Vibrio vulnificus

More Cases of Necrotising Fasciitis from Vibrio vulnificus infection

Vibrio vulnificus
Obtained from the CDC Public Health Image Library: CDC/James Gathany (PHIL #7815)

Further to the last post about Vibrio vulnificus – a free living marine bacteria found in warm waters, the Department of Health has made three press releases over the last 7 days of further cases of necrotizing fasciitis (flesh-eating disease) caused by Vibrio vulnificus infections in Hong Kong. V. vulnificus causes infection by ingestion (seafood) or through open wounds when swimming or wading in infected waters or via puncture wounds from the spines of fish such as tilapia. It prefers warm seawater or brackish (mixed fresh- and seawater) and occurs worldwide in warm salt-bearing waters and can be present in infected shellfish. In people with compromised immune systems, V. vulnificus is more likely to spread into the blood stream, when it can cause severe symptoms including blistering skin lesions, septic shock, and even death .

All three cases reported by the Department of Health in August had underlying illnesses (this could be e.g. hepatitis, HIV, diabetes etc.) and all had a wound on an arm or leg which when swabbed tested positive for Vibrio vulnificus: 

9th of August 2012: a 56-year-old man from  Yuen Long with underlying illness developed pain over left ankle on August 5. After admission to North District Hospital on the same day, he was diagnosed as having necrotising fasciitis (flesh-eating disease). An amputation was performed, but the patient’s condition deteriorated and he passed away on the next day.

13th of August 2012: a 77-year-old man from Kwun Tong with underlying illness presented right forearm redness, pain and swelling on August 8, recalling a puncture injury to his right forearm by a sharp object, suspected to be a prawn. He was admitted to United Christian Hospital the next day where medical staff diagnosed necrotizing fasciitis. The man received intensive care and his condition is all stable.

15th August: an 80-year-old man from Kwun Tong with underlying illness presented fever and chills on August 11 and developed redness on his left lower leg the next day. He was admitted to United Christian Hospital and was diagnosed with necrotising fasciitis followed by an above-knee amputation of the left leg. The man is now in serious condition.

I know of one further case where a man developed swelling and redness in one leg which had an open wound and which came into contact with seawater. The patient fully recovered after a week-long hospitalization and treatment with antibiotics.

According to a spokesman for the  Centre Health Protection (CHP), necrotising fasciitis is a serious bacterial infection which can destroy tissue and cause death within 12 to 24 hours after infection. The CHP reminds people to adopt the following preventive measures:

* Avoid foot/leg contact with dirty water when visiting a wet market;
* Avoid exposure of open wounds or broken skin to seawater or salty water;
* Wounds should be thoroughly cleaned and properly covered; and
* Wear thick rubber gloves when handling raw shellfish.

Patients should seek medical advice promptly if they develop symptoms and signs of infection such as increasing redness, pain and swelling.

 

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