title: Rapidly advancing necrotizing fasciitis caused by Photobacterium (Vibrio) damsela: a hyperaggressive variant.
abstract: OBJECTIVE
  To describe the first case of Vibrio damsela necrotizing fasciitis in New England, emphasizing the importance of very early operative intervention to achieve source control in this extremely aggressive infection.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Surgical intensive care unit at Tufts-New England Medical Center in Boston, MA.
  
  
  METHODS
  A 69-yr-old retired fisherman with rapidly progressive necrotizing fasciitis from Photobacterium (Vibrio) damsela infection and ensuing multiple-system organ failure.
  
  
  METHODS
  Surgical debridement, ventilator support, vasopressors, continuous veno-venous hemofiltration, and blood product transfusions.
  
  
  RESULTS
  Death.
  
  
  CONCLUSIONS
  A high index of suspicion is necessary for the diagnosis of this specific pathogen and concordant infection. The willingness to surgically debride and amputate without hesitation at a very early point may be the only intervention capable of saving the lives of patients affected by Photobacterium (Vibrio) damsela.
authors.affiliation: Department of Surgery, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Kristen H
authors.initials: KH
authors.lastname: Goodell
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jordan
authors.forename: Roger
authors.initials: R
authors.lastname: Graham
authors.forename: Charles
authors.initials: C
authors.lastname: Cassidy
authors.forename: Stanley A
authors.initials: SA
authors.lastname: Nasraway
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D016638:Critical Illness; D003646:Debridement / Q000379:methods; D018450:Disease Progression; D004359:Drug Therapy, Combination; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000628:therapy*; D017809:Fatal Outcome; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009511:New England; D010776:Photobacterium / Q000302:isolation & purification; D012121:Respiration, Artificial; D018570:Risk Assessment; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000175:diagnosis / Q000628:therapy*; D014733:Vibrio / Q000302:isolation & purification*; D014735:Vibrio Infections / Q000175:diagnosis / Q000628:therapy*