Systemic Vibrio infection presenting as necrotizing fasciitis and sepsis. A series of thirteen cases.
BACKGROUND
Vibrio species are an uncommon cause of necrotizing fasciitis and primary septicemia, which are likely to occur in patients with hepatic disease, diabetes mellitus, adrenal insufficiency, and immunocompromised conditions. These organisms are found in warm sea waters and are often present in raw oysters, shellfish, and other seafood. The purposes of the present report were to describe a series of patients who had this potentially lethal infection and to identify clinical features associated with a poor prognosis.


METHODS
We retrospectively reviewed the records of thirteen patients (ten men and three women) who had necrotizing fasciitis and sepsis caused by Vibrio species. All patients had a history of contact with seawater or raw seafood. Eight patients had a hepatic disease such as hepatitis or cirrhosis of the liver, three had diabetes mellitus (without hepatic disease), and two had chronic renal or adrenal insufficiency (without hepatic disease).


RESULTS
Twelve patients underwent fasciotomy or limb amputation. Five patients (38%) died within two to six days after admission, and eight patients survived. Patients with a systolic blood pressure of < or =90 mm Hg and leukopenia in the emergency room had a significantly higher mortality rate (p < 0.05).


CONCLUSIONS
The diagnosis of Vibrio necrotizing fasciitis should be suspected when a patient has the appropriate clinical findings and a history of contact with seawater or raw seafood. The treatment should begin as early as possible, essentially when the patient has symptoms of sepsis. Although emergency fasciotomy or limb amputation did not reduce the mortality rate in this series, we consider such operations to be an important aspect of treatment.
Tsai
Yao-Hung
YH
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chia-Yi, No. 6, West Sec, Chia-Pu Road, Putz City, Chia-Yi County, 613, Taiwan. orma2244@adm.cgmh.org.tw
Hsu
Robert Wen-Wei
RW
Huang
Kuo-Chin
KC
Chen
Chih-Hung
CH
Cheng
Chin-Chang
CC
Peng
Kuo-Ti
KT
Huang
Tsung-Jen
TJ
D000368:Aged; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D011379:Prognosis; D017747:Seafood / Q000382:microbiology; D012623:Seawater / Q000382:microbiology; D018805:Sepsis / Q000175:diagnosis / Q000382:microbiology*; D014733:Vibrio / Q000302:isolation & purification; D014735:Vibrio Infections / Q000175:diagnosis* / Q000401:mortality / Q000635:transmission