Neorickettsia helminthoeca in Dog, Brazil

all 29 patients, a history of eating raw oysters or other raw or undercooked seafood before illness onset was uncommon and was only reported by 1 patient. Although V. vulnificus has not been proven as the cause of gastroenteritis, Hseuh et al. have suggested that such results might have occurred because patients with diarrhea seldom sought care from a large teaching hospital or saved stool samples for investigation (7). V. vulnificus infection was first reported in humans in 1979 (1). Since then, most case reports have focused on immunocompromised persons and their risk from eating raw oysters among (4–6). Our study found that a considerable proportion of V. vulnificus infections in Hong Kong occur among healthy persons. Furthermore, severe forms of the infection, such as necrotizing fasciitis and septicemia, are relatively common among healthy persons, although they may cause fewer deaths than they do among persons with predisposing medical conditions. Among healthy persons, V. vulnificus infection is most likely associated with a history of cutaneous injury caused by handling seafood, which can allow the bacteria to enter the body through an open wound. The risk of exposure is more important in this locality than in other areas where swimming or eating raw oysters and undercooked seafood are the major risk factors (4,6–8), possibly because fresh seafood is widely consumed, and seafood is easily accessible in wet markets in Hong Kong. Our study shows that the risk is higher during the summer, which is consistent with the fact that V. vulnificus is more active in warmer temperatures (9). We suggest that all persons, even healthy persons, exercise caution to avoid injury while handling seafood. Physicians should consider possible V. vulnificus infection when diagnosing a rapidly progressive skin and soft tissue infection in a healthy person who reports an injury from handling seafood. P.H. Chung,* S.K. Chuang,* Thomas Tsang,* Lai Wai-man,† Raymond Yung,‡ and Janice Lo‡ for the Collaborative Study Group on Vibrio vulnificus Infection in Hong Kong *Department of Health, Hong Kong Special Administrative Region, People’s Republic of China; †Hospital Authority, Hong Kong Special Administrative Region, People’s Republic of China; and ‡Centre for Health Protection, Hong Kong Special Administrative Region, People’s Republic of China