| 6 August 2005 |
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Vibrio vulnificus Necrotizing Fasciitis
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"Flesh - eating disease" is the common name for necrotizing fasciitis. It is a serious bacterial infection of the soft tissue and fascia (a sheath of tissue covering the muscle). It destroys tissue and can cause death within 12 and 24 hours. About 20 to 30 percent of cases are fatal. Necrotizing fasciitis can be caused by a number of different bacteria, most commonly group A Streptococcus, which is carried by many people in their throat or on their skin without getting sick. The disease may also be caused by Vibrio vulnificus.
Vibrio vulnificus infection
Vibrio vulnificus is a bacterium in the same family as those that cause cholera. It normally lives in warm seawater. According to the information from Centers for Disease Control and Prevention, United States, this infection is seasonal; over 85% occur between May and October. Environmental factors, such as warm water and moderate salinity, can increase the number of V. vulnificus organisms in shellfish.
Transmission
- Wound infections may occur when wounds or soft tissues are exposed to the bacterium that is present in seawater or seafood, etc.
- Eating raw or undercooked shellfish, particularly oysters harvested from warmer waters.
- No human to human transmission is noted.
Risk groups
In wound infection, all persons can be affected. Persons with underlying medical conditions, especially liver disease, may be at increased risk of blood stream infection and serious complications.
Clinical features
Vibrio vulnificus can cause wound or soft tissue infections. Like other necrotizing fasciitis, symptoms may include intense pain, redness, swelling and rapidly developing tissue destruction. Sometimes, the swelling starts at the site of minor injury such as a small cut or bruise, but in other cases there is no obvious source of infection. In persons with underlying medical conditions, especially liver disease, can cause bloodstream infections characterised by fever, chills, decreased blood pressure, blistering skin lesions, and often, death. In otherwise healthy persons, causes diarrhea, vomiting, and abdominal pain. Immediate medical care in a hospital is often necessary.
Incubation period
Usually 12 to 72 hours.
Sequelae
Bloodstream infections in persons with liver disease are fatal approximately 50% of the time. Persons who recover suffer no long-term consequences.
Treatment
Appropriate antibiotics are needed to kill the bacteria and should be given promptly. Patients may need surgery to stop the infection from spreading.
Health advice
Some tips for preventing V. vulnificus infections, particularly among immunocompromised patients, including those with underlying liver disease:
- Avoid exposure of open wounds or broken skin to warm seawater or salty water.
- Any wound should be thoroughly cleansed and properly covered.
- Wear protective clothing (e.g., gloves) when handling raw seafood.
- Cook seafood, especially shellfish (oysters, clams, mussels) thoroughly.
- For shellfish, boil until the shells open and avoid cross-contamination of ready-to-eat food with raw seafood.
If symptoms and signs of infection (e.g. increasing redness, pain and swelling) occur, patients should seek medical advice promptly.
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