title: Sudden death caused by fulminant bacterial infection: background and pathogenesis of Japanese adult cases.
abstract: OBJECTIVE
  To analyze a risk factor for the onset of fulminant bacterial infection.
  
  
  METHODS
  Nine unexpected acute death cases were clinicopathologically analysed. All cases represented the sudden onset of shock symptom, led to acute death within a few days, and later bacteremia was identified. Pathogens were Streptococcus pneumoniae (S. pneumoniae) (5 cases), group A beta Hemolytic Streptococcus pyogenes (S. pyogenes) (3 cases), and Vibrio vulnificus (V. vulnificus) (1 case).
  
  
  RESULTS
  Seven of the nine patients had underlying chronic illness. S. pneumoniae infection was associated with splenic dysfunction, and group A beta Hemolytic S. pyogenes and V. vulnificus infections were associated with alcoholic liver injury. Group A beta hemolytic S. pyogenes and V. vulnificus infections involved necrotizing fasciitis, and alcoholic liver cirrhosis was confirmed in two of the four patients.
  
  
  CONCLUSIONS
  Despite the different type of bacteria, the onset of fulminant bacterial infection depended upon depressed bacterial phagocytosis in the liver or spleen. Underlying chronic illnesses should be identified as a predisposing common risk factor. It is important to understand the relations between underlying chronic illness and the onset of fulminant infection.
authors.affiliation: Department of Pathology, Showa University Fujigaoka Hospital. takumatajiri1003@yahoo.co.jp
authors.forename: Takuma
authors.initials: T
authors.lastname: Tajiri
authors.forename: Genshu
authors.initials: G
authors.lastname: Tate
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Miura
authors.forename: Shinji
authors.initials: S
authors.lastname: Masuda
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Ohike
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Kunimura
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Mitsuya
authors.forename: Toshio
authors.initials: T
authors.lastname: Morohoshi