seafood industry.
4. The economy of many coastal cities and states depends upon the
revenue generated from the seafood industry.
Impact of _Vibrio vulnificus_:
1. In the past several years, the fishery industry, in the state of
Texas, lost potential revenue of USD 3.4 million from oysters and
crabs, because
of closure due to bacteria and other contaminants.
2. The Interstate Shellfish Sanitation Conference (ISSC) suggests that
post-harvest-treated consumable oysters must not consist of >3 _V.
vulnificus_ per gram of meat.
3. This year (2003), the state of California released emergency
restrictions on sales of all oysters harvested from the Gulf of Mexico
between May and October, unless they are treated with a scientifically
validated method to reduce _V. vulnificus_ to non-detectable levels (3
organisms per gram of oyster meat).
4. ISSC Goal: An at least 60 per cent reduction of _V.vulnificus_-related
illnesses by 2007.
--
Stephen M Apatow
Humanitarian Resource Institute
<s.m.apatow@humanitarian.net>
[For noncholera _Vibrio_ infections other than gastroenteritis, the
combination of ceftazidime and doxycycline, or an antipseudomonal
penicillin (such as, ticarcillin and clavulanate, piperacillin and
tazobactam) is the therapy of choice. Alternative antibiotics are
cefotaxime, ceftriaxone, or a fluoroquinolone.
The following is extracted from the "FDA Bad Bug Book."
<http://vm.cfsan.fda.gov/~mow/chap10.html>
_Vibrio vulnificus_, a lactose-fermenting, halophilic, Gram negative,
opportunistic pathogen, is found in estuarine environments and
associated with various marine species, such as plankton, shellfish
(oysters, clams, and crabs), and fin fish. It is found in all of the
coastal waters of the United States. [Cases of illness have also been
associated with brackish lakes in New Mexico and Oklahoma.]
Environmental factors responsible for controlling members of _V.
vulnificus_ in seafood, and in the environment, include temperature,
pH, salinity, and increased dissolved organics.
This organism causes wound infections, gastroenteritis, or a syndrome
known as "primary septicemia". Wound infections result either from
contaminating an open wound with sea water harboring the organism, or
by lacerating part of the body on coral, fish, etc., followed by
contamination with the organism. The ingestion of _V. vulnificus_ by
healthy individuals can result in gastroenteritis. The "primary
septicemia" form of the disease follows consumption of raw seafood
containing the organism by individuals with underlying chronic
disease, particularly liver disease. In these individuals, the
microorganism enters the blood stream, resulting in septic shock,
rapidly followed by death in many cases (about 50 per cent). Over 70
per cent of infected individuals have distinctive bulbous skin
lesions.
In Feb 2004, the Southern Medical Journal published a review, an
editorial, and a case report regarding _V. vulnificus_:
The review (1) summarized cases with atypical aspects, including
sepsis in a windsurfer who developed infection after being struck by
lightning in the water, and who was later resuscitated, an infected
corneal ulcer in an oyster shucker who sustained shell fragments in
his eye, and a bacteremia in an HIV infected host. In the review, the
authors reviewed treatment, which included appropriate wound care,
with debridement as needed, and antimicrobial agents. They pointed
out that, though the incidence of this infection is low (0.5-2.0
reported cases per million individuals), its significant mortality
(the leading cause of foodborne mortality in some areas) makes _V.
vulnificus_ an important public health issue.
The editorial (2) points out that individuals with preexisting live
disease are 80 times more likely to become ill, and 200 times more
likely to die, as a consequence of eating raw oysters contaminated
with this organism, than are those without liver disease. Other risk
factors include hemachromatosis (iron overload disease), long term
corticosteroid use, diabetes, renal failure, and all forms of
cellular immunosuppression.
The case report (3) highlights a unique case of a woman with chronic
leg ulcers who developed infection of the ulcer with _V. vulnificus_
after being treated by a traditional folk healer, who sprayed fresh
fish blood on the ulcer.
1. Ulusarac O, Carter E. Varied clinical presentations of _Vibrio
vulnificus_ infections: a report of 4 unusual cases and review of the
literature. South Med J 2004; 97:163-8.
2. Mitra AK. _Vibrio vulnificus_ infection: epidemiologicy, clinical
presentations, and prevention. South Med J 2004; 97: 118-9.
3. Tal S, Guller V, Zimhony O, et al. A 'fishy remedy": an unusual
transmission of _Vibrio vulnificus_ infection. South Med J 2004; 97: 205-7.
- Mod.LL]
VIBRIO VULNIFICUS - USA (TEXAS)
*******************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
[1]
Date: Sat 14 Aug 2004
From: John Hardee <tsu@nwlink.com>
Source: Houston Chronicle [edited]
<http://www.chron.com/cs/CDA/ssistory.mpl/health/2735560>
Man loses battle with Gulf bacteria
-----------------------------------
A Houston dentist has lost his month long battle with a bacterium
that invaded a cut on his leg while he was fishing near Port
O'Connor, officials said on Fri 13 Aug 2004. The man, 52, died late
on Thu 12 Aug in a Victoria hospital, where he had been undergoing
treatment since 17 Jul, 2 days after he was exposed to the saltwater
bacteria _Vibrio vulnificus_. His is the 7th vibrio-related death in
Texas in 2004, officials said. At least 12 Texans have been injured
by the cholera-like bacteria as well, according to the Texas
Department of Health.
Another man on the fishing-contest outing was infected by a different
strain of the bacterium. He was released from the Victoria hospital
on Mon 9 Aug 2004, after more than 3 weeks of treatment, including
several surgical procedures to remove tainted flesh. Officials
attributed his survival to swift medical treatment after exposure.
The dentist apparently got a minor cut on his leg, on 15 Jul, when he
slipped on a dock. The following day, the leg became swollen, and he
sought treatment in Port Lavaca. By the 2nd day he was critically
ill, a spokesman at Citizens Medical Center in Victoria said.
"By the time he got here, vibrios had already infiltrated his blood
system, and he was in shock, which itself can be deadly," CMC
spokeswoman Melissa Purl said. Within days, both legs were amputated,
and he sank into a coma, she said. The dentist was one of several
Houston-area residents stricken by the bacteria in Gulf waters this
summer [2004]. A Bay City man, who went fishing in the Laguna Madre,
and a Dayton man, who vacationed in Freeport, were successfully
treated, in late July 2004, for infection with the bacteria.
Health experts said the bacteria are common in the Gulf, and, most
prevalent in coastal and bay waters in warmer months. The bacteria
can be ingested via contaminated seafood, such as oysters, or
absorbed through skin wounds, but don't penetrate healthy skin. The
Centers for Disease Control and Prevention (CDC), which has recorded
vibrio-related illnesses and deaths since 1988, said cases are rare,
but underreported. A typical year brings 16 deaths along the Gulf
Coast states, CDC said.
The Texas Department of Health reported on Fri 13 Aug that, so far
this year, there have been 31 illnesses caused by vibriosis,
including the 7 deaths, 4 of which were attributed to eating
contaminated oysters. Experts say those who enter coastal waters
should make note of skin cuts and check them later for redness or
swelling. If caught quickly, illness caused by the bacteria is
controllable with antibiotics.
[byline: John W Gonzalez]
--
John Hardee
Portland Oregon
<tsu@nwlink.com>
******
[2]
Date: Thu 29 Jul 2004
From: ProMED-mail <promed@promedmail.org>
Source: Houston Chronicle [edited]
<http://www.chron.com/cs/CDA/ssistory.mpl/sports/2707587>
Infections hit Texas coast fishermen
------------------------------------
A recent outbreak of rare, but potentially dangerous, bacterial
infections has some coastal fishermen scared to go near the water.
Experts say there is reason for concern, and opportunity to increase
awareness, but no cause for panic. _Vibrio vulnificus_, and its many
relatives, are naturally occurring bacteria found in warm saltwater
throughout much of the world.
CDC's Division of Bacterial and Mycotic Diseases notes that "an
average of 50 culture-confirmed cases, 45 hospitalizations, and 16
deaths" occur annually along the Gulf Coast. Nationally, the numbers
roughly double across the board. These bacteria are most often
responsible for illnesses and deaths from consumption of contaminated
seafood, but fishermen often contract the bacteria through open
wounds.
The Texas Department of Health issued a release, on 22 Jul 2004, that
documented 20 confirmed cases of these infections this year [2004],
including 3 deaths. "At least 2 (of the infections) were associated
with exposure of cuts, or open wounds, to coastal saltwater,"
according to the release.
TDH spokeswoman Emily Palmer amended that report on Wed 28 Jul 2004,
noting that 11 cases of wound-related Vibrio infections in Texas have
now been confirmed since June 2004. In 2003, there were 14
wound-related infections statewide among 43 total cases, 7 of which
were fatal.
Among the latest to make the unfortunate list of infected patients
are 3 fishing guides. The man most recently stricken was on high
personal alert for the disease, after word of earlier diagnoses hit
the coastal community. He, therefore, knew to seek medical attention
at the 1st serious hint of infection. A Port O'Connor guide, he had
worked for 10 consecutive days. When he got home, his left ankle felt
tender, "like a slight sprain." The next morning, he felt queasy and
skipped breakfast. Wading with clients a few hours later, he became
light-headed and passed out. A face full of bay water brought him
quickly back to consciousness, and the fishing guide knew that he was
in trouble.
Back in the boat, he summoned other guides to retrieve his customers,
then called for a family member to meet him at the dock. When he
removed his wading boots, he noticed a black spot "about the size of
a quarter" below the sore ankle. "In the time it took us to get from
the dock to the emergency room (about an hour)," he said, "that dot
about doubled in size."
The patient was met at DeTar Hospital Navarro by Dr Brian F Burns, a
plastic surgeon who also is treating 2 other victims of V.
vulnificus_ infection at Citizens Medical Center in Victoria, TX.
"While Dr Burns drew a circle around (the infected area), and
explained what he was going to do," the guide said, "I could see a
redness going up my leg." The infected tissue was removed, the
patient was administered antibiotics, and he improved. This man is
luckiest, thus far, of Texas waders stricken this summer [2004] by
the bacteria. Burns said that early detection, and treatment, saved
him from severe complications, and, probably spared his life.
Doctors at CMC were forced this week [last week of July 2004] to
amputate both legs of a Houston man, who also has suffered organ
failure since infection early in July 2004, and, who remained in
critical condition on Wed 28 Jul 2004. He waited just a couple of
days after the initial infection, friends say, before seeing a
doctor. Another man, who contracted the infection around the same
time, and in the same area, has lost most of the tissue between the
ankle and knee of one leg. On Wed 28 Jul 2004, he was listed as
stable but remained in intensive care at CMC.
A 4th man, another fishing guide, was hospitalized this week [last
week of July 2004] with _V. vulnificus_ infection in his right leg.
He already has undergone 2 surgeries to remove damaged tissue. "On
Friday, [9 Jul 2004], I cut my leg on the trailer, but didn't think
anything of it," the patient said from his hospital room in Bay City.
"I fished the next 5 days. It got worse and worse. By the next
Friday, I was bedridden. My fever got to 104 (degrees)."
_V. vulnificus_ also found its way into the arm of a Rockport guide
this month [July 2004]. His said that his temperature was 104.7
degrees [Fahrenheit; 40.4 degrees Celsius], when paramedics checked
him at the dock, "and he was drinking a cold drink when they took
it." This patient has undergone surgery, and skin grafting, to repair
his arm. He's improving, his wife said, but he won't able to work
again for weeks.
Dr James Oliver, a PhD at the University of North Carolina in
Charlotte, has studied the _Vibrio_ family for nearly 3 decades. He
was surprised by the number of wound-related cases in Texas over such
a short time and over such a small area. Matt Richardson, an
epidemiologist at TDH in Austin, confirmed that _V. vulnificus_ is
the "absolute worst of the marine bacteria" on a list that includes
many other family members, as well as a slow-growing, but
tough-to-kill, germ called atypical mycobacteria. He advised all
coastal anglers to be cautious but said that it won't attack
unbroken, healthy skin. People in generally good health who are
exposed to this bacterium through wounds usually experience only mild
symptoms that do not persist. Ingestion by healthy people, reports
CDC, may cause vomiting, diarrhea, and abdominal pain.
Common-sense precautions should be adequate to avoid life-threatening
infection. Keep an antibacterial soap and generous supply of fresh
water nearby. If the skin is broken, clean and flush the area at the
1st opportunity. Should the site worsen, or other indications such as
redness, fever, lethargy, or flu-like symptoms appear, go straight to
the emergency room. "Vibrio infections can be successfully treated
with antibiotics if treated early," according to the TDH. The CDC's
recommendation is for "doxycycline or a 3rd-generation cephalosporin
(such as ceftazidime)."
[byline: Doug Pike]
******
[3]
Date: Sat 14 Jul 2004
From: Stephen M Apatow <s.m.apatow@humanitarian.net>
The following information provides an excellent overview of the
challenges associated with warm weather, along the Gulf of Mexico,
providing a suitable niche for microbial growth and existence,
including bacterial genera of clinical importance (_V. vulnificus_,
_V. cholerae_, _V. parahaemolyticus_, _V. mimicus_, _Aeromonas_,
_Plesiomonas_), as well as discussion of economic issues:
Microbes and Marine Biotechnology: Pathogen Detection in Shellfish,
Asim K Bej, Department of Biology, University of Alabama at
Birmingham <http://dhp.disl.org/PDFs/SAME-2003.pdf>
Economic value of marine resources:
1. Contributes about 1/3 of the USA gross national products (GNP).
2. Seafood industry is one of the primary contributors to this GNP.
3. Gulf of Mexico coastal water is rich in seafood, due to the warm
weather, and is a major resource for the seafood industry.
4. The economy of many coastal cities and states depends upon the
revenue generated from the seafood industry.
Impact of _Vibrio vulnificus_:
1. In the past several years, the fishery industry, in the state of
Texas, lost potential revenue of USD 3.4 million from oysters and
crabs, because
of closure due to bacteria and other contaminants.
2. The Interstate Shellfish Sanitation Conference (ISSC) suggests that
post-harvest-treated consumable oysters must not consist of >3 _V.
vulnificus_ per gram of meat.
3. This year (2003), the state of California released emergency
restrictions on sales of all oysters harvested from the Gulf of Mexico
between May and October, unless they are treated with a scientifically
validated method to reduce _V. vulnificus_ to non-detectable levels (3
organisms per gram of oyster meat).
4. ISSC Goal: An at least 60 per cent reduction of _V.vulnificus_-related
illnesses by 2007.
--
Stephen M Apatow
Humanitarian Resource Institute
<s.m.apatow@humanitarian.net>
[For noncholera _Vibrio_ infections other than gastroenteritis, the
combination of ceftazidime and doxycycline, or an antipseudomonal
penicillin (such as, ticarcillin and clavulanate, piperacillin and
tazobactam) is the therapy of choice. Alternative antibiotics are
cefotaxime, ceftriaxone, or a fluoroquinolone.
The following is extracted from the "FDA Bad Bug Book."
<http://vm.cfsan.fda.gov/~mow/chap10.html>
_Vibrio vulnificus_, a lactose-fermenting, halophilic, Gram negative,
opportunistic pathogen, is found in estuarine environments and
associated with various marine species, such as plankton, shellfish
(oysters, clams, and crabs), and fin fish. It is found in all of the
coastal waters of the United States. [Cases of illness have also been
associated with brackish lakes in New Mexico and Oklahoma.]
Environmental factors responsible for controlling members of _V.
vulnificus_ in seafood, and in the environment, include temperature,
pH, salinity, and increased dissolved organics.
This organism causes wound infections, gastroenteritis, or a syndrome
known as "primary septicemia". Wound infections result either from
contaminating an open wound with sea water harboring the organism, or
by lacerating part of the body on coral, fish, etc., followed by
contamination with the organism. The ingestion of _V. vulnificus_ by
healthy individuals can result in gastroenteritis. The "primary
septicemia" form of the disease follows consumption of raw seafood
containing the organism by individuals with underlying chronic
disease, particularly liver disease. In these individuals, the
microorganism enters the blood stream, resulting in septic shock,
rapidly followed by death in many cases (about 50 per cent). Over 70
per cent of infected individuals have distinctive bulbous skin
lesions.
In Feb 2004, the Southern Medical Journal published a review, an
editorial, and a case report regarding _V. vulnificus_:
The review (1) summarized cases with atypical aspects, including
sepsis in a windsurfer who developed infection after being struck by
lightning in the water, and who was later resuscitated, an infected
corneal ulcer in an oyster shucker who sustained shell fragments in
his eye, and a bacteremia in an HIV infected host. In the review, the
authors reviewed treatment, which included appropriate wound care,
with debridement as needed, and antimicrobial agents. They pointed
out that, though the incidence of this infection is low (0.5-2.0
reported cases per million individuals), its significant mortality
(the leading cause of foodborne mortality in some areas) makes _V.
vulnificus_ an important public health issue.
The editorial (2) points out that individuals with preexisting live
disease are 80 times more likely to become ill, and 200 times more
likely to die, as a consequence of eating raw oysters contaminated
with this organism, than are those without liver disease. Other risk
factors include hemachromatosis (iron overload disease), long term
corticosteroid use, diabetes, renal failure, and all forms of
cellular immunosuppression.
The case report (3) highlights a unique case of a woman with chronic
leg ulcers who developed infection of the ulcer with _V. vulnificus_
after being treated by a traditional folk healer, who sprayed fresh
fish blood on the ulcer.
1. Ulusarac O, Carter E. Varied clinical presentations of _Vibrio
vulnificus_ infections: a report of 4 unusual cases and review of the
literature. South Med J 2004; 97:163-8.
2. Mitra AK. _Vibrio vulnificus_ infection: epidemiologicy, clinical
presentations, and prevention. South Med J 2004; 97: 118-9.
3. Tal S, Guller V, Zimhony O, et al. A 'fishy remedy": an unusual
transmission of _Vibrio vulnificus_ infection. South Med J 2004; 97: 205-7.
- Mod.LL]