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In Florida, flesh-eating bacteria follow in Hurricane Ian’s wake

Lee County has reported 26 of the state’s 27 cases since Ian barreled ashore

Water floods a damaged trailer park in Fort Myers, Fla., after Hurricane Ian passed through the area. (Steve Helber/AP)

More than three weeks after Hurricane Ian sent seawater surging inland, some coastal Floridians are contending with another, less visible threat: a salt-loving microbe commonly found in warm bodies of water that has claimed 11 lives and is responsible for 64 infections so far this year. And 26 of those cases occurred in Lee County since Ian barreled ashore.

The culprit’s name? Vibrio vulnificus a.k.a. the flesh-eating bacteria of the Gulf Coast.

“The Gulf Coast is the epicenter of disease like this,” said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine. “You have a mix of climate change, poverty and aggressive urbanization, all contributing to the exacerbation of vibrio infections and an increase of other diseases like dengue, zika and parasitic infections.”

Flesh-eating disease, or necrotizing fasciitis, is commonly caused by the streptococcus bacteria. But vibrio vulnificus — one of several species of vibrio that have different characteristics — can lead to similarly severe infections. The tissue around a wound rapidly dies, and the bacteria swoop into other parts of the body leading to sepsis, shock and organ failure. Treatment with antibiotics is complicated by the poor blood supply in dying tissue. Many people require disfiguring surgeries or even amputations to remove dead and infected tissue. About 1 in 5 dies, sometimes only a day or two after falling sick.

Despite the current concerns, wound infections with vibrio are not common and not contagious. In 2020, the Florida Department of Health recorded 36 cases and seven deaths. In 2021, there were 34 cases and 10 deaths. During the previous peak in 2017, when Hurricane Irma caused extensive flooding, the department recorded 50 cases statewide and 11 deaths.

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Lee County, where residents are still struggling to clear debris from the storm, offers the strongest evidence of Ian’s impact: 26 of the county’s 28 cases this year occurred in the weeks since the late September storm swept in. But vibrio is a constant low-level threat. Health officials farther north in Escambia County issued a warning in July about the risks of contracting vibrio.

Twenty-seven of Florida’s 64 cases have occurred since the hurricane. The remaining case was in Collier County, just south of Lee County.

“We have a background of vibrio all of the time in Florida,” said Carina Blackmore, the state’s director for the division of disease control and health protection. “We send out messaging once a year to physicians in the state making them aware of what to look out for and how to test.”

As natural disasters become more aggressive, more public funding and resources need to be put toward protecting the most vulnerable parts of the country by improving infrastructure, say experts who anticipate that climate change will increase the microbial threat. Not only do intense storm surges bring brackish water inland, such as during Ian, but warming waters and rising sea levels are also likely to provide a welcoming environment for vibrio farther north.

“We do predict we will see increasing numbers in waterways,” said Anthony Ouellette, a professor of biology and chemistry at Jacksonville University. The bacteria thrive in water warmer than 68 degrees Fahrenheit, he said, and in the mix of salt and fresh water that is found in estuaries and salt marshes. They become concentrated in filter feeders like oysters and mussels, which pump large volumes of water through their bodies.

Eating un- or undercooked shellfish that harbor vibrio can lead to vomiting and diarrhea. Experts recommend wearing protective gloves to open them and cooking them thoroughly. The juice of uncooked shellfish can seep into open wounds and cause infections.

The recent storm has doctors on the lookout for an increase in infections. Manuel Gordillo, an epidemiologist at Sarasota Memorial Hospital, said the facility has seen more soft tissue damage in Ian’s wake, as people wade through water, step on nails or other storm debris, and often delay care because they are preoccupied by cleanup. While he has not yet seen cases of vibrio, some of those wounds have been infected with strep.

“By the time they come to medical attention, it is late,” Gordillo said. “They need radical surgical treatments.”

The Florida health department warns people with cuts, scrapes or even a recent piercing or tattoo not to paddle or swim. Those with preexisting health concerns such as chronic liver disease, kidney disease or a weakened immune system are at greater risk from vibrio, public health experts say, and should wear water shoes to prevent cuts from rocks and shells.

Wounds that do come into contact with brackish water or the juices of raw seafood should be cleaned in soap and water. Anyone with signs of infection, such as redness and swelling around the wound, a fever or fast heart rate, should seek immediate medical attention.

While the human body provides the perfect temperature for vibrio to thrive, most of the bacteria do not have the properties to make people sick. Vibrio typically perform a useful job in estuaries and salt marshes, breaking down dead organisms in a natural recycling process. During the winter, they settle into sediment and reemerge when the water warms.

“Some people are unlucky,” Ouellette said. “They are in the wrong water at the wrong time. And they can die from it.”

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