WOMAN
CONTRACTS FLESH EATING BACTERIA KNOWN AS VIBRIO VULNIFICUS FROM CRABS
not trying to scare anyone, I
love to eat crabs, but this stuff don’t play around, just like the fisherman
said.
just have to wear some gloves
when cleaning crabs and fish from now on. ...
31 in Fla. infected by bacteria in salt water
By TAMARA LUSH, Associated Press | October 11, 2013 | Updated: October 11, 2013 5:54pm
This photo provided by Patty Konietzky shows her husband's foot of what
they thought was a bug bite on Sept. 22, 2013, in Ormond Beach, Fla. Patty and
her husband, Henry "Butch" Konietzky, went crabbing in the Halifax River near
Ormond Beach in September. Butch developed a sore which was later confirmed to
be vibrio vulnificus. The bacteria spread quickly in his body and he died 60
hours later. ST. PETERSBURG, Fla. (AP) — Patty Konietzky thought the small
purple lesion on her husband's ankle was a spider bite. But when the lesion
quickly spread across his body like a constellation, she knew something wasn't
right.
After a trip to the hospital and a day and a half later, Konietzky's
59-year-old husband was dead.
The diagnosis: vibrio vulnificus (vih-BREE'-oh VUHL'-nihf-ih-kus), an
infection caused by a bacterium found in warm salt water. It's in the same
family of bacterium that causes cholera. So far this year, 31 people across
Florida have been infected by the severe strain of vibrio, and 10 have
died.
"I thought the doctors would treat him with antibiotics and we'd go home,"
said Konietzky, who lives in Palm Coast, Fla. "Never in a million years it
crossed my mind that this is where I'd be today."
State health officials say there are two ways to contract the disease: by
eating raw, tainted shellfish — usually oysters — or when an open wound comes in
contact with bacteria in warm seawater.
In Mobile, Ala., this week health department officials said two men with
underlying health conditions were diagnosed with vibrio vulnificus in recent
weeks. One of the men died in September and the other is hospitalized. Both men
were tending to crab traps when they came into contact with seawater.
While such occurrences could potentially concern officials in states with
hundreds of miles of coastline and economies largely dependent on ocean-related
tourism, experts say the bacteria is nothing most people should worry about.
Vibrio bacteria exist normally in salt water and generally only affect people
with compromised immune systems, they say. Symptoms include vomiting, diarrhea
and abdominal pain. If the bacteria get into the bloodstream, they provoke
symptoms including fever and chills, decreased blood pressure and blistering
skin wounds.
But there's no need to stop swimming in the Gulf of Mexico, says Diane
Holm, a spokeswoman for the state health department in Lee County, which has had
a handful of cases that included one fatality this year.
"This is nothing abnormal," she said. "We don't believe there is any
greater risk for someone to swim in the Gulf today than there was yesterday or
10 years ago."
There have been reports this year in Gulf states of other waterborne
illnesses, but they are rare. In fresh water, the Naegleria fowleri amoeba
usually feeds on bacteria in the sediment of warm lakes and rivers. If it gets
high up in the nose, it can get into the brain. Cases have been reported in
Louisiana, Arkansas and in Florida, including the August death of a boy in the
southwestern part of the state who contracted the amoeba while knee boarding in
a water-filled ditch.
Dr. James Oliver, a professor of biology at the University of North
Carolina in Charlotte, has studied vibrio vulnificus for decades. He said that
while Florida has the most cases of vibrio infection due to the warm ocean water
that surrounds the state, the bacteria is found worldwide, generally in
estuaries and near the coast.
"It's normal flora in the water," he said. "It belongs there."
The vast majority of people who are exposed to the bacteria don't get sick,
he said. A few people become ill but recover. Only a fraction of people are
violently ill and fewer still die; Oliver said many of those people ingest
tainted, raw shellfish.
Oliver and Florida Department of Health officials say people shouldn't be
afraid of going into Florida's waters, but that those with suppressed immune
systems, such as people who have cancer, diabetes or cirrhosis of the liver,
should be aware of the potential hazards of vibrio vulnificus, especially if
they have an open wound.
Holm said nine people died from vibrio vulnificus in Florida in 2012, and
13 in 2011, so this year's statistics aren't alarming. What's different, she
said, was that victims' families are speaking to the news media about the
danger.
Konietzky watched as her husband Henry "Butch" Konietzky died on Sept. 23.
She said she feels it's her mission to let others know about the potential
risks. Next week, she and her husband's adult daughter are scheduled to appear
on "The Doctors" television program to discuss the disease.
"We knew nothing about this bacteria," she said. Never mind that both she
and her husband grew up in Florida and have spent their lives fishing and
participating in other water activities.
The couple had gone crabbing on the Halifax River near Ormond Beach on
Sept. 21, she said. Her husband first noticed the ankle lesion in the middle of
that night. He didn't wake his wife, but in the morning, told her that it felt
like his skin was burning near the lesion. Patty Konietzky took a photo of it
and hours later, when her husband said he was in pain and the lesions had
spread, they went to the emergency room.
Konietzky said her husband didn't have any health problems or open wounds
that she knew of, and when doctors told her that he had an infection in his
bloodstream, she didn't think it was too serious. Within hours, her husband's
skin turned purple and it "looked like he had been beaten with a baseball
bat."
Nearly 62 hours after he was in the water, Butch Konietzky died. His wife
notes that she, too, was in the same water — yet wasn't infected.
"To walk around in the water and doing the things we did, you didn't give
it any thought," she said.
Konietzky said her husband wouldn't want her — or anyone else — to stop
fishing or enjoying outdoor activities because of a fear of the bacteria.
Nonetheless, she wants people to be aware of the risk and is pushing her local
county commission to post signs warning folks about the bacteria.
"I'm not going to be afraid of it," she said. "I have to personally put
some meaning on the loss of my husband. And speaking out is all I can do."
________
Online: Centers for Disease Control: http://www.cdc.gov/nczved/divisions/dfbmd/diseases/vibriov/index.html
Follow Tamara Lush on Twitter at http://twitter.com/tamaralush
Monday, October 7, 2013
Nine Floridians Killed, 18 Sickened by Vibrio This Year; Some Cases Linked
to Oysters
ALSO, it’s all along the Texas coast...see;
VIBRO ALONG THE TEXAS COAST
Friday, June 7, 2013
Big Increase VIBRIO PARAHAEMOLYTICUS Along Texas Coast
"It is along the whole coast of Texas,"
Bacteria Death Posted: Jun 13, 2013 6:43 PM CDT <em
class="wnDate">Thursday, June 13, 2013 7:43 PM
EST</em>Updated: Jul 01, 2013 6:43 PM CDT <em
class="wnDate">Monday, July 1, 2013 7:43 PM EST</em> By
Isiah Carey, Reporter - bio
HOUSTON (FOX 26) - Eva Rutledge says, "I didn't expect it. His leg was
bruised. He had a bruise on his leg how in the hell - excuse me - turn in to
that. How did he lose his leg to a bruise."
Family members say 66 year old James Jim Rutledge of Katy was a man of few
words...He was a person who loved his family and the outdoors. Rutledge's garage
is filled with his hobbies from deer hunting to fishing. And his wife says
fishing is what in part lead to his unexpected and shocking death.
"Down at his place we'd always get up at 5 am we'd run out there all the
bass schooling out there you know catching them like crazy," says Eva.
It was last week when family members say James bruised his leg here on this
homemade wooden motor stand in his garage...Then Saturday morning Eva Rutledge
says he was fine and went fishing with friends.
Eva says, "Jim never got in the water ever since the warning years ago
without waiters covering him...but you get out in the water and you're gonna get
splattered no matter what."
When Rutledge returned home - by Saturday night his wife said he appeared
to be weak. Then on Sunday Jim's leg looked like this. It was full of lesions
and boils. He was rushed to the hospital.
Eva says, "they took him down to surgery and scraped away the skin and they
said the muscle was dead and the tissue was dead and they had to go in and
amputate his leg."
Eva says by Monday afternoon doctors believe Jim may have come into contact
with Vibrio bacteria while fishing near Galveston. The organism can be found in
coastal areas...it is a bacteria that could make you sick or even kill
you....
"It just literally ate his body. It shut down one place then it went up and
shut down another," says Eva.
By 8:00 Monday night family members say 66 year old Jim Rutledge had
died...That was only two days after going fishing...Doctors tell family members
he died from a form of severe infection called sepsis possibly caused by
Vibrio.
Eva says, "that was it I lost him that was the end of him."
Eva is now determined to get out the word. She wants those in the community
to head the warning from fishing reports. Warnings when the bacteria level is
high in bodies of water around Texas.
She says, "it needs to be on the news people need to be warned and they
need to know what they're up against."
In the meantime, Jim's family is planning to bury him Friday. They all say
they will wear fishing shirts in his memory...a memory his wife has not come to
grips with just yet.
"I don't believe he's gone yet. I don't know how to explain it. He's off
for the weekend - he's staying with the guys it's no big deal," says Eva.
The family is now waiting on official answers from the Harris County
Medical Examiner.
Signs and symptoms of Vibrio:
(Source: Wikipedia)
Vibrio vulnificus causes an infection often incurred after eating seafood,
especially raw or undercooked oysters. V. vulnificus does not alter the
appearance, taste, or odor of oysters. the bacteria can also enter the body
through open wounds when swimming or wading in infected waters, or via puncture
wounds from the spines of fish such as tilapia.
Symptoms include vomiting, diarrhea, abdominal pain, and a blistering
dermatitis that is sometimes mistaken for pemphigus or pemphigoid.
V. vulnificus is eighty times more likely to spread into the bloodstream in
people with compromised immune systems, especially those with chronic liver
disease. When this happens, severe symptoms including blistering skin lesions,
septic shock, and even death can occur. This severe infection may occur
regardless of whether the infection began via contaminated food or via an open
wound.
Dangerous Bacterial Infection Causes Alert in Corpus Christi Area Posted:
Jun 4, 2013 2:17 PM by Janine Reyes Updated: Jun 4, 2013 8:55 PM
CORPUS CHRISTI -- A big increase in bacterial infections found in warm salt
water has health officials on alert tonight. It's called Vibrio
Parahaemolyticus.
You and your family could come in contact with the potentially dangerous
bacteria.
Justin Bovee and his son are enjoying a day at the beach, unaware that
inside the water, they could come into contact with Vibrio
Parahaemolyticus.
"It is along the whole coast of Texas," explained Dr. William Burgin, Jr.
With the Corpus Christi-Nueces County Public Health District.
The whole coast of texas usually sees 2-7 cases per year.
In Corpus Christi, in just 3 weeks, we've already seen 3 cases and that's a
lot.
The bacteria is found in warm salt water that means you can pick it up two
ways, either by swimming in infected water with an open wound or by eating the
shellfish that swims in that water.
Bovee says he'll be more leery about eating seafood. He's not too worried
about swimming in it, because he has a strong immune system. His son doesn't do
much swimming. "He doesn't get in the water too much anyway, he only goes about
knee deep, then he gets freaked out and goes back to the beach," Bovee
said.
Still, dr burgin with the health department cautions that it's young people
who have picked up the infection. One from eating infected food, the other two
from being in the water.
Having cuts or scrapes will put you at a higher risk.
"You never know, you may go in with no scratches, but out there in the
water you step on something and that breaks the skin," Burgin explained.
That's why it's important to stay aware, get out if you get cut and
something as simple as wearing water shoes at the beach to help prevent those
cuts and scrapes in the water.
If you catch Vibrio Haemolyticus by eating infected fish, symptoms are
diarrhea, abdominal cramping, nausea and fever.
If you catch it by swimming in infected water, you will develop an abscess
that does not respond to normal antibiotics and you'll have to see a doctor
immediately.
Intraspecific Diversity of Vibrio vulnificus in Galveston Bay Water and
Oysters as Determined by Randomly Amplified Polymorphic DNA PCR Meilan Lin1,†,
Deborah A. Payne2 and John R. Schwarz1,* + Author Affiliations
1Department of Marine Biology, Texas A&M University at Galveston,
Galveston, Texas 77551 2Department of Pathology and Otolaryngology, The
University of Texas Medical Branch, Galveston, Texas 77555 Next Section ABSTRACT
Randomly amplified polymorphic DNA (RAPD) PCR was used to analyze the temporal
and spatial intraspecific diversity of 208 Vibrio vulnificus strains isolated
from Galveston Bay water and oysters at five different sites between June 2000
and June 2001. V. vulnificus was not detected during the winter months (December
through February). The densities of V. vulnificus in water and oysters were
positively correlated with water temperature. Cluster analysis of RAPD PCR
profiles of the 208 V. vulnificus isolates revealed a high level of
intraspecific diversity among the strains. No correlation was found between the
intraspecific diversity among the isolates and sampling site or source of
isolation. After not being detected during the winter months, the genetic
diversity of V. vulnificus strains first isolated in March was 0.9167. Beginning
in April, a higher level of intraspecific diversity (0.9933) and a major shift
in population structure were observed among V. vulnificus isolates. These
results suggest that a great genetic diversity of V. vulnificus strains exists
in Galveston Bay water and oysters and that the population structure of this
species is linked to changes in environmental conditions, especially
temperature.
V. vulnificus in sport fish mucus and recreational waters of south
Texas
Lijie Shi1 Gregory W. Stunz1, Katrina V. Gordon2, Gregory W. Buck1, and
Joanna B. Mott1 1Dept. of Life Sciences, Texas A&M University-Corpus
Christi, Corpus Christi, TX 78412 2Dept. of Integrative Biology, University of
South Florida, 4202 E Fowler Ave, Tampa, FL 33620
Abstract
Vibrio vulnificus is a Gram-negative, motile, curved bacterium with polar
flagella found naturally in marine environments and commonly associated with
oysters, clams, mussels, and fish. Infection by V. vulnificus can lead to
serious consequences with a mortality rate as high as 50%, and death usually
occurring within 48 hours of admission to a hospital. Infection routes are
either through ingestion of undercooked seafood or through a wound lesion. The
majority of the infections reported in Texas coastal areas have been associated
with fishing and recreational activities. In this study, levels of V. vulnificus
on two commonly fished species and in the water column were measured monthly in
the Aransas Bay complex. Surface mucus of spotted seatrout (Cynoscion nebulosus)
and red drum (Sciaenops ocellatus) and water samples were collected, and routine
field parameters were recorded. V. vulnificus concentrations were determined
using the species specific VVAP probe as recommended in the Food and Drug
Administration Bacteriological Analytical Manual [FDA BAM, (Kaysner and DePaola
2004)]. Enterococcus levels in the water were measured following EPA Method
1600. V. vulnificus was isolated from mucus of both species of fish and from
water samples, with concentrations ranging from 101-3x103/100ml of water and
mucus. Numbers in water increased with water temperature. Enterococcus levels in
the water were <10 as="" associated="" cfu="" coastal="" commonly="" data="" div="" fished="" from="" handling="" health="" in="" initial="" levels="" ml.="" of="" on="" pathogen="" potential="" provided="" risks="" routine="" species="" study="" texas="" the="" this="" two="" v.="" vulnificus="" waters.="" waters="" well="" with="">
snip...
Discussion
The study, conducted throughout the six month period from March to August
2010, demonstrated that V. vulnificus is present in the mucus of commonly fished
species in the Coastal Bend area of Texas. Concentrations in water and fish
mucus of this bacterium ranged from 101 to 103 per 100ml, and as the temperature
increased over the season, the concentration of bacteria also increased, with
May samples being an exception. However, statistics suggested that the increase
in V. vulnificus concentration was more related to salinity than temperature
(P<0 .05="" a="" additional="" affected="" all="" also="" although="" an="" and="" as="" assess="" at="" be="" better="" causing="" cfu="" compounds="" concentration="" concentrations.="" concentrations="" contrast="" contribute="" did="" div="" drum="" effects.="" enterococcus="" environment="" explore="" factors="" finding="" fish="" for="" from="" generally="" genes="" handling="" health="" higher="" however="" in="" increased="" indicator="" infection="" infections="" is="" levels="" longer="" low="" may="" measured.="" ml="" mucus="" needed="" not="" of="" open="" order="" other="" outcome="" populations="" potential="" produced="" project="" quality="" red="" relate="" research="" results="" risks="" route="" sampling="" seatrout.="" seatrout="" serious="" sites="" source.="" species="" specific.="" spotted="" stress="" such="" suggest="" suggested="" temperature="" than="" that="" the="" these="" this="" to="" transmission="" used="" v.="" very="" virulence="" vulnificus="" water.="" water="" were="" which="" with="" wounds="">
see full text with graphic charts with different species of fish with
VIBRIO VULNIFICUS ;
THE EFFECT OF HIGH-MAGNITUDE PRECIPITATION EVENTS ON VIBRIO VULNIFICUS
MORBIDITY CASES IN ESTUARINE ENVIRONMENTS
THESIS
Presented to the Graduate Council of Texas State University-San Marcos in
Partial Fulfillment of the Requirements
For the Degree
Master of SCIENCE
by
Najeda L. Patolo, B.A. San Marcos, Texas May 2012
snip...
CHAPTER 6
DISCUSSION AND CONCLUSIONS
Results from the Kendall‟s Tau-b correlation analysis show that there is a
clear and significantly negative correlation between precipitation and salinity
in both bay systems. This result was expected based on evidence presented in
past studies (Mott et al., 2008, Ramirez et al., 2008) and is also a logical
result. An increase in high-magnitude precipitation events in a shallow
estuarine system will cause local salinity levels to temporarily drop.
Correlation analysis between precipitation and water temperature in both bay
systems shows no significant relationship. It is expected that seasonality (time
of the year) will be a greater determining factor for changes in water
temperature. High water temperatures influence the presence of V. vulnificus,
but changes to that particular variable in the area not directly correlated to
precipitation events in the study area.
67
The relationship results of the Phi test for concordance or discordance
between the occurrence of V. vulnificus morbidity cases and above-normal
precipitation events in both bay systems are not significant. A potential source
of error in this analysis is the small sample size of morbidity cases. There are
only 30 reported cases identified to the Galveston Bay system and 5 for the
Matagorda Bay system over a 5-year period. Perhaps repeating this study at a
more coarse scale over a longer time period and using a greater sample of
morbidity cases will have a different outcome.
As was previously stated, underreported numbers of infection may also have
affected the amount of morbidity data used in this case study. It is
hypothesized that analysis of the entire coastal region of Texas and
geographically identified morbidity cases may result in a stronger study and
possibly different results.
42 68 CHAPTER 7
FUTURE IMPLICATIONS AND STUDY
If global and sea surface temperatures continue to rise at the rate
predicted (Patz et al. 2000), corresponding changes in the hydrologic cycle can
also be expected, especially in humid-subtropical and tropical locations where
water temperatures are consistently warm. Warm coastal waters will expand,
resulting in sea levels rising, an increase in flood events, and larger
hydrologic events in locations with sea temperatures above 26°C (Patz and Olson
2006). This rise in flood events and the resulting decrease in salinity levels
may increase the geospatial range of Vibrio vulnificus.
Environmental changes to the coastal and estuarine ecosystems of the Texas
Gulf Coast may also affect the flora and fauna, which harbor the hazardous
bacteria. Future analysis of population clustering in coastal urbanized areas
will give the researcher a better idea of where morbidity clusters occur,
depending on where the populations are concentrated. In coastal locations where
temperatures are high and salinity temperatures are moderated either by a
freshwater source inland or high levels of precipitation, such
69
analysis will be useful in determining areas able to support Vibrio
vulnificus growth and reproduction.
In the 2011 Regional Water Plan for the state of Texas, the Texas Water
Development estimated a +50% rise in population for Harris County, +17% for
Galveston, and +17% for Matagorda County (Table 1). These increases in the
resident population combined with increased weather variability in an already
environmentally sensitive ecosystem may very well be a contributing factor to
the number of reported water-borne diseases in the Texas Gulf Coast. General
knowledge of the bacteria is not always made readily available to the public,
and specific water bodies identified that may be potentially hazardous after a
heavy precipitation event are not always identifiable.
Over the last four decades, sufficient scientific analysis of Vibrio
vulnificus has identified the specific environmental needs of the pathogen.
Safety measures are taken during shellfish harboring, and information about food
poisoning is readily available through the Center for Disease Control and the
GCOIC. It appears, however, that those test variables may not determine when and
where morbidity cases are reported. More research may need to be performed to
determine specific recreational and industrial locations that are high-traffic
locations during hurricane season in the study area and in the entire Texas Gulf
Coast.
Extensive study is required to determine how much fecal coliform affects
the presence of Vibrio vulnificus in order to determine potential locations
within large bay
70
systems that are ideal for bacterial growth. The general migration patterns
of seasonal populations may also be studied to determine if there is a
connection between popular recreation locations and reported morbidity
cases.
42 71
APPENDIX 1
MORBIDITY DATA
Reported Vibrio vulnificus Morbidity Cases and Sites Texas Coast
(1999-2003)
ONSET SHELLFISH SHELLFISH SITE WOUND EXPOSURE SITE
Apr-99 1 E. Galveston Bay N/A
Apr-99 1 Galveston Bay N/A
May-99 1 Galveston Bay N/A
May-99 Unknown Unknown N/A
Jul-99 0 N/A Baycliff/Kemah/Texas City
Jul-99 0 N/A Galveston Beach
Jul-99 0 N/A Galveston Bay
Aug-99 0 N/A Aransas Pass
Aug-99 Unknown Unknown Unknown
Aug-99 Unknown Unknown Unknown
Aug-99 0 N/A Trinity Bay
Sep-99 0 N/A Galveston Bay
Sep-99 1 Unknown N/A
Jan-99 0 N/A Bay Oaks Harbor, Baytown
Dec-99 1 Galveston Bay N/A
May-00 1 Galveston Bay N/A
Jun-00 1 Galveston Bay N/A
Jul-00 0 N/A Matagorda Bay
Jul-00 1 Galveston Bay N/A
Jul-00 1 Galveston Bay N/A
72
Reported Vibrio vulnificus Morbidity Cases and Sites Texas Coast
(1999-2003)
ONSET SHELLFISH SHELLFISH SITE WOUND EXPOSURE SITE
Jul-00 0 N/A Trinity Bay
Sep-00 1 LA N/A
Sep-00 1 Galveston Bay N/A
1-May 0 N/A Brazos River near coast
1-May 1 Lake MacIHAs, LA N/A
1-May 0 N/A Lavaca Bay
1-Jun 0 N/A Galveston Bay
1-Jun 0 N/A Canal 4 mi. NW of Raymondville
1-Jul 1 Galveston Bay N/A
1-Aug 1 Galveston Bay N/A
1-Aug 0 N/A Galveston Bay
1-Sep 0 N/A Port Lavaca
1-Sep 1 Unknown N/A
1-Oct 1 Unknown N/A
2-Jun 0 N/A Unknown
2-Jun 1 Galveston Bay N/A
2-Jul 1 Galveston Bay N/A
2-Jul Unknown Unknown Unknown
2-Jul 0 N/A Aransas Bay
2-Jul 0 N/A Unknown
2-Jul 0 N/A Unknown
2-Aug 0 N/A Matagorda Bay
2-Aug 0 N/A Bolivar Peninsula
2-Aug 0 N/A Port O'Connor
2-Aug 1 Unknown N/A
2-Sep Unknown Unknown Unknown
2-Sep 0 N/A Unknown
2-Oct 1 Unknown N/A
Table Continued: 73
Reported Vibrio vulnificus Morbidity Cases and Sites Texas Coast
(1999-2003)
ONSET SHELLFISH SHELLFISH SITE WOUND EXPOSURE SITE
2-Oct 1 Galveston Bay N/A
3-May 0 N/A Palacios area on bay
3-Jun 0 N/A Galveston, West Bay
3-Jul 0 N/A Aransas Pass
3-Jul 0 N/A
3-Jul 0 N/A Port Arthur
3-Aug 1 Galveston Bay N/A
3-Sep 0 N/A Matagorda Bay
3-Oct 1 Galveston Bay N/A
3-Oct 1 Galveston Bay N/A
3-Nov 1 Unknown N/A
3-Nov 1 Galveston Bay N/A
snip...see full text ;
Tompkins: Dangers of deadly bacteria in state's saltwater By Shannon
Tompkins | June 27, 2012 | Updated: June 28, 2012 12:37pm
snip...
Through June 20 of this year, six cases of vibrio vulnificus infections
have been reported to TDSHS. Cases of vibrio vulnificus infections typically
peak in July and August. Vibrio vulnificus infection cases/deaths reported to
Texas Department of State Health Services, 2007-11:
Shellfish consumption Water contact Other/unknown Total
Year Cases Deaths Cases Deaths Cases Deaths Cases Deaths
2011 7 2 6 0 4 2 17 4
2010 10 2 16 5 6 1 32 8
2009 11 6 6 1 2 1 19 8
2008 7 4 5 1 5 2 17 7
2007 12 7 11 0 3 1 26 8
Source: Texas Department of State Health ServicesHouston Chronicle
http://www.chron.com/sports/outdoors/article/Tompkins-Know-dangers-of-deadly-bacteria-in-3668554.php
TSS
