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Dermatologie 12. April 2016

Necrotizing fasciitis due to Vibrio cholerae non-O1/non-O139 after exposure to Austrian bathing sites

We report on two cases of necrotizing fasciitis of the lower leg due to nontoxigenic Vibrio cholerae (V. cholerae). A 73-year-old woman and an 80-year-old man were hospitalized with symptoms of necrotizing fasciitis on July 18 and August 15, 2015, respectively. In both cases, symptoms started the day after swimming in local ponds. Swabs gained intraoperatively and a blood culture from the male patient, yielded V. cholerae non-O1/non-O139, negative for cholera toxin gene ctx and positive for hemolysin genes hlyA and hlyB. Water samples taken from pond A on August 17, 2015 (32 days after exposure of case 1) and from pond B on August 20, 2015 (7 days after exposure of case 2) yielded non-O1/non-O139 V. cholerae in most-probable numbers of > 11,000 per 100 ml each. The occurrence of two cases of necrotizing fasciitis within a 1 month period related to two Austrian non-saline bathing waters, previously not known to harbor V. cholerae, is probably linked to the prevailing extreme weather conditions (heat wave, drought) this summer in Austria. While case 1 was discharged in good clinical condition after 73 days, case 2 died after four months of hospitalization. Public health authorities are challenged to assess the effects of long-term climate change on pathogen growth and survival in continental bodies of fresh water.

Background: Vibrio (V.) cholerae is a gram-negative rod-shaped bacterium, which preferentially grows in warm (> 15 °C) brackish and estuarine water. Only serogroups O1 and O139 are known to cause classic cholera. The other approximately 200 serogroups of non-O1/non O-139 V. cholerae rarely harbor cholera toxin (ctx), often carry hemolysin genes hlyA and hlyB and usually only cause self-limited gastroenteritis or mild extra intestinal symptoms. We report two cases of necrotizing fasciitis caused by non-O1/non-O139 V. cholerae, acquired by swimming at Austrian bathing sites, at the peak of a 2 month long heat period characterized by an extraordinarily low amount of rainfall, in 2015.

 

Sonja Hirk, Steliana Huhulescu, Univ. Prof. Franz Allerberger, Sarah Lepuschitz, Sonja Rehak, Sandra Weil, Elisabeth Gschwandtner, Michael Hermann, Stephanie Neuhold, Alexander Zoufaly, Alexander Indra, Wiener klinische Wochenschrift 3/4/2016

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