title: Clinical, epidemiological, and microbiological features of Vibrio vulnificus biogroup 3 causing outbreaks of wound infection and bacteraemia in Israel. Israel Vibrio Study Group.
abstract: BACKGROUND
  Vibrio vulnificus is a gram-negative bacterium that causes septicaemia and wound infection. Cases occur sporadically, and no previous outbreaks due to a common source or a clonal strain have been reported. In the summer and autumn of 1996 and 1997, an outbreak of invasive V. vulnificus infection occurred in Israel in people who had recently handled fresh, whole fish purchased from artificial fish-ponds.
  
  
  METHODS
  We reviewed clinical and epidemiological information, and undertook an environmental investigation to assess disease characteristics, modes of transmission, phenotypic characteristics of the bacterium, and fish-marketing policy. The clonal nature of 19 isolates was studied by biotyping, pulsed-field gel electrophoresis, and restriction-fragment length polymorphism (RFLP) analysis of a PCR fragment.
  
  
  RESULTS
  During 1996-97, 62 cases of wound infection and bacteraemia occurred. 57 patients developed cellulitis, four had necrotising fasciitis, and one developed osteomyelitis. In all cases, the fish were cultivated in inland fish-ponds. In the summer of 1996, fish-pond managers initiated a new marketing policy, in which fish were sold alive instead of being packed in ice. Phenotypically, the isolates had five atypical biochemical test results. The isolates were non-typeable by pulsed-field gel electrophoresis, and all had the same PCR-RFLP pattern which had not been seen previously.
  
  
  CONCLUSIONS
  The cause of the outbreak was a new strain of V. vulnificus, classified as biogroup 3. A new fish-marketing policy that began in 1996 may have exposed susceptible people to the organism.
authors.affiliation: Infectious Diseases Unit, Ha'Emek Medical Center, Afula, Israel. naiel@rannet.com
authors.forename: N
authors.initials: N
authors.lastname: Bisharat
authors.forename: V
authors.initials: V
authors.lastname: Agmon
authors.forename: R
authors.initials: R
authors.lastname: Finkelstein
authors.forename: R
authors.initials: R
authors.lastname: Raz
authors.forename: G
authors.initials: G
authors.lastname: Ben-Dror
authors.forename: L
authors.initials: L
authors.lastname: Lerner
authors.forename: S
authors.initials: S
authors.lastname: Soboh
authors.forename: R
authors.initials: R
authors.lastname: Colodner
authors.forename: D N
authors.initials: DN
authors.lastname: Cameron
authors.forename: D L
authors.initials: DL
authors.lastname: Wykstra
authors.forename: D L
authors.initials: DL
authors.lastname: Swerdlow
authors.forename: J J
authors.initials: JJ
authors.lastname: Farmer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control; D005260:Female; D005399:Fishes / Q000382:microbiology*; D005511:Food Handling; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011640:Public Policy; D014733:Vibrio / Q000145:classification; D014735:Vibrio Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D014946:Wound Infection / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control