The importance of serum creatine phosphokinase level in the early diagnosis, and as a prognostic factor, of Vibrio vulnificus infection.
BACKGROUND
Vibrio vulnificus infection causes rapidly progressive skin lesions and sepsis in compromised hosts with liver cirrhosis, and is often fatal. Early diagnosis and rapid treatment are important.


OBJECTIVE
To clarify the characteristics of V. vulnificus infection that distinguish it from other cutaneous and soft-tissue bacterial infections and to confirm that serum creatine phosphokinase (CPK) levels are useful in early diagnosis, and are a prognostic factor for, V. vulnificus infection.


METHODS
We analysed the clinical and laboratory findings (especially serum CPK levels) in eight patients with V. vulnificus infection who were treated at the Saga Medical School Hospital between January 1989 and December 1999.


RESULTS
All eight patients had liver dysfunction and typical skin manifestations. Six had eaten raw seafood before onset. Seven patients had initial skin manifestations in their legs or feet and eventually died, despite prompt therapy in the intensive care unit. CPK levels of six of these seven patients were already elevated at their initial presentation. Only one patient, with skin manifestations solely on his left hand, showed and maintained a normal CPK level and survived. In 23 patients with cutaneous and soft-tissue infections (10 with necrotizing fasciitis, three with erysipelas, 10 with cellulitis), only three patients with necrotizing fasciitis and streptococcal toxic shock syndrome (STSS) showed CPK elevation.


CONCLUSIONS
A high level of serum CPK in cutaneous or soft-tissue bacterial infection is considered useful for an early diagnosis of V. vulnificus infection and STSS. A history of eating raw seafood, underlying liver disease and multiple lesions suggest a diagnosis of V. vulnificus infection, rather than STSS.
Nakafusa
J
J
Division of Dermatology, Department of Internal Medicine, Saga Medical School, 5-1-1 Nabeshima, Saga City 849-8501, Japan.
Misago
N
N
Miura
Y
Y
Kayaba
M
M
Tanaka
T
T
Narisawa
Y
Y
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000097:blood / Q000209:etiology; D011379:Prognosis; D017747:Seafood / Q000382:microbiology; D012772:Shock, Septic / Q000097:blood; D013290:Streptococcal Infections / Q000097:blood; D016896:Treatment Outcome; D014735:Vibrio Infections / Q000097:blood* / Q000175:diagnosis / Q000628:therapy; D014736:Vibrio parahaemolyticus
D015415:Biomarkers; D003402:Creatine Kinase