Vibrio vulnificus, fatal – china: (Hong Kong)   

A ProMED-mail post, http://www.promedmail.org, ProMED-mail is a program of the International Society for Infectious Diseases http://www.isid.org 

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Date: Wed 30 May 2012 
Source: The Standard http://www.thestandard.com.hk/news_detail.asp?we_cat=4&art_id=122935&sid=36553059&con_type=1&d_str=20120530&fc=2 

An 84-year-old woman who cut herself while descaling a fish has died from water-borne Vibrio vulnificu_ bacteria [infection], the Centre for Health Protection said last night [29 May 2012]. The Wan Chai resident, who had a chronic underlying medical condition, ran a fever last Wed 23 May 2012, and developed symptoms such as fever, vomiting, and lethargy. She was admitted to Ruttonjee Hospital the next day with lower limb bruising and upper limb swelling before succumbing on Sat 26 May 2012. 

The center said a specimen of her blood tested positive for V. vulnificus_ and that its investigators are trying to identify the kind of fish involved and where it was bought. According to Department of Health figures, there have been 54 such infections and 16 deaths since 2010, including 6 this year [2012]. 

_V. vulnificus_ infection can lead to rapidly expanding cellulitis (skin infection) or septicemia (bacteria in the blood). It was first isolated in 1976. 

The infection can be brought on by eating seafood, especially raw or undercooked oysters. The bacterium may also enter the body through open wounds when swimming or wading in infected waters, or through puncture wounds from the spines of fish such as tilapia. 

[Vibrio vulnificus, a lactose-fermenting, halophilic [salt-loving], Gram negative, opportunistic pathogen, is found in estuarine environments and associated with various marine species such as plankton, shellfish (oysters, clams, and crabs), and finfish. It is usually found in the warmer waters. Cases of illness have also been associated with brackish lakes. Environmental factors responsible for controlling members of V. vulnificus in seafood and in the environment include temperature, pH, salinity, and increased dissolved organics. 

Wound infections result either from contaminating an open wound with seawater 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 septicemic" form of the disease follows consumption of raw seafood containing the organism by individuals with underlying chronic disease, particularly liver disease. The organism can also enter through damaged skin. In these individuals, the microorganism enters the blood stream, resulting in septic shock, rapidly followed by death in many cases (about 50 percent). Over 70 percent of infected individuals have distinctive bulbous skin lesions (shown at http://safeoysters.org/images/sym_2_photo.jpg). 

A reasonable discussion of the disease in humans can be found in ProMED-mail posting "Vibrio vulnificus, salt water exposure - USA (TX) 20070719.2317." There are 2 points to be emphasized: that vibrios are normal flora in warm saltwater (not indicative of any sewage contamination) and that most of the life-threatening illnesses occur in individuals with underlying medical illnesses, including immunocompromised states, chronic liver disease, and diabetes.So-called normal individuals often just get gastroenteritis. The range of disease due to V. vulnificus can involve more northern geographical areas if the area is affected by a substantial heat wave. 

See also: 

Necrotizing fasciitis - USA: (HI), Vibrio vulnificus suspected 20120317.1072640 

 2011 
Vibrio vulnificus, fatal - Taiwan: (TW) raw oyster 20110914.2804 

2009 
Vibrio vulnificus - USA: Gulf oyster ban planned 20091030.3756 Necrotizing fasciitis, fatal - Canada: (MB) 20090118.0222 

2007 
Vibrio vulnificus, salt water exposure - USA (LA) 20070724.2376 Vibrio vulnificus, salt water exposure - USA (TX) 20070719.2317 Vibrio vulnificus, shellfish - USA (FL) 20070427.1376 Vibrio vulnificus, 2000-2005 - Australia (NT) 20070302.0742 

2006 
Vibrio vulnificus, oysters - USA (GA) 20060930.2805 Vibrio vulnificus - Germany (Mecklenburg-Vorpommern) 20060819.2319 Vibrio vulnificus - USA: RI 20060805.2173 

2005 
Vibrio vulnificus, post-hurricane - USA (04): Additional Vibrio species 20050915.2723 Vibrio vulnificus, post-hurricane - USA 20050906.2642 Vibrio vulnificus, salt water exposure - USA (MD) 20050905.2622 

2004 
Vibrio vulnificus, oysters - USA (FL) 20041120.3117 Vibrio vulnificus - USA (TX) 20040816.2274 

2003 
Vibrio vulnificus, fatal - Israel (03) 20031230.3173 Vibrio vulnificus, fatal - Israel 20031229.3159 

1997 
Necrotizing fasciitis - USA (Washington) (02) 19970607.1194 Necrotizing fasciitis - USA (Washington) 19970603.1148