Two deaths reported in Florida from flesh-eating bacteria Posted: Friday, June 12, 2015 7:19 PM EDT Updated: Friday, September 4, 2015 7:19 PM EDT 
 
 There have been a total of two deaths in Florida linked to vibrio vulnificus, more commonly referred to as flesh-eating bacteria. 
 
 The closest case on the Gulf Coast has been found in Santa Rosa County. 
 
 The deaths occurred in Brevard and Marion counties. 
 
 According to the Florida Department of Health, vibrio vulnificus is a bacterium that normally lives in warm seawater and is part of a group of vibrios that are called "halophilic" because they require salt. 
 
 A person can be infected with vibrio vulnificus when they eat raw shellfish. People with open wounds who get into the warm, brackish water containing the virus can also be infected. 
 
 Officials say vibrio vulnificus is rare, but under-reported. Florida Health said between 1988 and 2006, the Centers for Disease Control and Prevention (CDC) received reports of more than 900 Vibrio vulnificus infections from the Gulf Coast states, where most cases occur. 
 
 What are some tips for preventing Vibrio vulnificus infections? ||||| A rare, potentially deadly bacteria that lives in warm seawater has infected seven people and killed two so far this year in Florida, according to state health officials. 
 
 "People can get infected with Vibrio vulnificus when they eat raw shellfish," Florida Health Department spokeswoman Mara Burger said in a statement. "Since it is naturally found in warm marine waters, people with open wounds can be exposed to Vibrio vulnificus through direct contact with seawater." 
 
 When the bacterium is eaten in contaminated food, symptoms of the disease include vomiting, diarrhea and abdominal pain. When Vibrio vulnificus enters the body through an open wound, it can cause infections that may lead to skin breakdown and ulcers -- the notorious "flesh-eating" symptoms. 
 
 While healthy people typically experience only mild symptoms, those with a weakened immune system, particularly people living with chronic liver disease, are at a higher risk for severe complications. The bacterium can invade the bloodstream and cause fever, chills, blistering skin lesions, septic shock, and death. 
 
 Cases of Vibrio vulnificus are rare - there were 32 cases reported in Florida last year - and infections are seasonal. Over 85 percent occur between May and October, according to the Centers for Disease Control and Prevention. 
 
 To avoid infection, experts recommend not entering the water if you have fresh cuts or scrapes. People with a compromised immune system should take extra precautions by wearing proper foot protection to prevent cuts caused by rocks and shells on the beach. 
 
 Shellfish, including oysters, clams, and mussels, should be cooked thoroughly and eaten promptly after cooking. Raw shellfish should be avoided. 
 
 Most cases of Vibrio vulnificus are treated with antibiotics. In some severe cases, amputation of the infected limb is necessary. ||||| How do persons get infected with Vibrio vulnificus? 
 
 People can get infected with Vibrio vulnificus when they eat raw shellfish, particularly oysters. The bacterium is frequently isolated from oysters and other shellfish in warm coastal waters during the summer months. Since it is naturally found in warm marine waters, people with open wounds can be exposed to Vibrio vulnificus through direct contact with seawater. There is no evidence of person-to-person transmission of Vibrio vulnificus. 
 
 How can Vibrio vulnificus infection be diagnosed? 
 
 Vibrio vulnificus infection is diagnosed by stool, wound, or blood cultures. Notifying the laboratory when this infection is suspected helps because a special growth medium should be used to increase the diagnostic yield. Doctors should have a high suspicion for this organism when patients present with stomach illness, fever or shock following the ingestion of raw seafood, especially oysters, or with a wound infection after exposure to seawater. 
 
 What type of illness does Vibrio vulnificus cause? 
 
 Vibrio vulnificus can cause disease in those who eat contaminated seafood or have an open wound that is exposed to warm seawater containing the bacteria. Ingestion of Vibrio vulnificus can cause vomiting, diarrhea and abdominal pain. Vibrio vulnificus can also cause an infection of the skin when open wounds are exposed to warm seawater; these infections may lead to skin breakdown and ulcers.Healthy individuals typically develop a mild disease; however Vibrio vulnificus infections can be a serious concern for people who have weakened immune systems, particularly those with chronic liver disease. The bacterium can invade the bloodstream, causing a severe and life-threatening illness with symptoms like fever, chills, decreased blood pressure (septic shock) and blistering skin lesions. Vibrio vulnificusbloodstream infections are fatal about 50 percent of the time.A recent study showed that people with these pre-existing medical conditions were 80 times more likely to develop Vibrio vulnificus bloodstream infections than healthy people. Wound infections may also be serious in people with weakened immune systems. The wound may heal poorly and require surgery. Sometimes amputation may even be needed for recovery. 
 
 How common is Vibrio vulnificus infection? 
 
 Vibrio vulnificus is a rare cause of disease, but it is also underreported. Between 1988 and 2006, the Centers for Disease Control and Prevention (CDC) received reports of more than 900 Vibrio vulnificus infections from the Gulf Coast states, where most cases occur. Before 2007, there was no national surveillance system for Vibrio vulnificus, but CDC collaborated with Alabama, Florida, Louisiana, Texas and Mississippi to monitor the number of cases in the Gulf Coast region. In 2007, infections caused by Vibrio vulnificus and other vibrio species became nationally notifiable. 
 
 What are some tips for preventing Vibrio vulnificus infections? 
 
 Do not eat raw oysters or other raw shellfish. 
 
 Cook shellfish (oysters, clams, mussels) thoroughly. 
 
 For shellfish in the shell, either a) boil until the shells open and continue boiling for 5 more minutes, or b) steam until the shells open and then continue cooking for 9 more minutes. Do not eat those shellfish that do not open during cooking. Boil shucked oysters at least 3 minutes, or fry them in oil at least 10 minutes at 375°F. 
 
 Avoid cross-contamination of cooked seafood and other foods with raw seafood and juices from raw seafood. 
 
 Eat shellfish promptly after cooking and refrigerate leftovers. 
 
 Avoid exposure of open wounds or broken skin to warm salt or brackish water, or to raw shellfish harvested from such waters. 
 
 Wear protective clothing (e.g., gloves) when handling raw shellfish. 
 
 How is Vibrio vulnificus infection treated? 
 
 If Vibrio vulnificus is suspected, treatment should be initiated immediately because antibiotics improve survival. Aggressive attention should be given to the wound site; for patients with wound infections, amputation of the infected limb is sometimes necessary. For more information on care and treatment specifics, please visit the CDC’s website. Information about the potential dangers of raw oyster consumption is available 24 hours a day from the FDA’s Seafood Hotline: 1-800-332-4010. For more information on Vibrio vulnificus, visit the CDC’s website. ||||| Enjoy the Water, but be Smart and Avoid the Vibrios 
 
 After the particularly chilly winter of 2014, local residents will head to the water for fishing, swimming, and a host of other water activities that define our lives here on the coast. Most people are unaware of a dangerous flesh eating bacterium, Vibrio vulnificus, which thrives in our coastal salt water. Scientists have identified more than 100 distinct species of Vibrio bacteria. 
 
 But only a few are pathogenic and harmful to humans. Among those are 
 
 Vibrio cholerae, the bacterium that causes cholera which still kills over 500,000 people annually. CDC states that Vibrio parahaemolyticus causes on average about 45,000 cases of disease in the U.S. each year, 86% of which are food-borne gastorenteritis. By comparison, CDC estimates that Salmonella causes 1 million cases of gastroenteritis annually, Shigella 500,000 and Listeria 1,600. The V. parahaemolyticus death rate is low, about 2% for gastroenteritis and 20-30% for wound-related cases. 
 
 The subject of this article, Vibrio vulnificus, can cause both food-borne and wound-related illnesses. The CDC reports a long-term average of 96 cases of serious Vibrio vulnificus infection per year, including food-borne and wound-related. The overall death rate is slightly over 50%, said by many experts to be the highest human fatality rate for any bacterium. According to FDA, 90% of all Vibrio vulnificus illnesses (morbidities and motalities) in the U.S. result from consumption of raw Gulf coast oysters. However, this article focuses on wound-related illness caused by Vibrio vulnificus. 
 
 Vibrio vulnificus is not the only Vibrio known to cause wound infections, but it is the most likely to cause disease. During the winter, populations of Vibrio vulnificus are lower and seem almost dormant, so they present little threat to the general public. As temperatures rise, Vibrio vulnificus multiplies. Warmer weather also brings coastal residents and visitors into contact with the water. This increases the chance of encountering the organism. Infections are seasonal; over 85% occur between April and October. Read on to learn about the threat and how to stay safe. 
 
 Every Gulf state from Florida to Texas has reported Vibrio vulnificus wound infections. Here in Ocean Springs, Joseph Smith contracted Vibrio while fishing in 2012 and physicians had to remove his leg. In Florida, there were nine deaths in 2012 and 13 deaths in 2011 attributed to the bacterium. Last year in June and July at Grand Isle, Louisiana there were several cases of wound infections of Vibrio vulnificusthat resulted in hospitalization and one death. 
 
 A Vibrio Vulnificus infection showing redness and swelling, soon after the patient was admitted to the emergency room. Photo courtesy of Louisiana Sportsman 
 
 Later, after multiple surgeries to remove affected tissue. The patient required weeks of ongoing wound care following his hospital stay. Photo courtesy of Louisiana Sportsman 
 
 
 
 The CDC states that Vibrio infections may be under-reported. Since 1988, the CDC has maintained a voluntary surveillance system for culture-confirmed Vibrio infections in Alabama, Florida, Louisiana, Mississippi, and Texas. Between 1988 and 2006, CDC received reports of more than 900 infections from the Gulf Coast states. In 2007, surveillance was expanded to national notification of infections caused by any Vibrio species. Wounds account for approximately 60% of all U.S. Vibrio vulnificus cases. 
 
 
 
 Dark purple bars show total cases. Light pink bars show cases resulting from eating shellfish. The difference between the two represent wound-related cases. Source: Vibrio vulnificus cases in the U.S. by year 1998-2004Dark purple bars show total cases. Light pink bars show cases resulting from eating shellfish. The difference between the two represent wound-related cases. Source: safeoyster.org 
 
 Dr. Jay Grimes, Professor of Marine Microbiology at GCRL, reports that with global climate change, Vibrio vulnificus populations are increasing as water temperatures rise. The rising water temperatures promote the increase in Vibrio vulnificus not only in our own coastal waters. New cases of the bacterium are being found in waters where they were not previously perceived as a threat. 
 
 Small wounds can happen easily when you are out fishing or enjoying some time on the beaches, for example, getting hooked on your own fishing tackle or stepping on an oyster shell. At the time, it may seem an insignificant injury. But, the Vibrio vulnificus bacterium can enter through a new wound or through an existing wound, like a tiny cut, scratch or even a mosquito bite. For most healthy individuals, any infection or irritation is minor and hardly noticed. The case is different for people who have weakened immune systems. The bacterium invades the bloodstream, potentially causing a severe and life-threatening illness. Vibrio wound infections happen fast; symptoms may become evident in only four hours. 
 
 For prevention, people with open wounds should avoid contact with sea water. But, if you have a wound exposed to warm saltwater and see any combination of redness, swelling, fever, chills and experience pain the get to the hospital immediately and be sure to tell the physician that your wound was exposed to salt water. Physicians recommend that you don’t try to “tough it out!" Dr. Ekenna Okechukwu, Infectious Disease Specialist and Doctor of Internal Medicine at Singing River Health Systems, said “The earlier you seek help, the more likely a good outcome is possible. Do not delay in seeking help. Treatment of a Vibrio vulnificus wound infection will usually include antibiotics and surgery in cases of wound infection. 
 
 A Vibrio vulnificus infection can be tricky to diagnose and treat. And many clinicians and physicians have not seen a case first-hand. Anybody - young, old, male, or female - can be exposed to this fast-moving infection, but people who have weakened immune systems are at the highest risk. Dr. Ekenna Okechukwu, states “People with underlying diseases like liver cirrhosis or other chronic liver disease, chronic alcoholism, cancer, or persons on treatment with immunosuppressive drugs, including chemotherapy or steroids may be more prone to get sick and complicated infections, especially if they have an open wound.” One study reported that people with compromised immune systems were 80 times more likely to develop Vibrio vulnificus bloodstream infections than healthy people. 
 
 
 
 Avoid Wounds 
 
 When fishing, harvesting oysters, or handling crab traps, use caution and wear gloves where practical to prevent wounds, flush any wounds quickly with sterile water and treat them with hydrogen peroxide and povidone-iodine (e.g., BetadineR). Wear protective coverings on your feet and, in general, use caution when in and around coastal waters. Dr. Grimes emphasizes that an ounce of prevention is worth pounds of cure. 
 
 If You Have a Wound 
 
 If you get a small wound while you are out enjoying the Gulf Coast or enter the water with a small wound or sore, and begin to see symptoms of an infection, don’t take chances. Immediate medical attention and treatment quickly can be the difference whether you keep all of your limbs and your life. Dr. Grimes recommends that anyone who has a wound exposed to saltwater follow these steps. 
 
 
 
 Avoid a Vibrio vulnificus Infection in a Wound Exposed to Warm Saltwater Flush out wound with sterile water. Use bottled water if you are on a boat. Do not use sea water. Wash the wound with soap and water. Flush and clean the wound with hydrogen peroxide. Disinfect with a generous application of Betadine. Hydrogen peroxide and Betadine are available at all drug stores and should be included as part of your first aid kit on any boat. If your wound starts to swell and turn bright red, go immediately to the closest emergency room. Inform the attending physician about the injury and that it was exposed to saltwater. Tell the ER physician you suspect a Vibrio infection. 
 
 
 
 The Bottom Line 
 
 While Vibrio wound infections present a serious danger in warm saltwater, thankfully, they are not common and rarely affect those with healthy immune systems. Dr. Grimes stresses that common sense precautions will help you avoid infections, and that prompt diagnosis and treatment of a Vibrio infection saves lives and limbs. 
 
 Resources 
 
 Seminar for Clinicians Scientists here at the Gulf Coast Research Laboratory want to help health care professionals learn the key indicators for spotting Vibrio vulnificus infections in patients. Dr. Grimes was part of a team that offered a half-day program titled Coastal Concerns for Clinicians on May 3, 2014. This program alerted and educated healthcare providers on Vibrio vulnificus, parasites, viruses, harmful algae, and other waterborne threats to humans here in our coastal region. 
 
 
 
 
 

– A bacterium that flourishes in warm, brackish water has killed two people in Florida this year and will likely take more lives—but people can easily lower their chance of infection. Florida health officials say one person picked up the bacterium, known as vibrio vulnificus, via "raw seafood exposure" and another through "multiple exposures," UPI reports. It's not unusual in Florida, where 32 vibrio vulnificus cases were reported last year and seven were fatal. People usually get infected by entering vibrio vulnificus-infected water with open wounds—even a mosquito bite can serve as a point of entry, per the Gulf Coast Research Laboratory—or eating raw seafood. Sufferers with weakened immune systems (chronic liver disease in particular) are especially at risk, according to the Florida Department of Health. Mild cases resemble stomach flu or food poisoning, CBS News reports, but vibrio vulnificus becomes life-threatening when it enters the bloodstream. Then come symptoms like blistering skin lesions, low blood pressure, chills, and fever. Sufferers sometimes endure painful skin infections and have their limbs amputated; death results in about half of life-threatening cases. As the laboratory puts it, that's "said by many experts to be the highest human fatality rate for any bacterium." The more grim results explain why vibrio vulnificus is loosely called a "flesh-eating" bacteria even though it doesn't meet the official criteria, UPI noted last year. For more, see WTVM's list of ways to avoid vibrio vulnificus, including tips on shellfish-cooking and a warning to avoid raw oysters altogether. Another vibrio vulnificus factoid: Maryland and Gulf Coast states like Florida have the worst infection rates, but the bacterium is spreading to new waters thanks to global warming, per the laboratory. (More dangers in our waters: Two teens lost limbs on Sunday in North Carolina shark attacks.)