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Part 1 of a 2-part series

Cautionary tales: Caroline countians warn of Vibrio dangers

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Kyle Register of Ridgely never thought about Vibrio. In fact, he had never heard of the dangerous bacteria that lurks in the Chesapeake Bay’s waterways.

All that changed when Vibrio almost killed him.

The “flesh-eating” bacteria can be aggressive and merciless. While severe or fatal infections are relatively rare and not confined to Chesapeake waterways, Caroline countians who have fought Vibrio infections locally are sounding the alarm.

According to the Centers for Disease Control and Prevention, “Many people with Vibrio vulnificus infection can get seriously ill and need intensive care or limb amputation. About 1 in 5 people with this infection die, sometimes within a day or two of becoming ill.”

Eating or handling raw shellfish infected with Vibrio can be equally dangerous, because an oyster on the half-shell doesn’t look, smell or taste different from one that doesn’t have Vibrio; only cooking kills the bacteria.

On Aug. 28, Dr. Holly Trice, director of nursing at the Caroline County Health Department said only one Vibrio infection had been reported in the county, and was still being investigated by the state health department. She said warm water temperatures foster Vibrio’s growth, but lower water temperatures at night inhibit it.

Register, however, is now adamant about avoiding swimming in local rivers and eating raw shellfish that may be contaminated, and wants people to know why.

More than a month after his trip to the ER with a Vibrio infection, Register changes the dressings on his wound three times a day as he awaits the healing stage that will allow skin graft surgery.

A hard lesson to learn

Register, 43, whose nickname is “Slade,” grew up near Church Hill and spent many happy days on the Chester River. Saturday, Aug. 17, was no different.

On a tiny stretch of the Chester River between Conquest Beach and Rolph’s Wharf, Register ripped his left foot open on what he thinks was an oyster shell as he walked on the sandy bottom about 15 feet out. Because of nerve damage from surgery to repair a broken heel years earlier, Register said he just didn’t feel the 3-inch gash on the inside of his foot, from arch to ankle.

Although he doused the wound with rubbing alcohol he and his companion Audra Williamson bought on the way home, Vibrio was already wreaking havoc on his immune system.

About 12 hours later, the father of two teens was in the emergency room at the University of Maryland Shore Medical Center at Easton, where he could see the infection daily inching up his leg. By 3:30 a.m. Friday, he was in an ambulance speeding to the R. Adams Cowley Shock Trauma Center at the University of Maryland Medical Center in Baltimore, where he was met by over a dozen medical personnel.

Doctors cut away infected and necrotized (dead) skin down to the muscles, leaving a large, gaping wound on his calf from the bottom of his foot to his knee. He woke up to the sound of a wound vac and pain “way past 10,” he said. He learned that Vibrio was one of three infections his body was fighting – but it was the most dangerous.

With the encouragement and prayers of his father Kenneth and his church, as well as those of Pastor Doug Morley and the members of Greater Impact Church in Greensboro, Register feels “the hand of God” helped him avoid amputation during the second surgery, something that “completely shocked” his medical team, he said.

Register said Dr. William Chiu had told him before the second surgery of four he had a 50-50 chance of keeping his leg. After the surgery, the doctor admitted the odds were actually 30%, but he “was trying to give me a little bit of hope to hang on to,”

Register currently returns to Shock Trauma once a week, where first he was being treated with biologics to help his skin grow back; unfortunately, that method was unsuccessful.

The former home builder and master carpenter was between jobs, and doesn’t know how he would be able to go back to work, given his midday wound care and inability to wear shoes until he heals completely. Any new infection or failed skin graft could land him back in the hospital.

“I can’t say enough nice things about the people at Shock Trauma,” Register said. “I have never felt safer. I have never felt more confident in a medical team.”

Williamson, a Preston native who grew up swimming in the Choptank River rarely left Register’s side during his hospitalizations. She said her friend, who is married to a waterman, “made sure he has bleach on the boat and peroxide and antibacterial cream,” after witnessing Register’s ordeal.

Scientists track the data

According to the Maryland Department of the Environment, there are over 80 species of Vibrio bacteria. It belongs to the family of bacteria that cause cholera, but “not all strains of Vibrios cause human illness.”

They cause “an estimated 80,000 illnesses each year in the U.S.,” according to the Centers for Disease Control and Prevention, which classifies Vibriosis “a nationally notifiable disease” for clinicians.

Vibrio vulnificus, however, “is known to cause life-threatening infections. About 150–200 V. vulnificus infections are reported to CDC each year and about one in five people with this infection die—sometimes within 1–2 days of becoming ill,” the CDC stated.

In September 2023, following five fatal infections from New York to North Carolina, the CDC issued a Health Alert which included “wound and foodborne infections.”

“Unlike other Vibrio species, V. vulnificus is primarily transmitted through open-wound contact with salt water or brackish water, but occasionally (in approximately 10% of cases) the bacteria also can infect people if they eat raw or undercooked shellfish,” the CDC reported in its Sept. 2023 report, adding in bold type, “V. vulnificus wound infections have a short incubation period and are characterized by necrotizing skin and soft tissue infection.”

Scientists don’t consider pollution a factor is Vibrio’s proliferation.

“The most significant factors for finding them in surface waters are temperature, salinity (a measure of how much salt is in the water), and chlorophyll,” according to the MDE. “Vibrio bacteria are not commonly found in the winter when water temperatures are low, but may be common in the summer and early fall when water temperatures are warm.”

Register has become a crusader, telling and showing anyone who asks how he was injured.

“I’d be out in the community walking through Walmart to get groceries or whatever, with this (wound pump) backpack and a hose attached to my leg, and they were, ‘Hey, do you mind me asking what happened to you?’”

“Not at all,” he said. “Let me talk to you.”

Kyle Register wants to spread the word and encourages readers to email him with questions at sladeregister81@gmail.com.

For more information on how to prevent and respond to a possible infection, visit the Maryland Department of the Environment. ShoreRivers posts weekly bacteria monitoring reports every Friday from Memorial Day to Labor Day at www.shorerivers.org/swim.