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Volume 14, Number 12—December 2008

CME ACTIVITY

Clinical Characteristics and Molecular Subtyping of Vibrio vulnificus Illnesses, Israel

Ronit Zaidenstein, Chantal Sadik, Larisa Lerner, Lea Valinsky, June Kopelowitz, Ruth Yishai, Vered Agmon, Michele Parsons, Cheryl Bopp, and Miriam WeinbergerComments to Author 
Author affiliations: Assaf Harofeh Medical Center, Zerifin, Israel (R. Zaidenstein, M. Weinberger); Israel Ministry of Health, Jerusalem, Israel (C. Sadik, L. Lerner, L. Valinsky, J. Kopelowitz, R. Yishai, V. Agmon); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (M. Parsons, C. Bopp); Tel Aviv University, Ramat Aviv, Israel (M. Weinberger)

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Table 1

Clinical characteristics of patients with Vibrio vulnificus biotype 3 infections, Israel, 1998–2005*

Clinical characteristics All patients Patients with laboratory-confirmed infection Patients with suspected infection p value†
No. patients studied (%) 132 (100) 94 (100) 38 (100)
Males, no. (%) 64 (48.5) 40 (42.6) 24 (63.2) 0.036
M:F ratio 0.94:1 0.7:1 1.7:1
Mean age, y; median (range)
58.9; 66 (10–93)
63.1; 68 (10–93)
48.7; 47.5 (11–88)
NS
Clinical presentation
Mean incubation time, h; median (range) 17.7; 12 (1–96) 13.9; 12 (0.5–48) 28; 20 (1–96) <0.001
Bacteremia, no. (%) 31 (23.5) 31 (33.0) NA
Septic shock, no. (%) 11 (8.7)‡ 10 (11.0)§ 1 (2.9)¶ NS
Necrotizing fasciitis, no. (%) 16 (12.7)‡ 16 (17.6)§ 0 0.006
Uncomplicated cellulitis, no. (%) 92 (69.7)‡ 62 (68.1)§ 30 (85.7)¶ 0.072
Abscess formation, no. (%) 12 (9.8)‡ 7 (7.7)§ 5 (14.3)¶ NS
Peritonitis, no. (%)
1 (0.8)‡
1 (1.1)§
0
NS
Underlying diseases#
None, no. (%) 59 (44.7) 49 (52.1) 10 (26.3) 0.007
Liver disease, no. (%) 18(13.6) 18 (19.1) 0 0.002
Diabetes mellitus, no. (%) 18 (13.6) 13 (13.8) 5 (13.2) NS
Ischemic heart disease, no. (%) 9 (6.8) 8 (8.5) 1 (2.6) NS
Altered immune status,** no. (%) 13 (9.8) 9 (9.6) 4 (10.5) NS
Hemolytic anemia, no. (%)
3 (2.3)
2 (2.1)
1 (2.6)
NS
Outcome
Mean hospitalization time, d; median (range) 10.9; 9 (2–50) 12.7; 11 (2–50) 6.2; 5 (2–20) 0.003
Amputation, no. (%) 9 (6.8) 9 (9.6) 0 0.059
Death, no. (%)
10 (7.6)
10 (10.6)
0
0.062
No. patients with known fish exposure†† 104 72 32
Tilapia, no. (%) 86 (82.7) 60 (83.3) 26 (81.3) NS
Carp, no. (%) 14 (13.5) 10 (13.9) 4 (12.5) NS
Tilapia plus carp, no. (%) 2 (1.9) 1 (1.4) 1 (3.1) NS
Other, no. (%) 2 (1.9) 1 (1.4) 1 (3.1) NS

*NA, not available; NS, not significant.
†For comparison between patients with laboratory-confirmed and suspected infections.
‡n = 126.
§n = 91.
¶n = 35.
#Patients may have >1 underlying diseases.
**Due to malignancy or immunosuppressive state.
††Percentages of exposure to each fish type based on total no. patients with known fish exposure in each category.

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