Ivepidemiology A Incidence of illness

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1. Vibrio mimicus

Even before the designation of sucrose-negative V. cholerae as V. mimicus, sporadic cases of gastroenteritis associated with the organism had been reported worldwide (10). The pathogen has been isolated from human stools in the United States, Bangladesh, Mexico, Guam, Philippines, the Orient, Costa Rica, India, Japan, Belgium, and Romania (10,21,22,89-91). Most of the illnesses are sporadic cases; however, a few outbreak-related cases have also been reported (20,22,92,93). Studies in Bangladesh show that all age groups of both sexes are susceptible to infection (94). However, Campos et al. (22) reported that the majority of patients infected with V. mimicus were males. In a survey in Florida (1981-1988), it was isolated from 16 of the 181 cases of gastroenteritis and 2 of the 91 cases of septicemia (95). Both the septicemia cases and 14 of the gastroenteritis cases were associated with consumption of raw oysters. In a 1989 survey of Vibrio infections on the Gulf Coast of the United States, V. mimicus was isolated from 4 of the 71 patients who had gastroenteritis (26). In more recent surveys of Vibrio infections reported to the Centers for Disease Control and Prevention (CDC), 11 of the 386 in 1997 and 10 of the 551 in 1998 were caused by

V. mimicus (96). Nine of the 11 infections in 1997 and all 10 infections in 1998 were gastroenteritis cases.

2. Vibrio fluvialis

Sporadic and outbreak-related cases have been reported from all over the world. The pathogen has been isolated from patients who had contracted the disease in Bahrain, Bangladesh, Egypt, India, Indonesia, Iran, Iraq, Jordan, Kenya, Philippines, Saudi Arabia, Spain, Tanzania, Tunisia, and the United States (11,27,29-34,95). In addition to adults, it also affects children (25,27,97). It was isolated from 12 patients during a 6-year period (1982-1988) in Florida (33). The pathogen was recovered from stools of 10 patients who had gastroenteritis. Eight of the 10 patients had consumed raw oysters (5 patients), shrimp (2 patients), or cooked fish (1 patient). V. fluvialis was isolated from 5.6% of the 125 cases of Vibrio-related gastroenteritis associated with consumption of raw oysters (95). In 1989 an investigation along the Gulf Coast of the United States showed that it was isolated from 7 of the 71 patients who had gastroenteritis (26). Three of the patients reported eating raw oysters, while a fourth had eaten shrimp prior to becoming ill. Three of the 7 patients had to be hospitalized. Recent data show that V. fluvialis was responsible for 17 of 386 and 27 of the 551 Vibrio infections reported to the CDC in 1997 and 1998, respectively (96). Nine infections in 1997 and 16 infections in 1998 were gastroenteritis cases; 5 cases in each year were associated with wound infections. V. fluvialis was isolated from an 81-year-old patient who had severe diarrhea and died after 5 days of illness (30). V. fluvialis and V. mimicus were isolated from the stools of a 30-year-old man who had ileitis and reported eating seafood a few days before his illness (31). Both V. fluvialis and V. furnissii were present in the stool sample of a 1-month-old female who had mild diarrhea and was passing bright red blood in her stool (27). The child had not been exposed to any shellfish or anyone who had eaten shellfish but had been fed formula mixed with tap water. V.

fluvialis was isolated from the stools of a 46-year-old man who had acute gastroenteritis which began 36 hours after consumption of raw oysters (32). It was the only pathogen isolated from the stool of a 54-year-old man who had severe diarrhea and vomiting and subsequently died of cardiopulmonary arrest (24). He had consumed raw oysters one day before the onset of symptoms. The pathogen has also been isolated from an AIDS patient who had diarrhea (34). Analysis of stools from 20 U.S. Peace Corps volunteers who came down with diarrhea in Thailand showed that one of the samples had V. fluvialis (35). Examination of stools of 76 patients with diarrhea following the recent floods in Bangladesh showed that V. fluvialis was present in some of the samples (98). During a 16-month cholera surveillance program in Lima, Peru, the pathogen was frequently isolated from cases of diarrhea (38).

3. Vibrio furnissii

In the first reported outbreak, 23 of the 42 elderly American tourists returning from the Orient developed gastroenteritis (12). Two of the people required hospitalization and one woman died. A shrimp and crab salad or a cocktail sauce or both were determined to be the cause of the illness. In another outbreak in tourists returning from Hong Kong, 24 of the 59 people developed the illness; 9 of these required hospitalization. A food vehicle responsible for the illness could not be determined. In a third outbreak involving 67 tourists returning from Tokyo, a common food vehicle could not be implicated. V. furnissii and V. fluvialis were isolated from blood-tinged stools of a 1-month-old female who had not been exposed to any shellfish or persons who ate shellfish (27). She had, however, been fed formula mixed with tap water. A common source of infection could not be established for the 14 persons in Peru who had the pathogen in their stools (38).

4. Vibrio hollisae

The original description of the disease included three cases in Florida, four in Maryland, and one each in Louisiana and Virginia (39). Six of the patients had eaten raw seafood, while one had eaten seafood that may not have been raw. A female who consumed two dozen oysters harvested from the Chesapeake Bay came down with severe gastroenteritis and had to be hospitalized (99). Her friend, who had consumed only six oysters, suffered from a milder illness. In one instance, a case of septicemia has been associated with the consumption of catfish harvested from the Mississippi River, which has ~0.5% salinity at locations 80 miles downstream (41). A food vehicle could not be identified in the case of a man who had bacteremia (42). A survey of 32 patients in the Chesapeake Bay area over a 15-year period (1974-1988) showed that 1 of the 40 isolates was V. hollisae (100). In a survey of Vibrio infections in 1989 on the Gulf Coast, Levine et al. (26) found that 9 of the 121 infections were caused by V. hollisae. Eight of these nine were cases of gastroenteritis, and one was a wound infection. Seafoods most commonly associated with the gastrointestinal infections included raw oysters, clams, crabs, and shrimp. A similar survey of Vibrio illnesses in Florida over an 8-year period showed that 32 of the 333 cases were caused by V. hollisae (95). Twenty of these 32 were associated with consumption of raw oysters; 17 of these were gastroenteritis, and 3 were septicemia cases. Recent data from the CDC indicate that the pathogen was associated with 9 of the 386 and 11 of the 551 infections in 1997 and 1998, respectively (96). Nineteen of these cases were gastroenteritis-related.

5. Vibrio alginolyticus

Illness caused by V. alginolyticus occurs worldwide. In a survey of Vibrio illness during 19811988 in Florida, Desenclos et al. (95) reported that the pathogen was isolated from 14 of the 333 cases. Eleven isolates were associated with wounds, 2 with gastroenteritis, 1 with septicemia, and one with other disease. In a similar survey of Vibrio infections on the Gulf Coast of the United States in 1989, it was isolated from 7 of the 121 infections (26). The 7 isolates were from wounds (5), ear infection (1) and gangrenous gallbladder (1). In Europe, Hornstrup and Gahrn-Hansen (101) reported that V. alginolyticus was found in 17 of the 30 extraintestinal Vibrio infections that occurred in a Danish county over a 6-year period. All the 17 patients had ear infections. Recent data compiled by the CDC show that the pathogen accounted for 7 of the 386 infections reported in 1997; 2 were associated with gastroenteritis, 2 with wound infection, and 3 with other illnesses (96). Data for 1998 show that it accounted for 23 of the 551 infections; 2 were associated with gastroenteritis, 1 with septicemia, 8 with wound infections, and 12 with other types of infections.

6. Vibrio damsela

Surveys of Vibrio illness in Florida during 1981-1988 and the Gulf Coast in 1989 found that V. damsela was responsible for only 1 of 52 and 1 of 29 wound infections, respectively (26,95). The pathogen was associated with 5 of the 386 and 3 of the 551 Vibrio infections reported to the CDC in 1997 and 1998, respectively (96). All 3 cases in 1998 and 2 of the cases in 1997 were associated with wound infections. Surprisingly, one case in 1997 was associated with gastroenteritis. Five of the 6 cases reported by Morris et al. (39) were patients who were injured in or near seawater or brackish water. Most infections were the result of injuries sustained while coming in contact with marine life (e.g., stingray bite, stepping on catfish barb, filleting fish, fish fin puncture, cleaning catfish) (39,74-76,78,79). A case of primary septicemia in a man with underlying diabetes and alcoholic liver disease was associated with consumption of raw eels (77). Eels have been reported to succumb to infections with V. damsela (102). Most of the victims have been males, and most had underlying conditions such as heart disease, alcoholic liver damage, diabetes, and pancreatitis. Infections were usually on the leg or the arms.

7. Vibrio metschnikovii, Vibrio cincinnatiensis, and Vibrio carchariae

V. metschnikovii has been reported to cause bacteremia (80-82) and has been isolated from a 60-year-old woman and 11- to 20-month-old infants who had diarrhea (83,84). All the reported bacteremia cases have been in the elderly (70-84 years). None of the patients had any recent history of exposure to marine environment or consumption of seafood.

There have been only two reported isolations of V. cincinnatiensis from human clinical samples. It was first isolated from a 70-year-old man who had bacteremia and meningitis (18,85). The patient did not have a history of recent exposure to seawater, consumption of seafood, or recent travel. In addition, he did not have any diarrhea or underlying liver disease and was not receiving any medication at the time of admission to the hospital. The second isolate was from a stool sample of an immunocompromised elderly patient (86).

There has been only one reported illness caused by V. carchariae, and not much is known about the epidemiology of the pathogen (87).

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