Text settings Story text Size Small Standard Large Width * Standard Wide Links Standard Orange * Subscribers only Learn more Minimize to nav A 74-year-old man went to an emergency department in Florida with rapidly rotting limbs after jumping into the waters off Florida’s Gulf Coast.
Just three days earlier, the man was otherwise healthy and active on the coast. But at one point when he jumped into the water, he got a cut on his right leg. It quickly became painful and bruised. Two days later, the skin on his right arm also started changing color.
According to a case report in the New England Journal of Medicine, by day three, when he arrived at the hospital, he was in dire shape. The lower half of his leg was darkly colored, indicating bleeding under his skin. Doctors noted a crackling sound, suggesting gases bubbling out of his dying flesh, and some of the outer layers of skin were peeling off. His arm wasn’t much better. It appeared red, discolored, and swollen. A large blood blister (a hemorrhagic bulla) had formed, suggesting a severe flesh-eating infection. (You can see a graphic image here, including an end image of his arm.)
While the man was rushed into surgery to start cutting out the dead and infected tissue, doctors also began tests to find the cause of the infection. Blood and tissue samples turned up positive for Vibrio vulnificus, a flesh-eating bacterium found in warm, brackish waters.
V. vulnificus can infect people two ways: through wounds exposed to contaminated water—as in the man’s case—or, more commonly, through contaminated seafood. The bacteria can take up residence in the stomachs of shellfish, particularly oysters, as well as the intestines of fish. Either route can be gruesome. When ingested, the bacteria can release enzymes that neutralize stomach acids, then from there storm the intestines and can enter the blood.
These bacteria have a large arsenal of molecular munitions, including various toxins, that all help the bacteria hijack cells, siphon nutrients, degrade structural proteins, break down tissue linings, make blood vessels leaky, fuel destructive inflammation, suppress immune defenses, and generally lay waste to their victims.
The overall mortality rate of V. vulnificus infections is about 35 percent. But for anyone infected who also has an immunocompromising condition or a liver condition, mortality reaches 50–60 percent. Likewise, for those who develop sepsis—a life-threatening reaction to an infection—mortality is also about 50 percent. For patients like the man in this case, if antibiotics or surgical removal of necrotic tissue is delayed, mortality jumps to 100 percent.
In this case, the man did not die. But his right leg was so far gone by the time he reached the hospital that he needed to have it amputated above the knee. His forearm, meanwhile, required extensive skin grafting, which was collected from elsewhere on his body. After an antibiotic regimen and six months of healing, doctors reported that he had healed well.
The case highlighted that the threat of V. vulnificus is only increasing amid climate change, and medical experts see its rise as an urgent public health concern. Warming waters, geographic spread, and increases in antibiotic resistance are increasing risks. Between 1998 and 2018, US cases of V. vulnificus increased eightfold, including expanding into areas where the bacteria is considered rare, including Massachusetts, New Hampshire, and Maine.
“The abundance and geographic range of V. vulnificus is projected to increase owing to factors related to climate change, including rising water temperatures, storm surges, salinity changes, and algal blooms,” the man’s doctors wrote.
The Centers for Disease Control and Prevention advises that to avoid a Vibrio infection, only eat thoroughly cooked seafood and wash your hands after handling raw seafood. If you have an open wound, avoid going into brackish water or at least cover it tightly. If wounded while in brackish water or if an existing wound is exposed, wash it with soap and clean, running water.
