V. fluvialis has been implicated in outbreaks and sporadic cases of diarrhea. In a study conducted during a 9-month period (1976-1977), samples from 518 of the 10,674 patients with diarrhea showed the presence of the pathogen (25). Most of the patients from whom the pathogen was isolated were infants, children, and young adults. The stools sampled during this outbreak had an average of a million organisms per mL. Other symptoms associated with watery diarrhea in 34 of the patients include vomiting (97%), abdominal pain (75%), dehydration (67%), and fever (35%). About 75% of these patients had pus cells and erythrocytes in their stools. Levine et al. (26) reported that 86% of the patients with gastroenteritis had bloody stools. Presence of red blood in stools of a 1-month-old infant has also been observed (27). Gastroenteritis in an infant younger than 1 month has been reported (28). In a small outbreak in India, the pathogen was isolated from stools of 9 of the 14 people who had gastroenteritis (29). In the United States V. fluvialis is usually associated with sporadic cases (24,26,27,30-35). In two cases the infections were fatal (24,30).
In a few instances V. fluvialis has also been recovered from wound infections resulting from a boating injury (33) and leech therapy (36), from cecostomy drainage (33), and from a patient with acute suppurative cholangitis (37).
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