If you live in the New York City region, you probably heard news reports of a “flesh-eating bacteria” that has sickened several people. The disease is caused by an infection from a bacteria called Vibrio vulnificus, which can cause severe wound infections and, sometimes, blood stream infections, sepsis, and even death.
While worrisome, Vibrio vulnificus is extremely rare. Every year, there are about 100 cases reported in the United States. Vibrio vulnificus is less concerning for the general population, but is a major risk if you have a weakened immune system.
Timothy Sullivan, MD
In this Q&A, Timothy Sullivan, MD, an infectious diseases physician and Associate Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai, discusses why people are getting infected with Vibrio vulnificus in New York City, how to prevent it, and what to do if you’ve been infected.
Why are people suddenly getting infected with Vibrio vulnificus in the New York City region?
Vibrio vulnificus tends to grow in brackish water, which is a mixture of saltwater and freshwater that occurs in estuary areas where rivers meet ocean water, such as the Long Island Sound. As the bacteria tend to grow more rapidly in warm water, the disease has always been more common during the summertime. However, there seems to be a link between climate change and these infections. In recent years, it seems these infections have become increasingly common in more northern climates as ocean water temperatures rise globally.
What are the risks?
Those most at risk are people with weakened immune systems, which can be caused by a number of issues, including having an underlying liver disease, if you are a transplant recipient, or if you are undergoing cancer treatment. Among these individuals, you are at risk if you have open wounds, recent tattoos or piercings, and have been exposed to brackish water, or if you eat raw or undercooked shellfish.
What are the symptoms?
The symptoms depend on whether you were exposed to Vibrio vulnificus through brackish water or by eating raw or undercooked shellfish. If you were exposed through water, you can develop a wound infection, which would include redness, pain, and swelling near the wound. With this disease in particular, wound infections can progress very rapidly and progress to a condition called necrotizing fasciitis that destroys tissue beneath the skin, which is why the disease is referred to as “flesh-eating bacteria.” That infection can develop into severe redness and pain that spreads rapidly from the area of initial infection. The first signs and symptoms of infection following eating raw or undercooked shellfish include nausea, vomiting, diarrhea, and abdominal pain. If a severe infection develops, you may experience fevers, chills, rapid heart rate, low blood pressure, and confusion, which are all signs of a very severe bloodstream infection.
How is the disease treated?
A Vibrio vulnificus infection is typically treated with intravenous antibiotics. If you develop a severe wound infection, you may need to undergo surgery. In the most severe cases that develop into necrotizing infections, amputation may be required.
What should I do to avoid infection?
These recommendations are not for the general population but primarily for people who have weakened immune systems. Do not eat raw or undercooked shellfish, not only to avoid infection from Vibrio vulnificus but other potentially harmful bacteria, as well. You should also avoid direct exposure to brackish water or estuary regions. Even if you don’t have open wounds, avoid brackish water and handling shellfish, since you could injure yourself, such as being in a boating accident or cutting yourself while shucking oysters. If you are at risk for severe infection and have a wound that has been exposed to brackish water, raw seafood, or seafood juices, wash the wound as soon as possible with soap and water. If you want to eat shellfish, make sure it is well cooked.
What should I do if I think I’m infected?
A Vibrio vulnificus infection may be a medical emergency, so if you have a possible exposure to Vibrio vulnificus and signs of infection, you should go to the hospital immediately. You would need to be started on appropriate antibiotics and, if necessary, undergo surgery. Communicate to your doctor your risk factors and exactly how you were exposed, so they can accurately diagnose you and start your appropriate treatment as soon as possible.