Bullae and Sweat Gland Necrosis in the Differential Diagnosis for Vibrio vulnificus Infection in an Alcoholic Patient

Bullae and sweat gland necrosis remain rare cutaneous manifestation, and these conditions can be misdiagnosed as Vibrio vulnificus infections or other soft tissue infections because of their low index of suspicion. A 46-yr-old man with a history of continued alcohol consumption presented with erythematous and hemorrhagic bullous lesions on his left arm. The patient reported that after the ingestion of clams, he slept for 12 hr in a heavily intoxicated state. Then the skin lesions started as a reddish patch that subsequently became hemorrhagic bullae. V. vulnificus infection, cellulitis, and necrotizing fasciitis were considered in initial differential diagnosis. However, on the basis of sweat gland necrosis on histopathologic examinations and negative results on bacterial cultures, we made the diagnosis of bullae and sweat gland necrosis. Therefore, bullae and sweat gland necrosis should also be considered in chronic alcoholic patients who present with bullae and a previous history of unconsciousness.

Changes of Whole Blood Glucose Level in Toxemic Mice Induced by Vibrio vulnificus Cytolysin / 대한피부과학회지

BACKGROUND: Vibrio(V.) vulnificus is a pathogenic, marine, halophilic, gram-negative bacillus which causes fulminant septic shock. Shock can be complicated by occurrence of hypoglycemia, which is caused by an unbalance between glucose production and consumption. Metabolic changes, especially glucose metabolism, in septic shock caused by V. vulnificus are not well clarified yet. OBJECTIVE: Our purpose was to investigate the changes of blood sugar level after intravenous administration of V. vulnificus cytolysin which is known to be a major virulent factor for elucidating pathogenesis of septic shock. METHODS: After administration of the lethal dose(8 hemolytic units)of V. vulnificus cytolysin through mouse tail vein in non-fasting and fasting group, we obtained blood samples from heart according to time courses of every thirty minutes. We measured whole blood glucose level using commercially available blood glucose meter. RESULTS: The level of blood glucose increased until 90 minutes, began to decrease at 120 minutes, and fell to baseline at 360 minutes in non-fasting mouse group. In fasting group, although elevation of blood glucose level was not observed in early stage of toxemia, hypoglycemia was nearly concordant with non-fasting group in late stage of toxemia. CONCLUSION: Hypoglycemia should be checked in patients with V. vulnificus sepsis. Failure to recognize and treat the hypoglycemia may contribute to the prognosis of these patients.

An Experimental Study of Vibrio vulnificus Infection in Mice

An experimental of Vibrio vulnificus infection has been performed with the intravenous, subcutaneous and oral inoculation of Vibrio vulnificus into ICR mice. The results are as follows: 1) The LD50 of the intravenous, subcutaneous and oral inoculation of Vibrio vulnificus were 1.6x10(7) cells/ml, 4.0x10(7) cells/ml, and 2.5x10(9) cells/ml, respectively. 2) In the experimental group without treatment with CC14, the survival rates for intravenous inoculation were 100% (1/2 LD50), 39.1% (LD50), and 8.3% (2 LD50). The survival rates for subcutaneous inoculation groups were 100% (1/2 LD50), 46.9% (LD50), and 18.8% (2 LD50). And the survival rates for oral inoculation groups were 100% (1/2 LD50), 53.1% (LD50), and 43.8% (2 LD50). 3) In those treated with CC14 0.05 ml, the survival rates for intravenous inoculation groups were 43.8% (1/2 LD50), 29.1% (LD50), 0% (2 LD50). The survival rates for subcutaneous inoculation groups were 59.4% (1/2 LD50), 40.6% (LD50), and 9.4% (2 LD50). The survival rates for oral inoculation groups were 68.8% (1/2 LD50), 46.9% (LD50), and 18.8% (2 LD50). In those treated with CC14 0.1 ml, the survival rates for intravenous inoculation groups were 25.0% (1/2 LD50), 10.4% (LD50), and 0% (2 LD50). The survival rates for subcutaneous inoculation groups were 43.8% (1/2 LD50), 21.9% (LD50), 0% (2 LD50). The survival rates for oral inoculation groups were 50.0% (1/2 LD50), 37.5% (LD50), and 0% (2 LD50). 4) Liver, lungs, meninges and brain, kidneys, heart, gastrointestinal tract and spleen showed septic inflammatory findings. Their degree of inflammation were different according to the severity of hepatic damage and the inoculum size.

Four Cases of Vibrio vulnificus Infection / 대한피부과학회지

We recently noticed four cases of Vibrio(V.) vulnificus infection from July, 1985 to September, 1985. The V. vulnificus was isolated by culture from the necrotizirig skin bullae in three cases, blood culture in two cases, and cerebrospinal fluid(CSF) in one case. The clinical characteristics of V. vulnificus infection in our cases was as follows: 1)All patients were men with their age over forties and the outbreak of the disease was during the summer season. 2) It was suspected that all patients had the previous hepatic problems. 3) The skin lesions showing bullae in three patients and subcutaneous nodules in one patient were noticed. 4) Two patients were showed positive in blood culture and one of thern also showed positive in lesional skin, urine and CSF. Lesional skin culture showed positive in three patients. 5) The isolated v. ulnificus was sensitive to chloramphenicol, erythromycin, gentamycin, kanamycin and cefobid. 6) Two patients died due to sepsis within 48 hours after liospitalization and one patient died due to hepatic failure.