After a 74-year-old man jumped into the sea off the Gulf Coast of Florida, his limbs rapidly decomposed and he was eventually sent to the emergency room for rescue. The man, who had been healthy and active on the coast just three days earlier, suffered a cut on his right leg during a dive. The wound soon began to hurt and bruise, and two days later, the skin on his right arm began to change color.
According to a case report published in the New England Journal of Medicine, he was in critical condition when he arrived at the hospital on the third day. The lower part of his calf was dark, indicating subcutaneous bleeding. Doctors heard crackling sounds as they examined the body, indicating that bubbles were bubbling out of the dying flesh and that some of the outer layer of skin had begun to peel off. His arm was in equally bad shape, appearing red, discolored and swollen, with a large blood blister forming, indicating a severe flesh-eating infection.
While patients are rushed into the operating room to remove dead and infected tissue, doctors also begin testing to find the source of infection. Tests of blood and tissue samples showed the patient was infected with Vibrio vulnificus, a flesh-eating bacterium found in warm, salty water. Vibrio vulnificus can infect the human body in two ways: through a wound that comes into contact with contaminated water, as was the case in this case, or, more commonly, through the consumption of contaminated seafood. This bacteria takes up residence in the stomachs of shellfish, especially oysters, and in the intestines of fish. When ingested, the bacteria release enzymes to neutralize stomach acid and then invade from the intestines and possibly the bloodstream.
V. vulnificus possesses an extensive arsenal of molecular weapons, including a variety of toxins that help the bacterium hijack cells, absorb nutrients, degrade structural proteins, damage tissue linings, weaken blood vessels, trigger destructive inflammation, suppress immune defenses, and wreak overall havoc on its victims. The overall mortality rate from V. vulnificus infection is approximately 35%. But for infected people who also have immunodeficiency diseases or liver diseases, the mortality rate is as high as 50% to 60%. Likewise, for patients who develop sepsis, a life-threatening reaction to infection, the mortality rate is about 50%. For patients like this case, if antibiotic treatment or surgical removal of necrotic tissue is delayed, the mortality rate jumps to 100%.
In this case, the man survived. But his right leg was so damaged when he arrived at the hospital that it had to be amputated above the knee. His forearm required a large skin graft, taken from other parts of his body. After antibiotic treatment and six months of recovery, doctors reported that he was recovering well.
The case highlights the growing threat from Vibrio vulnificus in the context of climate change, with medical experts viewing its rise as an urgent public health issue. Warming ocean waters, expanding geographical distribution and increasing antibiotic resistance are all increasing risks. Cases of Vibrio vulnificus increased eightfold in the United States between 1998 and 2018, including spreading to areas where the bacteria were considered rare, such as Massachusetts, New Hampshire and Maine. "The abundance and geographic range of Vibrio vulnificus is expected to continue to increase due to factors associated with climate change, including rising sea temperatures, storm surges, salinity changes, and algal blooms," the patient's physician wrote.
The Centers for Disease Control and Prevention recommends that to avoid Vibrio infection, eat only thoroughly cooked seafood and wash your hands after handling raw seafood. If you have an open wound on your body, avoid entering salt water or at least keep the wound tightly bandaged. If you have been injured in brackish water, or if an existing wound has been exposed to such waters, wash it immediately with soap and clean running water.