OCEAN CITY, Md. — On Sept. 11, Michael Funk was cleaning crab pots at his bayside condominium; four days later he was dead, the victim of flesh-eating bacteria.
For Marcia Funk, his wife of 46 years, his death is compounded by what she called a lack of information here about the bacteria, Vibrio vulnificus.
"I really feel they kept it quiet because it's a tourist resort," Marcia Funk said. "It's like something out of a horror movie."
The bacteria, along with about a dozen others that are related, occurs naturally in areas of warm, brackish waters with low salinity. Most of the 80,000 people who become ill across the USA each year consume raw or under-cooked seafood, according to the Centers for Disease Control and Prevention. Those who contract the more severe vibrosis from the Vibrio vulnificus bacterium number fewer than 200, according to CDC reports since 2007, when the agency started to require nationwide reporting.
In 2014, the most recent information available, Maryland reported 39 cases of vibriosis from all types of the Vibrio bacteria that cause it, down from a record-breaking 58 cases the year before. In 2014, the five states with the most cases — California, Florida, Washington, Texas and New York — accounted for more than half the 1,200 reported infections although health officials believe that the disease is under reported.
Michael Funk's case involved a less common form of transmission, a cut.
A cut or tear in the skin can become infected and skin rapidly breaks down, becoming ulcerated. If the infection invades the bloodstream, the survival rate is about 50%, according to the Florida Department of Health, where 168 Vibrio cases were diagnosed in 2014. Thirty-two were the vulnificus strain, and seven of those victims died.
The CDC reported 21 deaths nationwide attributed to Vibrio vulnificus bacteria in 2014, also about 1 in 5 of those hospitalized. Most of the cases did not come from contaminated food.
Thirty-four people died across the country of all Vibrio bacteria infections, about 4% of those hospitalized.
A spokesman said the Maryland Department of Health and Mental Hygiene is investigating Michael Funk's death.
In 2014, state officials issued an advisory to visitors because of the number of cases in 2013. No advisories have been issued this year for Assawoman Bay, where Michael Funk contracted his infection.
Ocean City spokeswoman Jessica Waters said the municipality has many outreach and education campaigns, but Vibrio "has never been part of our awareness efforts, at least to my knowledge."
"We do work closely with the health department and as trends change or outbreaks arise," she said in email that offered condolences to the Funk family.
After Michael Funk, 67, cleaned his crab pots in preparation for a return to the couple's Phoenix home, he began to feel ill and went to the hospital, where a surgeon removed infected skin from his leg. He soon was flown to a shock trauma hospital in Baltimore where his leg was amputated.
He died Sept. 15.
"It was very fast moving," said his wife, adding that doctors immediately diagnosed the cause. "He was in so much pain."
The effects and severity of Vibrio infections can vary, depending heavily on strength of a person's immune system and the strain of the bacteria, said Roman Jesien, marine scientist and chairman of the Maryland Coastal Advisory Fishery Committee,
"Some people can have an infection, maybe get a little sick, and be just fine," Jesien said. "Others aren't as lucky. There's a lot of factors that come into play," including age and overall health.
While severe cases are rare, the strain of Vibrio plays a crucial role in its effect, he said.
"We don't see that many cases of that nature," Jesien said. "But they do happen, and there are things you can do to avoid it."
Most infections occur in the warmer months between May and October. Avoid cloudy or murky, warm water, don't swim in areas where it has rained within 48 hours and always cook seafood, including crab and fish thoroughly.
The ocean's saltiness keeps the bacteria at bay. But bays and lagoons where rivers and oceans meet lessen the salinity of the water and allow the bacteria to thrive.
Health officials advise keeping all wounds clean to limit the possibility of infection and to follow all advisories for potential outbreaks.
For Michael Funk, being on the water was a lifestyle.
"He loved the water. He loved boating. He loved crabbing," his widow said. "Basically, what he loved doing took his life."
Flesh-eating bacteria and fungi
Several flesh-eating organisms are common in nature, but the infections they cause are rare in humans. To cause a problem, they generally enter the body through a break in the skin, such as a cut, scrape, burn, insect bite or puncture wound and often strike people whose immune systems are vulnerable.
• Necrotizing cutaneous mucormycosis. More than one type of fungus can cause this skin infection, but the most common is Rhizopus arrhizus (oryzae). A cluster of cases, including five deaths, happened among residents injured in a May 2011 tornado in Joplin, Mo.
• Necrotizing fasciitis. More than one type of bacteria can cause this skin infection, but A streptococcus is the most common. In May 2012, this necrotizing fasciitis from Aeromonas hydrophila bacteria forced doctors to amputate portions of all four of Aimee Copeland's limbs. The Snellville, Ga., native was injured when a zip line that she was riding broke and plunged her into the Little Tallapoosa River, giving her a gash on her leg.
• Vibriosis. Vibrio vulnificus bacteria that live in coastal waters cause this type of infection. It is often associated with deaths from eating raw oysters that can carry the bacteria, but it also thrives in brackish water and can infect a person through a break in the skin.