Considerations of infections on boats.

This is crazy--10 days ago a case of Vibrio vulnificus in S. Florida--yesterday, here in Pensacola. This evening we find:
"The Florida Department of Health in Santa Rosa County (DOH-Santa Rosa) has confirmed the first case of Vibrio vulnificus infection in a Santa Rosa County resident this year. The bacterium was identified by means of a blood culture". It makes you wonder if the bacteriologist are more attuned to looking for the pathogen.
 
m2cw

Increased awareness by CDC and state health depts
Cholera and Other Vibrio Illness Surveillance System

Infections with toxigenic Vibrio cholerae O1 and O139, the serotypes of Vibrio cholerae that cause cholera, have been reportable in the United States for many years. CDC reports all confirmed cholera cases diagnosed in the United States to the World Health Organization. In January 2007, the Council of State and Territorial Epidemiologists (CSTE) recommended that infection with all Vibrio species be nationally notifiable.

The Cholera and Other Vibrio Illness Surveillance System (COVIS) was initiated by CDC, FDA, and the Gulf Coast states (Alabama, Florida, Louisiana, Mississippi, and Texas) in 1988. CDC has maintained a database of Vibrio infections from humans in order to obtain reliable information on illnesses associated with Vibrio species. Participating health officials collect clinical data, information about underlying illness, history of seafood consumption, and exposure to seawater during the seven days before illness, and also conduct tracebacks of implicated seafood. This information has been used to educate consumers about the health risks of seafood, as well as to help determine host, food, and environmental risk factors. By 1997, nearly all states were voluntarily reporting. Additionally, CDC serotypes all V. parahaemolyticus isolates received from state health departments and screens for cholera toxin production in all V. cholerae isolates.
see
http://www.cdc.gov/nationalsurveillance ... lance.html

for additional information and reports
From 2007
Vibrio vulnificus infection is the leading cause of death related to seafood consumption in the United States. This virulent, gram-negative bacterium causes two distinct syndromes. The first is an overwhelming primary septicemia caused by consuming raw or undercooked seafood, particularly raw oysters. The second is a necrotizing wound infection acquired when an open wound is exposed to warm seawater with high concentrations of V. vulnificus. Most patients, including those with primary infection, develop sepsis and severe cellulitis with rapid development to ecchymoses and bullae. In severe cases, necrotizing fasciitis can develop. Case-fatality rates are greater than 50 percent for primary septicemia and about 15 percent for wound infections. Treatment of V. vulnificus infection includes antibiotics, aggressive wound therapy, and supportive care. Most patients who acquire the infection have at least one predisposing immunocompromising condition. Physician awareness of risk factors for V. vulnificus infection combined with prompt diagnosis and treatment can significantly improve patient outcomes.

with this information
Physicians will order wound cultures and blood cultures at the same time

In the lab we use continuous monitoring of blood culture bottles. The instrument flags the bottle as soon as it is positive then we pull it, perform Gram stain, report and call Gram stain to doc, floor, etc, document, plant to media and after growth perform identification and AST. Some labs use rapid (same day) assays to detect bloodstream pathogens

One instrument is the BACTEC instrument from BD
http://www.bd.com/ds/productCenter/BC-Bactec.asp
It can monitor hundreds of the bottles continuous
 
Eating raw bivalve bottom feeders (clams, oysters) may seem "gastronomic" to some, but is tragic to others. "Vibrio" is something you want to avoid.

Another illness common to cruisers in "the islands" is ciguatera poisoning from eating reef fish or large fish, like barracuda, that feed on reef fish. The ciguatera toxin originates from dinoflagellates, a marine micro-organism, which attaches and grows on dead coral reef and marine algae. It is a tasteless, odorless, cumulative neurotoxin that is not neutralized or eradicated by cooking. Incredibly,
some asian chefs are specially trained to fillet the puffer fish just right to give their customers a "tingle" sensation of the lips (aka minimal poisoning) but no more. Severe ciguatera poisoning causes respiratory paralysis and death.

Grandma used to say, "You are what you eat".

Aye.
 
Yes I agree and working in public health, most reportable and notifiable diseases are under reported. In mid 90s, our enteric disease epi combed the reports and results generated by labs and found 63% of salmonellosis cases were reported. This was instrumental is obtaining funding for communicable disease reporting training which still occurs today
 
I'm glad this thread was started, and I appreciated the detail, product and chemical names, links to additional reading, etc.

In some ways it has to be about common sense, and then too, there is the individual decision factor. Things aren't always perfect. I'd always rather have more information than less, and I will take responsibility if I use it "wrongly." Then too, I look at it all critically (not in the negative way, but in the critical thinking way), and often try to read a number of opinions. Even if none are "wrong," the different angles help me to form my thoughts.

When I was sailing offshore, I had an extensive medical kit. It included injectable morphine (I did have prescriptions for all the meds and carried them along). I did take a week long "Wilderness Emergency Care" class at a college, so I wasn't completely without training, but if the time had come to use the morphine, was I really trained and practiced? Heck no! But that's where I would have had to make a decision on my own. I would only have used it if I was in a place/situation where there didn't seem to be any better option. There would have been some risk. But then that's life. Do I carry that kit on the C-Dory? No. In fact, I have only minimal supplies along and already knew I should add to them. Reading this thread gives me a nudge and some further ideas as to how to proceed. In some ways it was easier to have a huge kit than it will be to decide what's enough but not too much.

Anyway, I think what I'm trying to express is that I appreciate the information given, and I would hate to have it withheld because "I might do more harm than good with it." While the latter may end up being true in some specific instances, on balance, I believe it's better in general to have/give more info than it is to "protect" people.

I have been unable to access the forum as much as usual lately, and I have missed it. Great place and good folks :thup
 
Reading this thread is a trip down memory lane for me. Some things do change over time (for example the procedure for CPR,the use of a tourniquet and many others), some don't change (hand washing) Significant advances are added (Isoniazid&PAS for controlling TB and allowing the emptying of sanitoriums , vaccines like Sabin and Salk polio which, in 1964 wiped out every familiy's annual fear that their child might be doomed to a life in an iron lung, and MMR and tetanus providing individual and herd immunity. I have often felt that it is right and proper that officers the US Public Health Service wear a military uniform. In the quiet way they, and their state and local colleagues, carry out disease reporting, surveillance, prevention , and control, they protect us from enemies that maim and kill. Contrary to what some may believe, ignorance is not bliss and "common sense" is not so common. I thank Dr. Bob, Brent and others who contributed to this thread's wake up call.
 
another chilling story of antibiotic resistance bacteria

KLEBSIELLA, ANTIMICROBIAL RESISTANT - FRANCE: (NICE) NOSOCOMIAL DEATHS
**********************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 7 Oct 2013
Source: Mediapart, Le blog de Ficanas [in French machine trans.,
summ., & edited]
<http://blogs.mediapart.fr/blog/ficanas/071013/deja-19-morts-dans-les-hopitaux-de-nice-cause-d-une-bacterie>


Already 19 deaths have occurred in the Nice University Hospital Center
[CHU] because of multidrug-resistant _Klebsiella pneumoniae_ (OXA48)
bacteria.

According to the regional health agency, more than 75 people have been
affected by this bacterium, which is not transmitted by the air but by
direct contact.

--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[Maps of France can be seen at
<http://www.gite.com/art/france-map/map-of-france-regions.jpg> and
<http://healthmap.org/r/8LM*>.

Formally, an antibiotic is a substance produced by one microorganism
that inhibits the growth of, or kills, another microorganism. Since
anti-infectives are no longer produced directly from microorganisms,
the term antimicrobial or antimicrobial agent is more proper.

Although the use of antimicrobials in animal husbandry likely
contributes to the problem, the amazing overuse of our current
antimicrobial armamentarium that I am currently observing in my
clinical practice in the USA no doubt serves as an efficient
multiplier of these multidrug-resistant isolates just as intravenous
drug abuse and sexual promiscuity facilitated the explosion of HIV 30
years ago. This misuse, in my opinion, is directly related to the lack
of control of antimicrobial use, especially in intensive care units
and emergency care settings by intensivists and ER physicians who
often react without wisdom and with "cookbook" protocols instead of
using common sense and rational prescribing patterns. Once the patient
moves out of the ICU or ER, the physicians do not even see the
products of their unwise labors.

In the USA, reimbursements for medical care are based on procedures,
not thought processes. Until the power of therapeutic nihilism is
recognized, that is, using these agents only when rational, in
combinations that make sense, and in settings where therapeutic
interventions can have the ability to produce measurable and
meaningful improvement in a patient's life, the medical community will
continue down the slippery slope into an era where no therapeutic
options will exist. - Mod.LL]

[see also:
Antimicrobial resistant bacteria - USA: impact 20130917.1950905
Acinetobacter - USA: (FL) burn unit, multidrug-resistance
20130731.1856257
Enterobacteriaceae, carbapenem resistant - Malaysia: (SK) nosocomial,
fatal 20130818.1886654
Enterobacteriaceae, carbapenem resistant - Europe: survey
20130712.1822582
Enterobacteriaceae, drug resistant - USA (02): (CA) CRE
20130410.1636420
Enterobacteriaceae, drug resistant - USA 20130306.1572873
2012
----
Acinetobacter - Chile: (Santiago) burn unit, drug-resistant
20120629.1184441
2010
----
Gram negative bacilli, resistant, update (01): NDM-1, KPC
20101028.3908
Acinetobacter, resistant, fatal - Japan: (Tokyo) RFI 20100907.3203
2006
----
Acinetobacter, drug resistant - UK ex Iraq 20061009.2894
2005
----
Acinetobacter, drug resistant - USA ex Iraq 20050803.2248
2004
----
Acinetobacter, drug resistant - USA military 20041119.3105
Acinetobacter, drug resistant - USA ex Iraq (02): alert, corr.
20040624.1679
Acinetobacter, drug resistant - USA ex Iraq: alert 20040623.1670
2003
----
Acinetobacter, drug resistant - Iraq (02) 20030418.0953
Acinetobacter, drug resistant - Iraq: RFI 20030417.0934
2001
----
Acinetobacter, drug-resistant - Turkey: correction 20010529.1041
Acinetobacter, drug-resistant - Turkey 20010524.1011
1999
----
Antibiotic resistant Acinetobacter - New Zealand 19991013.1824
1998
----
Salmonella typhimurium DT104, resistant - Denmark(02) 19981114.2195
Salmonella typhimurium DT104, resistant - Denmark 19981025.2091
Klebsiella pneumoniae, nosocomial, drug-resistant: RFI 19980504.0872]
.................................................sb/ll/mj/lm
 
Thank you Marty. I have lived thru a "Golden Age" in medicine where we have gone from only a hand full of antibiotics, to where a male's life expectancy has gone form 56 years when I was born to over 78 years for a male born today. It has not been just antibiotics--but they have contributed to the ability to do the other amazing surgeries and other medical procedures and diagnostic studies we have at our disposal today.

Again, Brent is 100% correct in his warning about the indescreminate use of antibiotics. On the other hand there may be some justification for antibiotic as a prophylactic after certain surgeries as published in guidelines.

Ciguatera has been mentioned with the ubiquitous term "in the Islands". In fact ciguatera has been reported over 3000 cases per year in the continental USA. Cases have come from fish caught off N. Carolina, and in the Gulf Of Mexico off the oil rigs of Louisiana. The ciguatera toxins become progressively concentrated as they move up the food chain from small fish to large fish. These large fish are pelagic and move beyond the reef of the true tropical area. The larger the fish the greater the toxin concentration. It appears with sea temp warming that both the fish and even the Gambierdiscus toxicus which is the primary source of dinoflagellate, is found on the oil rigs in the Gulf of Mexico. There is also the problem of imported fish, so that the condition has been seen in Canada. I will not go into the symptoms or treatment of ciguatera, but if you become ill after eating flesh from a large fin fish, medical attention should be sought as soon as possible.

Another toxin was mentioned: tetrodotoxin which is found in Puffer Fish where the toxin is in the gonads, liver, intestines, and skin. There are very few deaths from this in the United States. This is in no way related to Ciguatera as implied.
 
Florida Dept of Health provides these helpful resources
Ciguatera Fish Poisoning

image of a ciguatera poster Ciguatera fish poisoning is transmitted when people eat a fish which contains a marine toxin called ciguatoxin. Ciguatoxins are produced by a dinoflagellate algae called Gambierdiscus toxicus. Large reef-dwelling fish accumulate marine toxins by eating toxic algae growing on coral reefs. Toxins are found in the highest concentrations in the muscle tissue, organs, and fat of tropical or subtropical predatory reef fish.

Over 400 known fish species have been classified as potential ciguatoxin carriers. Examples of species associated with Florida cases include barracuda, grouper, amberjack, snapper, tuna, kingfish, eel, trevally, seabass, mackerel, hogfish, and mahi-mahi. Cooking fish does not kill the heat-stable toxin. Ciguatoxic fish do not carry a foul odor or taste.

The symptoms associated with ciguatera may include: vomiting, diarrhea, stomach pain or cramping, itchy skin; aching teeth, muscles, or joints; tingling sensation in the extremities, painful urination, and temperature reversal with a typical onset within 24 hours following fish consumption. Gastrointestinal symptoms typically present first, within 24 hours of exposure, followed by neurological symptoms which usually begin 1-2 days following the exposure. Rare secondary cases of mother-to-child transmission during breastfeeding and male-to-female sexual transmission have been reported. If you suspect that you have ciguatera fish poisoning, contact your local County Health Department or the Florida Poison Control Hotline at: 1-800-222-1222. Seek medical treatment from a health care provider.
Additional Information

Information on Ciguatera Fish Poisoning (158 KB pdf Link opens in a new window.)

Ciguatera Card (367 KB pdf Link opens in a new window.)

Ciguatera Fish Poisoning Poster (6 MB pdf Link opens in a new window.)

Return to the Aquatic Toxins Disease Prevention Home Page

http://www.doh.state.fl.us/environment/ ... atera.html




Update: Neurologic Illness Associated with Eating Florida Pufferfish, 2002
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5119a3.htm


MSDS (scary one)
http://www.cdc.gov/niosh/ershdb/Emergen ... 50019.html


Case definition
http://www.bt.cdc.gov/agent/tetrodotoxin/casedef.asp
 
Err... aa... There is no specific antidote for ciguatera poisoning. If you ingest too much at one time or ingest a little many times over months or years (read: it is cumulative) to reach your body's limit of the neurotoxin, you're 86'd. It's over. Treatment is symptomatic only; like having a back rub to make you feel better even though you know you are checking out...

Aye.
 
Foggy":3goq5htg said:
Err... aa... There is no specific antidote for ciguatera poisoning. If you ingest too much at one time or ingest a little many times over months or years (read: it is cumulative) to reach your body's limit of the neurotoxin, you're 86'd. It's over. Treatment is symptomatic only; like having a back rub to make you feel better even though you know you are checking out...

Aye.
Click to expand...

Correct that there is no specific antidote. However if you have ciguatera poisoning, there are multiple medical measures which will both save your life and help to prevent ongoing symptoms. Although there may be some small cumulative effect of toxin, it is not as portrayed as above. The reality is that the vast majority of ciguatera poisonings survive. If you are severely ill, those chances of survival are greatly increased with prompt medical treatment.
 
Eerrr... Ahaa...

From The CDC: "Ciguatera has no cure. ……. People who have ciguatera can be treated for their symptoms."

http://www.cdc.gov/nceh/ciguatera

And from emedicine: "Treatment is largely supportive and symptom driven. ……..Possibly an effective treatment will be available in the near future."

http://emedicine.medscape.com/article/813869-treatment

In "the islands" some years back, the Grenadines I think, I spoke with two long term reef hunting spear fishing individuals both who had sublethal ciguatera poisoning. They both were given the same warning by their private physicians "never eat pelagic or reef fish again. You could die." I believe this supports my understanding that the neurotoxin is indeed cumulative.

Aye.
 
Above I mentioned the U.S. Public Health Service (of which The Centers for Disease Control [CDC] is now a part. In light of the title of this thread it may be of interest to note that it, the USPHS, had its origin with the passage, by the 5th Congress, of An Act for the Relief of Sick and Disabled Seamen in 1798.
 
There is no disagreement here. How ever supportive treatment is far more complicated than in these two brief general medical articles in the internet.
I have treated ciguatera.(I suppose, one of the advantages of training and practicing medicine in a large port city) The caution not to eat fish which are contaminated is a general caution, which I would give to anyone who has been affected--and a precaution I have always taken when sailing in the tropics, including several years in the Caribbean, S. Pacific, Central America, Hawaii, New Zealand and Australia. I have released fish, which I have been told that locals would have eaten.

There have been no extensive scientific studies in humans for residual ciguatera toxins --for good reason, since this would require serial biopsy and analysis of both fatty and liver tissue. There maybe some trace toxins in the fatty tissue and liver, or it may be an increased sensitivity to any sodium channel alteration in the cell membrane. The symptoms can be recurrent, and exposure to even a small does of Ciguatera toxin, can trigger an exacerbation--as can alcoholic beverages, nuts, coffee, tea and chocolate which contain caffeine; theobromine and theophylline. The other caution is shell fish which may have brevetoxins (which are the class of toxins in Paralytic or Neurogenic Shell fish poisoning) as found in the many shell fish, in the entire country and with red tide infestations.. The brevetoxins have a similar mechanism of action on the sodium channels mechanism in the cell membrane. There are over 20 different ciguatera toxins identified and a number of brevetoxins There are specific drugs which will help in the sodium channel disruption. The historical mortality and morbidity has been hard to determine, because eating affected fish has been part of the food sources of many parts of the world. Before modern treatment mortality in serious cases as cited at 12%, currently it is less than 0.01%,: even less in centers which have extensive experience with the condition and due to rapid recognition of the condition.
 
Well, OK then.

Raw oysters? - you're out. Raw clams? - no way! Try the triggerfish next time in St Lucia? - I'll pass. And, beach BBQ'd barracuda next time in Mexico? - no thanks!

Thank you for dragging me into the 21st century concerning ciguatera poisoning. Admittedly, it's been a few decades since I was in the lower latitudes enthusiastically dabbling and splashing with fish spearing, then eating it for dinner. It's also comforting to know, if I regress and go back to it, there has been medical progress in this area to make me feel better thinking, in the meantime, I only have a 0.01% chance of dying from my recent bad meal choice.

Now must I worry about mercury when I open a can of tuna?

Aye.
 
Interesting how things change with time. As a youngster living near San Diego in the 1950's, we would be gifted with sport caught barracuda maybe once or twice a year. It got fried up and eaten. Never heard of ciguatera poisoning in those years, and we never knew anyone who showed symptoms. Saw plenty of red tide on the local beaches, but don't know if those dinoflagelates carried the toxin or not. Of course we swam in it, ate fish caught in it, and some folks ate mussels year round, pulled off local reefs. I do not recall advisories or warnings about PSP. Now and then a beach would be closed becauxe of E. Coli contamination. Probably more should have been, considering the distribution of sewer outfalls, how sewage was (not) treated, some places, and sparse monitoring.

Here in the NW, 50-60 years later, we have occasional warnings about various toxins in shellfish, with monitoring commonplace. (Yes, I have eaten raw Willapa Bay oysters, many years, now. Never any aftereffects. Knock wood!) Within the mouth of the Columbia River, it is not unusual to see enormous patches of red, mainly at high tide, some 8-10 miles inside the jaws of the jetty, last ten years or so, maybe late August, early September. When I moved to Astoria in 1973, we never saw red blooms in the river at any time, probably up to about 1985 or so, at least.
 
Dave,
I think that the climate change--and fisheries change are in play.

We also routinely ate Barracuda caught on a trolling line going back an forth to Catalina. They were relatively small fish, about 36" was a good sized fish. Ciguatera seems to be reported more in Calif. now than in 30 or 40 years ago. Most of what we saw were folks which caught fish in Mexico and also from imported fish. Today I suspect that the catch of barracuda is far lower than it was back in the 50's thru 70's.

The dinoflagellates are different in various areas, and there are also different toxins associated with the "Red tides" . The West Coast has different species than the East Coast, and the Gulf. We have been fortunate, and not had any in our area recently. One of the problems for PSP is that as you go further North, the areas which can be practically tested are further and further apart. Thus less testing is done.

We test mostly for Coliform in our Bayous. We lived next to a park where the testing was done--and if positive--as it frequently was, the swimming at that park was closed. The other park across the bayou, was never closed, because there was no testing there! I am sure that the contamination was exactly the same. They are doing DNA on the coliform to determine the source, since all of the area is now on sewer--much is duck or dog (or similar mammal ) carried material.
 
Thataway wrote:

I think that the climate change--and fisheries change are in play.

Agree those are two likely contributors. In addition, greater public awareness of marine toxins and effects on humans -- in the 1950's, probably some consumers of fish got sick, but just ignored it or did not associate it with what they ate.

Locally, other changes, in particular decreased fresh water input into the lower Columbia in late summer may have favored dinoflagelate propagation and/or appearance higher up in the estuary. Too many variables.
 
Published Date: 2013-10-01 12:51:42
Subject: PRO/EDR> Vibrio vulnificus - USA (03): (FL) fatal, alert
Archive Number: 20131001.1977219

VIBRIO VULNIFICUS - USA (03): (FLORIDA) FATAL, ALERT
****************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Mon 30 Sep 2013
Source: CBS News [edited]
http://www.cbsnews.com/8301-204_162-576 ... rom-river/


A Florida man has reportedly died less than 48 hours after being exposed to water bacteria. The 59-year-old died last Mon 23 Sep 2013, being infected with _Vibrio vulnificus_, a bacterium that belongs in the same family as cholera that lives in warm, saltwater water, CBS affiliate WKMG in Orlando, Florida reported.

*****The Florida Department of Health added to WKMG that in 2013 there have been 26 cases of _V. vulnificus_ in the state alone, resulting in 9 deaths.*****

The man had been crab fishing in the Halifax River near Ormond Beach, FL. When he woke the next day, his family members told WKMG that he noticed what looked like a bug bite on his leg. Doctors did not take the injury seriously until he started feeling ill, and the wound started "festering." He went to the emergency room on 22 Sep 2013 and passed away the next day.

Family members state that the victim perfectly healthy before this incident.

_V. vulnificus_ usually infects people who eat contaminated seafood or enters the body when an open wound is exposed to water containing the bacteria. Infection can cause vomiting, diarrhea, and abdominal pain. However, if a person has a weakened immune system -- especially people with chronic liver disease -- the bacteria can infect the bloodstream. This can cause a serious illness that involves fever and chills, decreased blood pressure, and blistering skin lesions. _V. vulnificus_ bloodstream infections are fatal 50 percent of the time.

The Centers for Disease Control and Prevention say that _V. vulnificus_ infections are rare, but may be underreported. There were more than 900 reports of the bacteria in the Gulf Coast states between 1988 and 2006.

Flagler County Health Department Administrator Patrick Johnson told the Daytona Beach News-Journal that officials are concerned since 2 of the most recent cases happened near the same area. "This is an illness that generally happens when someone eats raw oysters but that's not the case here," Johnson said. "Because the 2 most recent cases are linked to the same area, we wanted to make the public aware."

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The following is exacted from the "Bad Bug Book," Center for Safety and Applied Nutrition, US FDA (Food & Drug Administration) at http://www.fda.gov/downloads/Food/Foodb ... 297627.pdf:

_Vibrio vulnificus_, a lactose-fermenting, halophilic, 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. Environmental factors responsible for controlling numbers of _V. vulnificus_ in seafood and in the environment include temperature, pH [acidity], salinity, and amounts of dissolved organics. It may be normal flora in salt water, and acquiring this organism from shellfish or water exposure does not imply that the water is contaminated by sewage.

Wound infections result either from contaminating an open wound with sea water 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 septicemia" 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 bullous skin lesions (shown at http://safeoysters.org/medical/diagnosis.html).

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 include more northern geographical areas if the area is affected by a substantial heat wave. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/2o_u.]

See Also
Vibrio vulnificus - USA (02): (FL) prevention 20130801.1858411
Vibrio vulnificus - USA: (LA) 20130716.
 
thataway":1m157t6h said:
This is crazy--10 days ago a case of Vibrio vulnificus in S. Florida--yesterday, here in Pensacola. This evening we find:
"The Florida Department of Health in Santa Rosa County (DOH-Santa Rosa) has confirmed the first case of Vibrio vulnificus infection in a Santa Rosa County resident this year. The bacterium was identified by means of a blood culture". It makes you wonder if the bacteriologist are more attuned to looking for the pathogen.
Click to expand...

I have been out of town for a few days, but from Saturday's paper, it appears that this 53 year old died 5 days after contracting the infection on Sept 30 2013. The family, fishing partner and treating physicians state that he had no open wounds or cuts when he went fishing in the shallow water along the ICW--in a very popular fishing area, near Pensacola Beach. There apparently some question of a compromised immune system--not specified. The infection was in a leg and the patient became septic very early in the infection. The treatment is unknown--and it is not clear when the blood culture was positive. The Public Health report states that there was an "open wound". I suspect that he scraped his leg or some superficial injury. He was wearing tennis shoes. Thus far 32 cases of Vibrio V. and 10 deaths in Florida so far this year.
 
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