Necrotizing Infections Rise With Warming Oceans, Study Shows

Nicola M. Parry, DVM

June 17, 2019

As ocean temperatures increase, serious Vibrio vulnificus infections are on the rise in previously nonendemic areas, according to a case series published online today in Annals of Internal Medicine.

Madeline King, PharmD, from the University of the Sciences in Philadelphia, Pennsylvania, and colleagues, report the occurrence of five cases of V  vulnificus necrotizing fasciitis at a hospital in New Jersey during the summers of 2017 and 2018.

By contrast, just one case had been diagnosed at the hospital in the previous 8 years, senior author Katherine Doktor, MD, from Cooper University Health Care in Camden, New Jersey, told Medscape Medical News.

This emerging Vibrio risk in nonendemic areas means clinicians need to be aware of the infection, she emphasized, especially if they have never seen a case in their practice.

The bacterium typically lives in warm seawater and is endemic to waters off the southeast coast of the United States. And, although cases of V vulnificus infection have been reported from the Chesapeake Bay area, they are rare in the more northern and cooler Delaware Bay region.

In this case series, the patients were all men, aged 38 to 64 years. Four of them had recently either been exposed to water in the Delaware Bay and/or eaten crabs from the region. The fifth denied exposure to water or crabs from the Bay but reported working at a New Jersey seafood restaurant. Two of the men had suffered leg trauma while crabbing in the Bay.

The patients presented with relatively nonspecific skin lesions on the limbs, including erythema and swelling, that rapidly progressed to necrotizing fasciitis. All required emergent debridement to manage the necrotic tissue. Blood or tissue cultures were positive for V vulnificus in each case.

One 64-year-old man with untreated hepatitis C developed unstable ventricular tachycardia during his third debridement and later died. In addition, a 60-year-old man with Parkinson's disease developed shock, respiratory failure, and disseminated intravascular coagulation, and ultimately required amputation of all 4 distal limbs.

Of the remaining men, a 38-year-old had untreated hepatitis B infection, a 46-year-old had type 2 diabetes, and another 64-year-old had untreated hepatitis C infection, as well as a history of long-term arthritis and methylprednisolone use and alcohol abuse.

Doktor explained that climate anomalies and increasing water temperatures over recent decades have provided favorable growth conditions for Vibrio in areas that were traditionally considered too cool for its growth. 

Nevertheless, despite the rising incidence of V vulnificus infections in previously nonendemic areas, Doktor emphasized that these cases remain rare and urged people not to panic.

"For most healthy individuals without risk factors, being in or around the water poses no increased risks," she said.

However, persons who are immunocompromised or who have broken skin should immediately consult a clinician if they develop any suspicious skin changes after spending time in the water, and especially in brackish waters, she concluded.

Two authors have reported serving on speakers' bureaus for Tetraphase and Allergan. The remaining authors have disclosed no relevant financial relationships.

Ann Intern Med. Published online June 17, 2019. Abstract

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