CCMS Medicine Summer 2017 - 20

www.CHESTERCMS.org

A review on Vibrio vulnificus and how it
can affect your leisure time at the beach
this summer and potentially your
saltwater aquarium hobby
BY LIZA P. JODRY, MD

V

ibrio vulnificus has been a recent news
story in the past few weeks. Why? Early
this spring, a 31-year-old male with a
new tattoo on his lower leg went into the Gulf
of Mexico and contracted V. vulnificus through
breaks in his skin from a tattoo he had gotten 5
days earlier. His tattooed skin became seriously
infected and he developed cellulitis and septic
shock. Despite aggressive treatment in the ICU
with antibiotics and supportive care he died 2
months later. A contributing risk factor which allowed him to get
so sick and die was his underlying chronic liver disease. His story
was featured in several news reports and health magazines. With
summer vacations planned, knowing potentially how and where
you can be exposed to this bacteria and how to protect yourself
can help you avoid contracting this rare but dangerous disease.
Implications to the safety of having saltwater aquariums is also
discussed below.
V. vulnificus is a halophilic (salt requiring) bacteria found
naturally in estuaries, brackish lakes, or coastal seawater;
this bacteria is capable of infecting marine fish and shellfish,
specifically in oysters harvested from coastal areas. It is one of
three species most common for causing human illness in the
US known as vibriosis; the second most common being V.
parahaemolyticus. The most common routes of infection are
consuming raw or undercooked shellfish/seafood (especially
oysters) or exposing a wound to infected saltwater. Nearly 90%
of infections occur during the months of May through October
when water temperatures are warmer. It is one reason the warmer
waters of the Gulf of Mexico are a common location of infections
as in the case referenced above. A second common location of
infection is the Atlantic side of the state of Florida.

20 CHESTER COUNT Y Medicine | SUMMER 2017

Over an eight-year period between 20082016 there were 118 infections on the Gulf side
of Florida and 91 infections on the Atlantic side.
In 2014 there were 124 infections nationwide
and 21 deaths; Texas had about 27 cases. In
2015 Texas had 35 cases with at least 77%
being wound-related. In Florida, V. vulnificus
is the most common Vibrio infection with
wound infections being most common followed
by oyster consumption. The Florida State
Department has some of the most detailed records. In the state
of Florida there were 32 cases and 7 deaths in 2014, 45 cases and
14 deaths in 2015 and 46 cases and 10 deaths in 2016. Many
cases have been reported along the Gulf of Mexico in the states
of Alabama, Mississippi, Louisiana, Texas and Florida. These
states all test certain bodies of water at risk for being infected
with Enterococci bacteria but testing for V. vulnificus is not
standard. They post swim advisories to warn beach goers. Last
summer, 2016, Alabama had no beaches under a swim advisory,
Mississippi had 1, Florida had 3 along the Panhandle, Louisiana
had 12 and Texas had numerous beaches under advisories for high
levels of Enterococci based on standards set by the environmental
protection agency (EPA). If Vibrio infections continue to increase,
maybe Vibrio species will be added to the testing.
V. vulnificus infections are overall very rare. In 2007 vibriosis
became a reportable disease and states were encouraged to report
all confirmed cases to the CDC. Yet, these infections are still
largely underreported. However, we know that vibriosis causes
~80,000 illnesses every year in the US with ~52,000 being
due to eating contaminated food and ~28,000 due to wound
infection. There are up to 100 deaths in the US each year.
People with V. vulnificus skin infection can get seriously ill and
need ICU admission for treatment and/or limb amputation.
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Table of Contents for the Digital Edition of CCMS Medicine Summer 2017
