5.     Vibrio Cholerae -------------------------------------Cholera

V. cholerae (6), the type species of the genus Vibrio, is the causative agent of cholera outbreaks and epidemics.
Cholera enterotoxin (CT) is the primary virulence factor of the disease cholera. A Florida study of illnesses from raw
shellfish consumption reported the following species in descending order of frequency; V. parahaemolyticus, non-
O1/O139 V. cholerae, V. vulnificus, V. hollisae, V. fluvialis, O1 V. cholerae (64,72).
in 1993, a large outbreak of cholera occurred in India/Bangladesh from a new, until then unknown serogroup, O139.
The O139 strain has become endemic in the Bengal region and is the cause of what may be known as the Eighth
Cholera Pandemic. Some non-O1/O139 strains also are invasive, produce a heat stable toxin, and have caused septic
infections in individuals with pre-disposing medical conditions. V. vulnificus (33), the leading cause of death in the US
related to seafood consumption and nearly always associated with raw Gulf Coast oysters (90,104), resembles V.
parahaemolyticus on TCBS agar, but can be differentiated by several biochemical reactions, including -galactosidase
activity (31). Epidemiological and clinical investigations have shown that V. vulnificus causes septicemia and death
following ingestion of seafood or after wound infections originating from the marine environment

Food supplies may be contaminated by the use of human feces as fertilizer or by freshening vegetables for market with
contaminated water. A number of common-source gastroenteritis outbreaks attributed to V. parahaemolyticus have
occurred in the US (57), associated with oyster consumption.  The invasive species, V. vulnificus, the causative agent of
septicemic shock (63,90,118), is a common organism in coastal waters of some areas of the US and other countries
(60,90,122,124). It is reported to cause 20 to 40 U.S. cases each year of primary septicemia with a 50% mortality rate
among individuals with liver disease and elevated serum iron levels (104). A review of cases has determined an
association between septicemia and consumption of raw oysters, nearly all from Gulf Coast waters. This species has
also been responsible for wound infections in individuals who are associated with marine environments.  http://www.
cfsan.fda.gov/~ebam/bam-9.html

painless, watery diarrhea and vomiting, severe dehydration, with intense thirst, muscle cramps, weakness, and minimal
urine production, may lead to kidney failure, shock, coma, and death. (Merck)

VIBRIO:  Several species of Vibrio are known to be human pathogens,  V. cholerae ([is] the causative agent of
cholera). Another species of Vibrio that causes diarrhea is V. parahaemolyticus. V. vulnificus is also obtained from
eating contaminated seafood. Unlike other Vibrio species, this one is invasive and is able to enter the blood stream
through the epithelium of the gut.  Additionally, wound infection may also occur from contaminated sea water. Cellulitis
or ulcer formations may result.


Vibrio vulnificus is scarcely recognized by many microbiologists, much less by the public. Yet, in this country, the
bacterium causes a disease with over a  50 percent mortality rate, and it causes 95 percent of all seafood-related
deaths.

This organism causes wound infections, gastroenteritis, or a syndrome known as "primary septicemia."
3. Nature of Disease: Wound infections result either from contaminating an open wound with sea water harboring the
organism, or by lacerating part of the body on coral, fish, etc., followed by contamination with the organism. The
ingestion of V. vulnificus by healthy individuals can result in gastroenteritis. The "primary septicemia" form of the disease
follows consumption of raw seafood containing the organism by individuals with underlying chronic disease, particularly
liver disease (see below). In these individuals, the microorganism enters the blood stream, resulting in septic shock,
rapidly followed by death in many cases (about 50%). Over 70% of infected individuals have distinctive bulbous skin
lesions.


Texas Man Battles Flesh-Eating Bacteria
HOUSTON (July 18) -- A Nacogdoches, Texas, man was in critical but stable condition after three surgeries aimed at
saving him from a flesh-eating bacteria that infected him during a swim off the coast of Galveston County


Rapidly advancing necrotizing fasciitis caused by Photobacterium (Vibrio) damsela: A hyperaggressive
variant

Objective: To describe the first case of Vibrio damsela necrotizing fasciitis in New England, emphasizing the importance
of very early operative intervention to achieve source control in this extremely aggressive infection.
Design: Case report.
Setting: Surgical intensive care unit at Tufts-New England
Medical Center in Boston, MA.
Patient: A 69-yr-old retired fisherman with rapidly progressive necrotizing fasciitis from Photobacterium (Vibrio) damsela
infection and ensuing multiple-system organ failure. Interventions: Surgical debridement, ventilator support,
vasopressors, continuous veno-venous hemofiltration, and blood product transfusions.
Measurements and Main Results: Death.
Conclusions: A high index of suspicion is necessary for the diagnosis of this specific pathogen and concordant infection.
The willingness to surgically debride and amputate without hesitation at a very early point may be the only intervention
capable of saving the lives of patients affected by Photobacterium (Vibrio) damsela. (Crit Care Med 2004; 32:278 –281)
KEY WORDS: necrotizing fasciitis; Vibrio damsela; Photobacterium damsela; skin and soft tissue infection; septic shock



5.     Vibrio Cholerae -------------------------------------Cholera

V. cholerae (6), the type species of the genus Vibrio, is the causative agent of cholera outbreaks and epidemics.
Cholera enterotoxin (CT) is the primary virulence factor of the disease cholera. A Florida study of illnesses from raw
shellfish consumption reported the following species in descending order of frequency; V. parahaemolyticus, non-
O1/O139 V. cholerae, V. vulnificus, V. hollisae, V. fluvialis, O1 V. cholerae (64,72).
in 1993, a large outbreak of cholera occurred in India/Bangladesh from a new, until then unknown serogroup, O139.
The O139 strain has become endemic in the Bengal region and is the cause of what may be known as the Eighth
Cholera Pandemic. Some non-O1/O139 strains also are invasive, produce a heat stable toxin, and have caused septic
infections in individuals with pre-disposing medical conditions. V. vulnificus (33), the leading cause of death in the US
related to seafood consumption and nearly always associated with raw Gulf Coast oysters (90,104), resembles V.
parahaemolyticus on TCBS agar, but can be differentiated by several biochemical reactions, including -galactosidase
activity (31). Epidemiological and clinical investigations have shown that V. vulnificus causes septicemia and death
following ingestion of seafood or after wound infections originating from the marine environment

Food supplies may be contaminated by the use of human feces as fertilizer or by freshening vegetables for market with
contaminated water. A number of common-source gastroenteritis outbreaks attributed to V. parahaemolyticus have
occurred in the US (57), associated with oyster consumption.  The invasive species, V. vulnificus, the causative agent of
septicemic shock (63,90,118), is a common organism in coastal waters of some areas of the US and other countries
(60,90,122,124). It is reported to cause 20 to 40 U.S. cases each year of primary septicemia with a 50% mortality rate
among individuals with liver disease and elevated serum iron levels (104). A review of cases has determined an
association between septicemia and consumption of raw oysters, nearly all from Gulf Coast waters. This species has
also been responsible for wound infections in individuals who are associated with marine environments.  http://www.
cfsan.fda.gov/~ebam/bam-9.html

painless, watery diarrhea and vomiting, severe dehydration, with intense thirst, muscle cramps, weakness, and minimal
urine production, may lead to kidney failure, shock, coma, and death. (Merck)

VIBRIO:  Several species of Vibrio are known to be human pathogens,  V. cholerae ([is] the causative agent of
cholera). Another species of Vibrio that causes diarrhea is V. parahaemolyticus. V. vulnificus is also obtained from
eating contaminated seafood. Unlike other Vibrio species, this one is invasive and is able to enter the blood stream
through the epithelium of the gut.  Additionally, wound infection may also occur from contaminated sea water. Cellulitis
or ulcer formations may result.


Vibrio vulnificus is scarcely recognized by many microbiologists, much less by the public. Yet, in this country, the
bacterium causes a disease with over a  50 percent mortality rate, and it causes 95 percent of all seafood-related
deaths.

This organism causes wound infections, gastroenteritis, or a syndrome known as "primary septicemia."
3. Nature of Disease: Wound infections result either from contaminating an open wound with sea water harboring the
organism, or by lacerating part of the body on coral, fish, etc., followed by contamination with the organism. The
ingestion of V. vulnificus by healthy individuals can result in gastroenteritis. The "primary septicemia" form of the disease
follows consumption of raw seafood containing the organism by individuals with underlying chronic disease, particularly
liver disease (see below). In these individuals, the microorganism enters the blood stream, resulting in septic shock,
rapidly followed by death in many cases (about 50%). Over 70% of infected individuals have distinctive bulbous skin
lesions.


Texas Man Battles Flesh-Eating Bacteria
HOUSTON (July 18) -- A Nacogdoches, Texas, man was in critical but stable condition after three surgeries aimed at
saving him from a flesh-eating bacteria that infected him during a swim off the coast of Galveston County


Rapidly advancing necrotizing fasciitis caused by Photobacterium (Vibrio) damsela: A hyperaggressive
variant

Objective: To describe the first case of Vibrio damsela necrotizing fasciitis in New England, emphasizing the importance
of very early operative intervention to achieve source control in this extremely aggressive infection.
Design: Case report.
Setting: Surgical intensive care unit at Tufts-New England
Medical Center in Boston, MA.
Patient: A 69-yr-old retired fisherman with rapidly progressive necrotizing fasciitis from Photobacterium (Vibrio) damsela
infection and ensuing multiple-system organ failure. Interventions: Surgical debridement, ventilator support,
vasopressors, continuous veno-venous hemofiltration, and blood product transfusions.
Measurements and Main Results: Death.
Conclusions: A high index of suspicion is necessary for the diagnosis of this specific pathogen and concordant infection.
The willingness to surgically debride and amputate without hesitation at a very early point may be the only intervention
capable of saving the lives of patients affected by Photobacterium (Vibrio) damsela. (Crit Care Med 2004; 32:278 –281)
KEY WORDS: necrotizing fasciitis; Vibrio damsela; Photobacterium damsela; skin and soft tissue infection; septic shock

Crit Care Med 2004 Vol. 32, No. 1 page 278