The Analysis of the Clinical Characteristics and Prognosis of Vibrio Vulnificus Septicemia

PURPOSE: Vibrio vulnificus, one of the most invasive and rapidly fatal human pathogens known is a free-living inhabitant of estuarine and marine environments throughout the world. Vibrio septicemia usually present with a sudden onset of fever, chills, vomiting, diarrhea, abdominal pain, pain in the extremities, and cutaneous lesions. There are many microbiologic studies of V. vulnificus, but few clinical and prognostic studies are reported. We performed a study in 81 clinically suspected V. vulnificus cases to analyze the clinical characteristics of and the prognosis for V. vulnificus septicemia. METHODS: The study included 81 clinically suspected cases V. vulnificus septicemia at the emergency department from 1997 to 2003. We retrospectively analyzed the clinical features and the laboratory data, and measured the simplified acute physiologic score (SAPS II). RESULTS: The overall fatality was 39.5%. The monthly incidence was high in July and August. Almost all cases were primary septicemia (92.6%). Many patients had underlying disease; such as liver disease (66.6%), and diabetes mellitus (18.5%). Alcohol drinking habits were observed in 61.7% of the cases. There were significant difference between non-survivors and survivors in the extent of skin manifestations, respiration rate, leukocyte count, platelet count, albumin, PT, PTT, creatinine, pH, HCO(3-), and SAPS II. CONCLUSION: The platelet count, PT, PTT, creatinine, pH, H CO3-, the leukocyte count, albumin, SAPS II, and the extent of skin manifestations can be used as severity indicators in V. vulnificus septicemia. Especially, the SAPS II on hospital day 2 and the extent of skin manifestations can be used as prognostic factors.

Clinical Analysis of Hyponatremia in Emergency Patients

PURPOSE: Hyponatremia is the most common electrolyte imbalance encountered in the hospital, there have been few studies about the clinical characteristics of hyponatremia in emergency patients. This study was performed to evaluate the causes and the initial symptoms of hyponatremia in emergency patients, the relationship between their ages and their initial symptoms and the relationship between the causes and the recovery time. METHODS: A total of 42 patients with hyponatremia, who were treated in the Emergency Department of Chonnam National University Hospital from 2000 to 2001, were studied by chart review. RESULTS: The initial symptoms were generalized weakness (33.3%), seizure (28.6%), mental change (21.6%), confusion (9.5%), dizziness (4.8%), and non-specific (2.4%). There was a significant difference in the initial symptoms between children and older. The initial symptom for younger patients was usually seizure. The most common causes of hyponatremia were dehydration and sodium loss (52.4%), other causes were hypothyroidism (11.9%), SIADH (7.1%), heart failure (7.1%), adrenal insufficiency (4.8%), polydypsia (4.8%), CRF (2.4%), nephrotic syndrome (2.4%) and unidentified causes (7.1%). There were significant differences in the recovery times among the causes of hyponatremia. CONCLUSION: The initial symptoms of hyponatremia in emergency patients were usually generalized weakness in older patients and seizure in the young. There were significant differences in the recovery times among the causes of hyponatremia. There were many more incidences of hypovolemic hyponatremia of emergency patients than normovolemic hyponatremia.