A couple hours after crabbing at his favorite spot on the Maurice River last July, Angel Perez noticed his limbs begin to swell and his body breaking out in blisters.
The 60-year-old Millville man then started hallucinating and ended up at Cooper University Hospital in Camden, where culture tests were taken and Perez was diagnosed with Vibrio vulnificus, a bacteria that lives in brackish, warm salt water.
Now, researchers believe rising water temperatures resulting from climate change may have led to an increased number of cases of the flesh-eating bacteria in the Delaware Bay and surrounding area. The infection has been reported along the Gulf Coast and in the Chesapeake Bay region, but rarely farther north.
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“(Sea surface temperature) changes have resulted in longer summer seasons and are associated with alterations in the quantity, distribution and seasonal windows of bacteria in marine ecosystems, including Vibrio species,” a study published Monday in the Annals of Internal Medicine says.
The team of specialists from Cooper University Hospital, the University of the Sciences and the Geisinger Health System detailed five cases of the infection in 2017 and 2018 stemming from the Delaware Bay area. Four of the five patients survived.
Some had wound infections, which occur through breaks in the skin, while others had intestinal infections after consuming seafood. All of the patients already had risk factors, such as liver disease and diabetes.
In July 2017, a 38-year-old man with untreated hepatitis B who worked at a seafood restaurant in New Jersey started vomiting and was taken to Cooper with a fever and a tender left calf with erythema, reddening of the skin. He denied exposure to crabs or the Delaware Bay, but his blood cultures grew the Vibrio vulnificus bacteria.
A 64-year-old man with untreated hepatitis C cleaned and ate crabs caught in the Delaware Bay in September 2017. Two days later, he experienced rapidly worsening erythema, pain and swelling of his right hand. He underwent emergency surgery but ended up dying.
In September 2017, a 46-year-old man with type 2 diabetes and morbid obesity suffered minor trauma to one of his legs while crabbing in the Delaware Bay. Two days later, his left foot was abnormally swollen with fluid, red and tender. Doctors removed the damaged tissue and performed a skin and tissue graft.
The fourth patient was Perez. He had Parkinson’s disease, and developed severe right leg swelling and pain in July 2018 that required surgery and later amputation. A week before admission, he had multiple exposures to crabs in the Delaware Bay. The day before going to Cooper, he ate a dozen crabs.
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The fifth patient was a 64-year-old man with untreated hepatitis C, alcohol abuse and arthritis. One day after eating crabs from the Delaware Bay and cutting his right leg with a crab trap, he started experiencing shock and had a skin lesion on his right arm. He had emergency surgery and tissue removed from his arm.
Dr. Katherine Doktor, an infectious disease specialist at Cooper University Health Care and one of the study’s authors, said she decided to raise the alarm about the severe skin infection after noticing a spike in cases outside of its traditional geographic boundaries.
At Cooper hospital, there was only one case of Vibrio vulnificus in the eight years leading up to 2017, she said. Over the past two summers, though, there were five. Warmer water temperatures would be more favorable conditions for the bacteria.
Doktor advises people to properly cook fresh seafood, pay attention to state water quality alerts and seek medical attention if a cut looks infected. Still, Doktor said, most healthy people don’t have to fear swimming in New Jersey’s waters.
“In general, people shouldn’t panic,” she said.