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Danger in the Water

September 28, 2016

Jaws, the 1975 American thriller motion picture, terrified audiences around the world and I would suspect caused lots of people to think twice about going in the water at beaches around the world, and especially on Long Island, NY. The prospect of being attacked by a shark is terrifying enough, not to mention a Great White. Yet most of us don’t think twice about another danger so tiny it cannot be seen with the naked eye.

Last June Charles Ballard Sr and his son Charles Jr went fishing at Virginia Beach in Virginia. As they waded through the surf they both cut their feet on jagged rocks. Within three days the cuts on Charles Sr’s feet became open sores. Charles was rushed to the hospital where doctors determined that he had contracted a rare, flesh eating disease, a deadly bacterium called Vibrio Vulnificus.

The Center for Disease Control (CDC) estimates there are 80,000 cases of vibriosis, 500 hospitalizations and 100 deaths each year in the USA related to Vibrio. It should be noted these estimates are not confirmed by CDC lab work.

Vibrio is a bacterium that grows well in salty environments, such as seawater. They are naturally and commonly found in warm marine and estuarine environments. Generally speaking the waters around Virginia Beach are too cold for Vibrio to thrive and it is very rare north of Maryland. More often Vibrio is found is the warmer waters of the Gulf Coast. 

The death of a 26-year-old Pine Island, Florida man in June 2015 has been attributed by his family to Vibrio. Yeager had been diagnosed with an auto immune disorder, but was believed to have recovered.  According to the Florida Dept. of Health, he was the fourth person to die in 2015 from Vibrio in Florida. The Florida Department of Health reports the state averages nine fatal cases of Vibrio vulnificus annually.

The Virginia Department of Health says Vibrio vulnificus is a naturally occurring bacterium in marine and estuarine water throughout the world. This organism can be found in Virginia’s coastal waters and is most prevalent during the warm months of the year. Infections have been reported in warm waters all along the coastal United States and in the Gulf. 

 

The U.S. Food and Drug Administration says: “Vibrio vulnificus, a lactose-fermenting, halphilic, gram-negative opportunist pathogen, is found in estuarine environments and associated with various marine species such as plankton, shellfish and fin fish. It is found in all of the coastal water of the U.S.  Environmental factors responsible for controlling members of Vibrio vulnificus in seafood and in the environment include temperature, pH, salinity and increased dissolved organics.” It is one of the reasons Virginia has a vigorous shellfish testing program where sample of oyster mean water are tested monthly for indications of a wide variety of health threats.

In July of 2015, seventy-five-year-old Charles Horner died after he cut his leg on a catfish spine in the Rappahannock River in Virginia. 

The CDC reports the most people with mild illness typically recover after about three days and suffer no long-term consequences. This was not the cases with Charles Ballard jr. Fortunately he was diagnosed rapidly and advised that he might lose a leg or possibly die. Dr. Gonzalo Bearman , the Chairman of the Division of infectious Diseases at VCU Medical Center in Richmond VA told Curt Autry of  NBC TV that at VCU they only see one or two Vibrio cases a year. He said in the last ten years, he’s treated fewer than thirteen cases.  

Dr. Lucy A Peipins, Ph. D Director of the VDH Division of Waterborne Hazards Control, advises that “people with liver disease such as cirrhosis or those with compromised immune systems are at high risk for contracting severe or fatal infection Vibrio vulnificus. No cases of Vibrio vulnificus infections have ever been reported from eating Virginia harvested shellfish.” Dr. Peipins says: “If you get a cut or scrape in marine or estuarine waters, be sure to clean the wound. Use soap and water or a disinfectant such as hydrogen peroxide. Cleaning the wound is important to avoid infection. If you notice any infection, see your physician. People with pre-existing open wounds should avoid coming in contact with marine or estuarine water and should wash all cuts and wounds that occur while in the water”  

 

There is no escaping the Vibrio vulnificus bacteria and other similar bacteria. Vibrios are one of the most common organisms in surface waters of the world. They can be found in salt and fresh water and in aquatic animals. Some glow in the dark and live in mutualistic association with fish and other marine life. They can be found in some raw or undercooked oysters. Healthy people who are exposed to Vibrio vulnificus may experience vomiting, diarrhea and abdominal pain. Most Vibrio vulnificus infections are acute and have no long term consequences. For those who have compromised immune systems, the consequences can be very severe, even fatal.

It is interesting to note that Charles Ballard Jr, who cut his feet on the same rocks at the same time his father did, suffered no ill effects. Unlike his dad, his immune system was evidently not compromised. 

As in most medical situations, prevention is the best medicine. If you are immunocompromised, you need to be extremely careful about allowing sea or river water to contact an open wound. The University of Wisconsin-Madison Dept of Bacteriology reports that immunocompromised individuals are 80-200 times more likely to develop Vibrio vunificus primary septicemia than healthy people. For that high risk group, the infection carries one of the highest mortality rates of all bacterial infections. If not treated within five days, it is almost always fatal. People who suffer from chronic liver disease, hemochromatosis, diabetes, stomach problems, kidney disease, cancer, immune disorders, (including HIV), and long term steroid use are at risk when they eat raw or poorly cooked seafood of any kind or allow an open wound to contact sea or estuarine water. Should you be exposed to the possibility of infection: bathe the wound with soap and water, flush it with hydrogen peroxide, do not pull the wound together. Apply digital pressure and go directly to a hospital.

Everyone should be extremely cautious around the water. Wear protective gloves and eye protection when you are cleaning fish or shucking shell fish. Wash your hands thoroughly with soap and water. Keep a bottle of hydrogen peroxide on board your boat or in the medicine cabinet of your waterfront home and have sterile pads on your boat or in your home for use in cleaning any cuts that could possibly have been exposed to the water. If the cut is deep enough to require stitches, go to the hospital rather than applying butterfly stitches. 

The important thing to remember is that Vibrio vulnificus bacteria or some of it cousins, may be present in the water in which you swim or fish. Assume it is there. To be on the safe side and take appropriate action should you  develop a cut that could put you at risk. If there is even a possibility the patient is immune compromised, get them to a high level trauma center that knows about Vibrio, immediately.

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