Rapidly developing and fatal Vibrio vulnificus wound infection.
Rapidly developing and fatal Vibrio vulnificus wound infection.
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DOI：
10.1016/j.idcr.2016.07.014
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发表时间：
2016
期刊：
影响因子：
1.5
通讯作者：
Oliver JD
中科院分区：
文献类型：
--
作者：
Baker-Austin C;Oliver JD
一名59岁男性于2013年9月在医院就诊，其右脚踝上出现疼痛性水疱和显著相关红斑（图1）。病人主诉从他的下踝部发出急性烧灼感。患者将感染归因于可能的昆虫叮咬，随后在美国墨西哥湾钓鱼期间暴露于海水。感染迅速进展（图A和图B之间为4小时15分钟），病变明显出现广泛肿胀和红斑。患者的病情随后恶化，充满液体的大疱在其身体表面的大部分上迅速和进行性扩散。尽管积极的治疗与抗菌药物强力霉素，头孢他酰亚胺，克林霉素，病人死于感染后约28小时入院。随后分离出革兰氏阴性细菌创伤弧菌。应当指出，该人没有明显的基本医疗条件，这使得这是一个特别值得注意和不寻常的情况。弧菌是已知生长最快的细菌之一，创伤弧菌伤口感染的进展可能非常迅速。事实上，在这里介绍的情况下，个人死于感染后48小时多一点。此外，创伤弧菌伤口感染具有20%的死亡率，这表明需要在临床环境中快速准确地识别这些病原体。据我们所知，这种特殊的临床表现是独一无二的，因为它显示了致命的创伤弧菌伤口感染的最早阶段，而不是通常记录的更严重和广泛的肿胀、红斑和随后的组织坏死。应该注意的是，包括美国和欧洲在内，最近弧菌伤口感染有所增加。微小的入口，感染和临床结果的快速性，以及非霍乱弧菌伤口感染的日益增长的地理传播，都是临床医生识别可能暴露于海水的必要性的基础。这对于有糖尿病、免疫紊乱或肝功能障碍病史的患者尤为重要。
A 59 year old male presented at a hospital in September 2013 with a painful blister and significant associated erythema on his right ankle (Fig. 1). The patient complained of an acute burning sensation emanating from his lower ankle. The patient attributed the infection to a possible insect bite, which had subsequently been exposed to seawater during a fishing excursion in the Gulf of Mexico, USA. The infection rapidly progressed (4 h and 15 min between panel A and B), with extensive swelling and erythema of the lesion evident. The patient’s condition subsequently deteriorated, with a rapid and progressive spreading of fluid-filled bullae over the majority of his body surface. Despite aggressive treatment with the antibacterial agents doxycycline, ceftazimide, and clindamycin the patient succumbed to the infection approximately 28 h after admission to hospital. The Gram-negative bacterium Vibrio vulnificus was subsequently isolated. It should be noted that the individual did not have obvious underlying medical conditions, which make this a particularly noteworthy and unusual case. Vibrios are amongst the fastest growing bacteria known, and the progression of V. vulnificus wound infections can be incredibly rapid. Indeed, in the case presented here, the individual succumbed to the infection in a little over 48 h following transmission. Furthermore, V. vulnificus wound infections carry a 20% mortality rate, underlying the need to quickly and accurately identify these pathogens in clinical settings. This particular clinical picture is to our knowledge unique in that it shows a fatal V. vulnificus wound infection at its very earliest stages, as opposed to the more severe and extensive swelling, erythema and subsequent tissue necrosis normally documented. A recent increase in Vibrio wound infections, including the USA, as well as in Europe should be noted. The minute portal of entry, the rapidity of infection and clinical outcome, and the increasing geographical spread of noncholera Vibrio wound infections underlie the need for clinicians to identify possible exposure to seawater. This is particularly important in patients who have a history of diabetes, immune disorders or liver dysfunction.