Warming waters bring flesh-eating bacteria to Delaware Bay

Last Updated: 2019-06-20

By Anne Harding

NEW YORK (Reuters Health) - A recent uptick in infections with Vibrio vulnificus, a flesh-eating bacterium, seen at a single New Jersey hospital suggests the pathogen's endemic area is spreading north.

The hospital saw five cases of the infection over the past two summers, compared to just one in the previous eight years, Dr. Katherine Doktor of Cooper University Hospital in Camden told Reuters Health by phone.

"We just wanted clinicians to be aware that while they may not have seen this in the past, this infection should be on their mind when somebody presents with a severe skin infection and has the right epidemiology, like being close to the water and shellfish consumption," she said. "Early treatment with both antibiotics and surgery are what leads to the best outcome for patients with this infection."

V. vulnificus prefers salty waters with surface temperatures above 13 degrees Celsius, and can infect people through broken skin or contaminated seafood. Wound infections and intestinal infections can lead to sepsis.

"Mortality from wound and bloodstream infections is high, particularly in patients with immunosuppression and those with cirrhosis or other iron-overload states," Dr. Doktor and her colleagues note.

All of the reported cases were in men. Four reported crabbing in the Delaware Bay and eating crabs before developing symptoms. The fifth worked in a New Jersey seafood restaurant.

Symptoms included vomiting, fever and rapidly progressing redness and swelling in a leg or hand. One patient died after developing unstable tachycardia during his third debridement, while one required amputation of all four distal limbs.

The pathogen is endemic to the southeastern U.S. coast, and cases after exposure in the Chesapeake Bay are "not uncommon," the authors note. But infections have only rarely been linked to exposure in the Delaware Bay, which is further north and slightly cooler, they add.

"We didn't want to cause any alarm or have people stop eating shellfish or anything like that, or stop going to the shore," Dr. Doktor said. "We just wanted clinicians to be aware that they may encounter this more frequently than they have in the past."

SOURCE: https://bit.ly/2x2hfro

Ann Intern Med 2019.