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Objective To investigate clinical features,treatments and prognostic factors of the patients with necrotizing fasciitis caused by vibrio infections and thus provide reference for the early treatment and prognostic assessment.Methods A retrospective analysis was conducted on clinical data of 56 patients with vibrio necrotizing fasciitis admitted to the emergency center of our hospital from May 1995 to June 2011.The clinical characteristics and treatments of the patients were summarized,and differences of clinical factors between the survival group and death group were compared.The possible influencing factors for prognosis were also analyzed.Results The main clinical manifestations included fever (61％),shock (84％) and organ dysfunction,of which renal insufficiency (88％) was the most common,with case fatality of 43％.Early pathological changes of limbs were only local swelling and pain,while skin ecchymosis,tension blood blisters,necrosis and subcutaneous crepitation were the signs of advanced stage.Comprehensive treatment regime including early administration of sensitive antibiotics plus surgical incision and drainage and medicine support was given.A series of factors were significantly different between the survival and death groups including the duration from the presentation of symptoms to hospital admission (P ＜ 0.05 ),limb lesions involving the trunk (P ＜ 0.01 ),creatine kinase level (P ＜ 0.05 ),and emergency incision and drainage ( P ＜ 0.01 ).Conclusions The most prominent clinical manifestations of vibrio necrotizing fasciitis are rapidly progressive local symptoms and signs,and sharp deterioration of systemic conditions.Delayed visiting,severe local lesions,and failure to emergency surgery may be the factors for poor prognosis.
ABSTRACT
El Vibrio cholerae y el V. parahaemolyticus son las principales especies de Vibrio que ocasionan infecciones en seres humanos. Las infecciones causadas por estos dos patógenos están teniendo una creciente importancia debido a su imparable expansión a nivel mundial. En el presente artículo se resumen los aspectos ecológicos asociados con la llegada y dispersión de las epidemias por V. parahaemolyticus y V. cholera en Perú desde una perspectiva sudamericana. De igual forma, se discute las similitudes en la aparición del cólera en 1991 y las infecciones por V. parahaemolyticus en 1997 en Perú, que sirvieron como experimentos únicos para analizar la relación entre las epidemias de Vibrio y los cambios en el medio ambiente. Estas dos radiaciones epidémicas constituyen unos claros ejemplos que apoyan la teoría de la dispersión oceánica de vibrios patógenos y permiten identificar a los episodios de El Niño como un mecanismo potencial de transmisión de enfermedades a través del océano.
Vibrio cholerae and V. parahaemolyticus are the two Vibrio species with a major impact on human health. Diseases caused by both pathogens are acquiring increasing relevance due to their expansion at global scale. In this paper, we resume the ecological aspects associated with the arrival and spreading of infections caused by V. parahaemolyticus and V. cholerae in Peru from a South American perspective. Moreover, we discuss the similarities in the emergence in Peru of cholera cases in 1991 and V. parahaemolyticus infections in 1997. These constituted exceptional experiments to evaluate the relationships between the Vibrio epidemics and changes in the environment. The epidemic radiations of V. cholerae and V. parahaemolyticus constitute to clear examples supporting the oceanic dispersion of pathogenic vibrios and have enabled the identification of El Niño events as a potential mechanism for the spreading of diseases through the ocean.
Subject(s)
Humans , Epidemics , Vibrio Infections/epidemiology , Vibrio Infections/transmission , Cholera/epidemiology , Cholera/transmission , Environment , Risk Factors , South America/epidemiologyABSTRACT
Objective To investigate the clinical features,treatment and prognosis of Vibrio vulnificus infection in patients with characteristic skin lesions.Methods Clinical data on 23 cases of Vibrio vulnificus infection with characteristic skin lesions collected from 1996 to 2008 in Second Affiliated Hospital Affiliated to Wenzhou Medical College,were analyzed retrospectively.Results There were 23 patients including 15 males and 8 females.Of them,15 had a history of chronic type B viral hepatitis or alcoholic liver disease;17 ate raw oysters before the onset.A rapid onset Was observed in all of these patients,and initial symptoms were dominated by swelling and pain of,as well as bullae and hemorrhagic bulla in lower extremities.Vibrio vulnificus was isolated by culture from blister fluid of 13 patients,from both blood and blister fluid of 9 patients,and from necrotic tissue of 2 patients.Histopathologic examination revealed vacuolar degeneration and necrosis of cells,interstitial neutrophilic infiltrates,and vasculitis.Bacteria were seen in infiltrated neutrophiles.Electromicroscopy showed numerous round or arcuated microorganisms and bacterial flagella in hypodermal cells.Seven patients diagnosed from May 1996 to May 2000 died from this infection,and survival WaS observed after treatment only in 2 out of 6 patients collected from July 2000 to October 2003 and 6 out of 10 patients from May 2004 to October 2008.Conclusions Early recognition of skin eruptions and timely management are essential for the control of Vibrio vulnificus infection and for the improvement in survival among pafients infected with this bacterium.
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Vibrio parahaemolyticus is a facultative anaerobio gram negative rod responsible of sea food-associated diarr-hoea. Although less common, it also causes wound infections and bacteraemia. We present a case of bacteraemia by this agent and a review of the literature.
Vibrio parahaemolyticus es un bacilo gram negativo, anaerobio facultativo, responsable de brotes de síndrome diarreico agudo por ingestión de mariscos crudos o mal cocidos contaminados. Ocasionalmente. se ha reportado asociado a infección de heridas y sepsis. Se reporta un caso clínico de bacteriemia por este microorganismo y se realiza una revisión de la literatura.
Subject(s)
Aged, 80 and over , Humans , Male , Bacteremia/microbiology , Vibrio Infections/microbiology , Vibrio parahaemolyticus/isolation & purification , Anti-Infective Agents/therapeutic use , Bacteremia/diagnosis , Bacteremia/drug therapy , Ciprofloxacin/therapeutic use , Treatment Outcome , Vibrio Infections/diagnosis , Vibrio Infections/drug therapyABSTRACT
Objective To identify the histopathological characteristics of multiple organ dysfunction syndrome (MODS) with V. vulnificus in mice. Methods Sixteen healthy KM mice (6～8 week old ) divided randomly into two groups, study group ( n =12) and control group ( n =4) The animal model of MODS was established by received either an intraperitioneal, intramuscular subcuneous inoculum of 4.34?10 6 cfu/0.2 ml of V.vulnificus or intraperitioneal injection of a sterile physiological salt solution (control group). Pathological changes of the man organs were individually obsenved in under election microscope (EM). Results Mortality rates exced 100%, 12/12) in study group after inoculums of mice within 4～8 h, while in 0% (0/0) in the control . The detection rate of V. vulnificus were in 100%(12/12) from blood, hearts, lungs, livers, intramuscularly, subcutaneous in the study group, while in 0% (0/4) after sterile saline intraperitioneal injection. The man histopathological changes were :degeneration and necrosis of the parenchyma cells in the different organs;interstitial swelling, mitochondriondrial injure of multiple organs.These changes were especially obvious in the lungs and myocardeum. Conclusions Above pathological changes suggested that results of MODS caused by V. vulnificus septicemia,the multiple organs failure as an important feature of the fatality of V. vulnificus infections,and my be helpful for researchers investigating of V.vulnificus.
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Objective We conducted an in vivo study with the mouse model of Vib rio vulnificus infection to evaluate the efficacies of combination therapy with antimicrobia l agents. Methods Vibrio vulnificus (6.0?10 8 cfu/ml)was injected intraperitoneally into the right abdominal cavity. One hour, 2 hour and 3 hour after inoculation, 7 antimicrobial agents were given alone or in combination intraperitoneally at human therapeutic dose level. The numbers of survial mouse and the supermicrostr ucture change of organs w ere observed. 7 antimicrobial agents were Imipenem, Chloramphenicol, Doxycycline Hydrochloride, Netilmicin, Cefoperazone, Piperacillin, Levofloxacin. Res ults Two hours after infection, the mouse survival rates of groups trea ted with Chloramphenicol, Levofloxacin, Netilmicin, Cefoperazone was 100%. Howev er, the survival rates in the mouse treated by Piperacillin was 60% and the surv ival rate of in the mouse treated with Imipenem or Doxycycline Hydrochloride was 20%. The survival rate in the mouse treated with Cefoperazone combined with Lev ofloxacin, Cefoperazone combined with Netilmicin, or Netilmicin combined with Do xycycline Hydrochloride, was 100%. The supermicrostructure injure of the organs in the mouse recovered. Conclusions These results indicate that Chloramphenicol, Netilmicin, Cefoperazone and Levofl oxacin alone had satisfactory efficacy in the treatment of experimental Vibrio v ulnificus infection in mouse. The combination therapies of Cefoperazone with Lev ofloxacin, Cefoperazone with Netilmicin, and Netilmicin with Doxycycline Hydroch loride are more advantageous than using antimicrobial agent alone.