The Risk of Deadly Vibrio Infection in Gastroenterology Patients

37 INTRODUCTION Vibrio bacteria naturally occur in marine environments worldwide and are not the result of pollution. At least 12 species are human pathogens. Toxigenic Vibrio cholerae is probably the most well known specie worldwide, because it is endemic in regions with poor sanitation and inadequate treatment of sewage and drinking water. It can cause an acute epidemic infection known as cholera which is characterized by severe diarrhea. Without medical treatment, cholera can result in sudden dehydration and death. The Centers for Disease Control and Prevention (CDC) reported only eight cases of toxigenic V. cholerae illness in the United States during 2004, nine cases in 2005, and eleven in 2006; half resulted from travel in foreign countries (the Philippines, Thailand, India, Bangladesh, Morocco, and Pakistan) (1). Non-toxigenic V. cholerae (does not produce cholera toxin) is more common in the U.S. and causes less severe diarrhea than cholera. Combining the annual numbers of human Vibrio isolates reported to CDC from 1997–2006, there were a total of 4,649 Vibrio cases in the United States (1). The percent of cases by specie were: 46% V. parahaemolyticus; 19% V. vulnificus; 10% non-toxigenic V. cholerae; 9% V. alginolyticus; 5% V. fluvialis; 2% each V. hollisae and V. mimicus; and 1% each V. damsela and toxigenic V. cholerae (serogroups O1, O75, O141). Additionally, 1% of cases were caused by other Vibrio species, 1% involved multiple species, and in 3% of cases, the specie was unknown (Figure 1). Since noncholera vibriosis was The Risk of Deadly Vibrio Infection in Gastroenterology Patients A SPECIAL ARTICLE