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Like Kyle Register of Ridgely, whose story was told in the October edition of the Caroline Review, waterwoman Rachel Fazenbaker of Denton knew nothing about Vibrio.
She crabs and oysters out of Bellevue in Talbot County, and about five years ago was infected with the Vibrio bacteria when a crab clamped onto her knuckle as she was crabbing on the Wye River near Easton.
“It bled a little bit,” she said. “But my hands – you know, pulling the anchors up out of the water and pulling them with the line, stuff like that – that's all it took.”
The “flesh-eating” bacteria can be aggressive and merciless. While severe or fatal infections are relatively rare and not confined to Chesapeake waterways (it has infected people along all U.S. coasts), 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.”
Fazenbaker said sheer exhaustion was the first symptom she experienced about 3 p.m., and she and her assistant headed home, where Fazenbaker collapsed into bed.
Her husband Dave woke her up at 7 p.m., about 12 hours after the crab nicked her. “He said, ‘You need to come down and get something to eat,’ and he looked at my finger (which had swollen to three times its size) and said, ‘Oh no. Never mind. We've got to go to the emergency room.’”
“And I begged him – I was so tired, unusually tired – ‘Please, I'll go tomorrow.’ He said, ‘No, you will not. You'll go right now.’ If it weren't for him, I'm afraid of what would have happened the next morning.”
Watermen “have early mornings and we go to bed early because we’ve got to get up early,” she said. “And I think by the time … they get up the next morning (with a Vibrio infection), it's almost too late.”
After being seen by a physician in the ER, Fazenbaker went home armed with a strong antibiotic, but the next day the same doctor called her. He had done some homework in the meantime and told her she needed to return to the ER immediately. “You need to get a shot,” he said.
By that time, “weird blisters” had started forming on her finger, and she went to Easton for an injection of antibiotics. “He said, ‘Just do me a favor. If you start seeing black lines, go to the emergency room immediately, because they'll have to take the finger,’” she said.
“That scared me, and I didn't know what it was – I'd never heard of (Vibrio) before, but it wasn't but maybe a month later, I heard some of the local watermen talking about it, because another waterman had to have his foot amputated,” Fazenbaker said.
“A lot of these watermen – you'll see they're missing a finger here and there – and that's what they say. They say it's from that Vibrio,” she said.
Dr. William Chiu of the University of Maryland Medical Center in Baltimore said the “majority of (patients) transferred in from other hospitals are often from the Eastern Shore and around the Chesapeake Bay.”
Register had a close call with Vibrio in mid-August (see his story in the Oct edition of the Caroline Review). He’s still waiting for his open wound exposing his muscles and bone on the inside of his left calf to “granulate” and create a bed for skin grafts to adhere, hopefully by the beginning of November, when he’ll be back in the hospital for surgery for three or four days. He said he’s “walking through pain, grinning and bearing it.”
“Hey, I'm fortunate to walk (and) … grateful to have a leg,” he said. “Pain’s only a little detail. It can’t really hurt me.”
Register said he still can’t return to work, and he changes the dressings twice a day. Each specialized dressing costs $25 and he needs two to cover the wound, which extends from just beneath his knee to below his ankle. “Everything is incredibly expensive. But I’m super, super fortunate,” he said.
Register’s primary physician when he was transferred to Shock Trauma in Baltimore from Shore Medical Center in Easton was – and still is – Dr. Chiu, a soft tissue specialist who greeted him when he arrived.
Dr. Chiu had to remove or “debride” the skin that had necrotized, or died and blackened, to control the aggressive infection.
“Tissues that lose blood supply need to be … debrided because that tissue that's no longer viable releases more harmful things into the blood – we call them cytokines – that further the infection, and they get a total body response called sepsis,” Dr. Chiu said. “Rapid debridement is important, because otherwise (the infection) spreads rapidly and delay sometimes causes a lot of tissue loss and sometimes limb loss, and when it is very advanced, patients become critically ill.”
In a Sept. 24 interview, with Register’s permission, Dr. Chiu said of those exposed to the Vibrio bacteria, “approximately 25% will actually get an infection from it. So having an open wound, or a wound created with your body in that environment, 25% is kind of a high risk for infection.”
However, once someone is infected, the danger increases.
“If you get a bad Vibrio infection, the mortality risk, or the chance of dying of it, is about 25%,” Dr. Chiu said. “The patients at the highest risk are those that have certain other chronic diseases, like if you have immunosuppression from whatever reason. …So, it's a serious bacteria, and often can cause death as well as limb loss.”
Dr. Chiu said he was happy Register did not lose his leg.
“When I first saw him, before even the first operation, I discussed with him that there was a risk that he would need an amputation, because limb loss is common in this,” he said. “In two weeks (he) underwent four operations. … It's still an open wound, so we're hoping that it continues to heal, but at least he left the hospital without requiring an amputation. So, I'm happy for him for that outcome.”
Register said being able to keep his leg and his recovery is the result of hundreds of people praying from him at his father’s church in Virginia and his own, Greater Impact Church in Greensboro.
Dr. Chiu said it’s “risky” entering local brackish marine waters, especially in warm weather “because people don’t know how much Vibrio is around.” People with a wound should avoid entering the water, but those who sustain a wound – even a minor scratch – should “get out of the water and wash the injury with soap and water,” he said.
“If you develop symptoms such as pain, redness, swelling or blistering, those are indications that an infection is starting, and you should probably seek medical attention at that time, instead of delaying to see if it will just get better,” Dr. Chiu said.
“I feel that people need to be made more aware of it and the precautions to take,” Fazenbaker said. “As soon as you get out of this water, shower, Dial, bleach, alcohol – whatever you can – shower and rinse immediately. If you have any cuts or nicks, pay attention to them. You've got to keep your eye on them because it happens so fast.”
“I know a lot of the watermen who keep a pump-up sprayer on their boat, and 50-50 diluted bleach, and at the end of the day, they spray everything down, even themselves and their boots,” Fazenbaker said.
She said she thinks “a lot of people don't know the symptoms” of a Vibrio infection, “and I feel as though the doctors aren't as familiar with it either.” She is “shocked at the lack of information” on the Department of Natural Resources website.
Both Fazenbaker and Register said they are concerned about children playing at local beaches.
“My heart breaks every time I see children out on the water tubing or water skiing or just playing down at the beach in Bellevue,” Fazenbaker said.
“It's scary stuff,” Fazenbaker said. “I think about it every summer, and and I will not get in that water – not if I don't have to.”
Register said he would never have allowed his children to swim in local rivers “knowing this could happen.”
“I think something needs to be posted around the beaches in Bellevue and Oxford and Cambridge, you know, around the ramps, the marinas,” Fazenbaker said. “I feel that people need to be made more aware of (Vibrio) and the precautions to take.”
