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Last Updated: Dec 27th, 2006 - 19:07:47 |
Hurricane Katrina made landfall on August 29, 2005, with major impact on the U.S. Gulf Coast. During August 29–September 11, surveillance identified 22 new cases of Vibrio illness with five deaths in persons who had resided in two states (Figure 1). These illnesses were caused by V. vulnificus, V. parahaemolyticus, and nontoxigenic V. cholerae. These organisms are acquired from the environment and are unlikely to cause outbreaks from person-to-person transmission. No cases of toxigenic V. cholerae serogroups O1 or O139, the causative agents of cholera, were identified. This report summarizes the investigation by state and local health departments and CDC, describes three illustrative cases, and provides background information on Vibrio illnesses. Results of the investigation underscore the need for heightened clinical awareness, appropriate culturing of specimens from patients, and empiric treatment of illnesses (particularly those associated with wound infections) caused by Vibrio species. No confirmed cases of illness have been identified with onset after September 5; additional Vibrio cases are under investigation.
A case of post-hurricane Vibrio infection was defined as clinical illness in a person who had resided in a state struck by Hurricane Katrina (i.e., Alabama, Louisiana, or Mississippi) with illness onset and reporting during August 29–September 11, where Vibrio species was isolated from a wound, blood, or stool culture. Among cases, a wound-associated Vibrio case was defined as an illness that likely resulted from infection of a wound or abrasion acquired before or during immersion in floodwaters.
Wound-Associated Illnesses
Eighteen wound-associated Vibrio cases were reported, in residents of Mississippi (seven) and Louisiana (five); in persons displaced from Louisiana to Texas (two), Arkansas (two), and Arizona (one); and in a person displaced from Mississippi to Florida (one). Speciation was performed in clinical laboratories for 17 of the wound-associated cases; 14 (82%) were V. vulnificus, and three (18%) were V. parahaemolyticus. Five (28%) patients with wound-associated Vibrio infections died; three deaths were associated with V. vulnificus infection, and two were associated with V. parahaemolyticus infection.
Age of patients with wound-associated illnesses ranged from 31 to 89 years (median: 73 years). Fifteen (83%) were male. The majority of patients were hospitalized; admission dates ranged from August 29 to September 5. Not all patients were initially hospitalized because of their wounds. An underlying condition that might have increased risk for severe Vibrio illness was reported in 13 (72%) of the patients with wounds; these conditions included heart disease (seven patients), diabetes mellitus (four), renal disease (three), alcoholism (three), liver disease (two), peptic ulcer disease (one), immunodeficiency (one), and malignancy (one).
Non-Wound–Associated Illnesses
Four persons were reported with non-wound–associated Vibrio infections (two in Mississippi, one in Louisiana, and one displaced from Louisiana to Arizona). Information on the Vibrio species and clinical illness was available for two of these patients; the species were nontoxigenic V. cholerae isolated from patients with gastroenteritis. One of the infections occurred in a boy aged 2 months with diarrhea whose stool culture yielded both Salmonella group C2 and V. cholerae non- O1, non-O139. He was hospitalized for 2 days in Mississippi. The other V. cholerae non-O1, non-O139 isolate was from a stool specimen from an adult who was not hospitalized. No deaths were associated with the non-wound cases.
Case Reports
To illustrate the rapid onset and severity of Vibrio wound infections, brief descriptions of three of the cases are provided.
Patient A. A man aged 60 years with a history of stroke, hypertension, and alcohol abuse arrived in Texas on August 31, after spending 3 days wading in the floodwaters of New Orleans, Louisiana. He was not housed at an evacuation center. On September 1, 2005, the man visited an emergency department with bilateral ankle wounds and diarrhea; he was treated and released. No details regarding treatment were available. Blood cultures subsequently yielded V. vulnificus. The patient was located and admitted to the hospital on September 2. He died the next day.
Patient B. A man aged 61 years from Mississippi with human immunodeficiency virus infection, coronary artery disease, and hyperlipidemia was examined on August 29 and determined to have hypothermia and multiple second- and third-degree abrasions on his trunk. V. parahaemolyticus was isolated from his blood. Despite receiving antimicrobial therapy with levofloxacin, he died the next day.
Patient C. A woman aged 49 years reported by her family to have hepatitis C was evacuated from New Orleans after a boat rescue. She visited an Arkansas hospital on September 4 with bullae, septic shock, and necrotizing fasciitis on her left leg, which was extensively debrided. V. vulnificus was isolated from her blood. As of September 12, she was being treated with ceftazidime and doxycycline and remained in critical condition.
Reported by: D Engelthaler, MS, K Lewis, MD, S Anderson, MPH, Arizona Dept of Health Svcs. S Snow, MD, L Gladden, Arkansas Dept of Health. RM Hammond, PhD, RJ Hutchinson, Florida Dept of Health. R Ratard, MD, S Straif-Bourgeois, PhD, T Sokol, MPH, A Thomas, MPH, Louisiana Office of Public Health. L Mena, MD, J Parham, MD, School of Medicine, Univ of Mississippi Medical Center, Jackson; S Hand, M McNeill, MD, PhD, P Byers, MD, B Amy, MD, Mississippi Dept of Health. G Charns, Medical City Hospital of Dallas; J Rolling, A Friedman, J Romero, MPH, T Dorse, MD, J Carlo, MD, Dallas County Health and Human Svcs Dept; S Stonecipher, DVM, LK Gaul, PhD, T Betz, MD, Dept of State Health Svcs. RL Moolenar, MD, National Center for Environmental Health; JA Painter, DVM, MJ Kuehnert, MD, J Mott, PhD, DB Jernigan, MD, PA Yu, MPH, TA Clark, MD, National Center for Infectious Diseases; SK Greene, PhD, AM Schmitz, DVM, AC Cohn, MD, JL Liang, DVM, EIS officers, CDC.
Republished from CDC
© 2004-2005 by foodconsumer.org unless otherwise specified
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