Global Climate Change and Wound Care: Case Study of an Off-season Vibrio alginolyticus Infection in a Healthy Man

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Author(s): 
Gabriele Sganga, MD; Valerio Cozza, MD; Teresa Spanu, MD; Pier Luigi Spada, MD; and Giovanni Fadda, MD

Abstract: Vibrio alginolyticus is a halophilic Gram-negative bacterium normally present in seawater. Vibrios are not capable of cutaneous invasion through intact skin and their isolation from extraintestinal sites is uncommon. However, interruptions in skin integrity (cuts or abrasions) can allow these bacteria to cause complicated skin and soft tissues infections. This case study describes the clinical assessment and management of a nonhealing traumatic wound, sustained in a coastal area during the winter months, in a healthy 70-year-old man. Culture results were positive for V. alginolyticus. Appropriate antibiotic treatment and topical wound care successfully resolved the infection. V. alginolyticus infections are usually benign; respond well to treatment, even with local therapy only; and tend to result from contact with warm ocean water. The clinical characteristics of the wound prompted a suspicion of a Vibrio infection even though the wound was sustained in the winter time and the patient did not have direct contact with ocean water. Although other case studies of Vibrio infections in the absence of direct contact with ocean water have been published, increased ocean temperatures due to global climate changes may explain the out-of-season infection in this patient. Clinicians should monitor the progression of wound healing and be prepared to modify treatment based on individual circumstances, especially in the case of unusual wound presentation, nonhealing, or a progressing wound infection.

     Vibrio alginolyticus is a halophilic Gram-negative, motile, curved bacterium and one of the 12 Vibrio species responsible for human infections.1-4 It is present in seawater with a worldwide distribution.1 Global warming has resulted in increased marine temperatures with an expected diffusion of these pathogens to northern global regions.5-7 Among Vibrio species, the most commonly related to skin and soft tissues infection are V. vulnificus, V. parahaemolyticus, V. alginolyticus, and V. damsela.8–12

     Patient history of persons infected with Vibrios usually shows a recent exposure to seawater,12-18 although cases without specific exposure have been reported.19-23 Normally, Vibrios are not capable of cutaneous invasion through intact skin; however, the presence of cuts (wounds) or abrasions provides a portal of entry and explains the high incidence of Vibrio-related wound infections in bathers and persons involved in other marine activities.12,14,19,21,24,25 The majority of V. alginolyticus isolates have been found in patients with skin and soft tissues infections,7,12,19,22,24,26-31 including ulcers and abscesses, necrotizing fasciitis,13,15,32,33 cellulitis,12,18,34 and infections of the ear (otitis media and otitis externa).7,12,19,20,22,25,27,35 A case of V. alginolyticus peritonitis associated with peritoneal dialysis also has been reported.36 Other rare complications are gastroenteritis (in immunocompromised patients),37,38 intracranial infection following an injury in saltwater,17 pleural empyema (in an immunocompromised patient),39 and bacteremia.26,39-41 Infections due to V. alginolyticus are usually benign and respond well to local therapy.

Case Study

     Mr. S. presented at the authors’ outpatient service with a post-traumatic wound infection. The 70-year-old healthy Caucasian man had no history of diabetes or smoking and was not taking any prescription medications.

References: 

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