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Volume 40 Issue 3
Mar.  2024
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2024  >  40(3): 266-272
Lin WP,Mu X,Chen SH,et al.Clinical characteristics of 11 patients with Vibrio vulnificus infection and the establishment of a rapid diagnosis procedure for this disease[J].Chin J Burns Wounds,2024,40(3):266-272.DOI: 10.3760/cma.j.cn501225-20230803-00036.
Citation: Lin WP,Mu X,Chen SH,et al.Clinical characteristics of 11 patients with Vibrio vulnificus infection and the establishment of a rapid diagnosis procedure for this disease[J].Chin J Burns Wounds,2024,40(3):266-272.DOI: 10.3760/cma.j.cn501225-20230803-00036.
shu

Clinical characteristics of 11 patients with Vibrio vulnificus infection and the establishment of a rapid diagnosis procedure for this disease

doi: 10.3760/cma.j.cn501225-20230803-00036
  • 1.

    The First Department of General Surgery, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510062, China

  • 2.

    Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China

  • 3.

    Department of Burns and Wound Repair, Shenzhen People's Hospital, the First Affiliated Hospital of Southern University of Science and Technology, the Second Clinical Medicine College of Jinan University, Shenzhen 518020, China

  • 4.

    Department of Burns and Wound Repair, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China

Funds:

Key Project of Guangdong Province Basic and Applied Basic Research Regional Joint Fund 2020B151520088

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    Abstract
  •   Objective   To analyze the clinical characteristics of patients with Vibrio vulnificus infection, share diagnosis and treatment experience, and establish a rapid diagnosis procedure for this disease.   Methods   This study was a retrospective case series study. From January 2009 to November 2022, 11 patients with Vibrio vulnificus infection who met the inclusion criteria were admitted to the Department of Burns and Wound Repair of Guangdong Provincial People's Hospital Affiliated to Southern Medical University. The gender, age, time of onset of illness, time of admission, time of diagnosis, route of infection, underlying diseases, affected limbs, clinical manifestations and signs on admission, white blood cell count, hemoglobin, platelet count, C-reactive protein (CRP), alanine transaminase (ALT), aspartate transaminase (AST), creatinine, procalcitonin, albumin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and blood sodium levels on admission, culture results and metagenomic next-generation sequencing (mNGS) results of pathogenic bacteria and the Vibrio vulnificus drug susceptibility test results during hospitalization, treatment methods, length of hospital stay, and outcomes of all patients were recorded. Comparative analysis was conducted on the admission time and diagnosis time of patients with and without a history of exposure to seawater/marine products, as well as the fatality ratio and amputation of limbs/digits ratio of patients with and without early adequate antibiotic treatment. For the survived patients with hand involvement, the hand function was assessed using Brunnstrom staging at the last follow-up. Based on patients' clinical characteristics and treatment conditions, a rapid diagnosis procedure for Vibrio vulnificus infection was established.   Results   There were 7 males and 4 females among the patients, aged (56±17) years. Most of the patients developed symptoms in summer and autumn. The admission time was 3.00 (1.00, 4.00) d after the onset of illness, and the diagnosis time was 4.00 (2.00, 8.00) d after the onset of illness. There were 7 and 4 patients with and without a history of contact with seawater/marine products, respectively, and the admission time of these two types of patients was similar ( P>0.05). The diagnosis time of patients with a history of contact with seawater/marine products was 2.00 (2.00, 5.00) d after the onset of illness, which was significantly shorter than 9.00 (4.25, 13.00) d after the onset of illness for patients without a history of contact with seawater/marine products ( Z=-2.01, P<0.05). Totally 10 patients had underlying diseases. The affected limbs were right-hand in 8 cases, left-hand in 1 case, and lower limb in 2 cases. On admission, a total of 9 patients had fever; 11 patients had pain at the infected site, and redness and swelling of the affected limb, and 9 patients each had ecchymosis/necrosis and blisters/blood blisters; 6 patients suffered from shock, and 2 patients developed multiple organ dysfunction syndrome. On admission, there were 8 patients with abnormal white blood cell count, hemoglobin, and albumin levels, 10 patients with abnormal CRP, procalcitonin, and NT-proBNP levels, 5 patients with abnormal creatinine and blood sodium levels, and fewer patients with abnormal platelet count, ALT, and AST levels. During hospitalization, 4 of the 11 wound tissue/exudation samples had positive pathogenic bacterial culture results, and the result reporting time was 5.00 (5.00, 5.00) d; 4 of the 9 blood specimens had positive pathogenic bacterial culture results, and the result reporting time was 3.50 (1.25, 5.00) d; the mNGS results of 7 wound tissue/exudation or blood samples were all positive, and the result reporting time was 1.00 (1.00, 2.00) d. The three strains of Vibrio vulnificus detected were sensitive to 10 commonly used clinical antibiotics, including ciprofloxacin, levofloxacin, and amikacin, etc. A total of 10 patients received surgical treatment, 4 of whom had amputation of limbs/digits; all patients received anti-infection treatment. The length of hospital stay of 11 patients was (26±11) d, of whom 9 patients were cured and 2 patients died. Compared with that of the 6 patients who did not receive early adequate antibiotic treatment, the 5 patients who received early adequate antibiotic treatment had no significant changes in the fatality ratio or amputation of limbs/digits ratio ( P>0.05). In 3 months to 2 years after surgery, the hand function of 8 patients was assessed, with results showing 4 cases of disabled hands, 2 cases of incompletely disabled hands, and 2 cases of recovered hands. When a patient had clinical symptoms of limb redness and swelling and a history of contact with seawater/marine products or a pre-examination triage RiCH score of Vibrio vulnificus sepsis ≥1, the etiological testing should be initiated immediately to quickly diagnose Vibrio vulnificus infection.   Conclusions   Vibrio vulnificus infection occurs most frequently in summer and autumn, with clinical manifestations and laboratory test results showing obvious infection characteristics, and may be accompanied by damage to multiple organ functions. Both the fatality and disability ratios are high and have a great impact on the function of the affected limbs. Early diagnosis is difficult and treatment is easily delayed, but mNGS could facilitate rapid detection. For patients with red and swollen limbs accompanied by a history of contact with seawater/marine products or with a pre-examination triage RiCH score of Vibrio vulnificus sepsis ≥1, the etiological testing should be initiated immediately to quickly diagnose Vibrio vulnificus infection.

     

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    • References(17)
  • [1]
    ChuangYC,YoungCD,ChenCW.Vibrio vulnificus infection[J].Scand J Infect Dis,1989,21(6):721-726.DOI: 10.3109/00365548909021703.
    [2]
    HollisDG,WeaverRE,BakerCN,et al.Halophilic Vibrio species isolated from blood cultures[J].J Clin Microbiol,1976,3(4):425-431.DOI: 10.1128/jcm.3.4.425-431.1976.
    [3]
    KimJS,LeeEG,ChunBC.Epidemiologic characteristics and case fatality rate of Vibrio vulnificus infection: analysis of 761 cases from 2003 to 2016 in Korea[J].J Korean Med Sci,2022,37(9):e79.DOI: 10.3346/jkms.2022.37.e79.
    [4]
    肖宁波,朱光琦,王秋景,等.创伤弧菌感染18例临床特征与外科干预对预后的影响[J].中华临床感染病杂志,2021,14(3):189-192,212.DOI: 10.3760/cma.j.issn.1674-2397.2021.03.005.
    [5]
    郑小庆,盛吉芳.创伤弧菌感染13例临床特点及预后分析[J].中国微生态学杂志,2016,28(2):213-217.DOI: 10.13381/j.cnki.cjm.201602023.
    [6]
    FleischmannS,HerrigI,WespJ,et al.Prevalence and distribution of potentially human pathogenic Vibrio spp. on German North and Baltic Sea Coasts[J].Front Cell Infect Microbiol,2022,12:846819.DOI: 10.3389/fcimb.2022.846819.
    [7]
    程大胜,纪世召,王光毅,等.创伤弧菌原发性脓毒症2例[J].中华烧伤与创面修复杂志,2022,38(3):276-280.DOI: 10.3760/cma.j.cn501120-20201027-00448.
    [8]
    DiW,CuiJ,YuH,et al.Vibrio vulnificus necrotizing fasciitis with sepsis presenting with pain in the lower legs in winter: a case report[J].BMC Infect Dis,2022,22(1):670.DOI: 10.1186/s12879-022-07655-1.
    [9]
    陈幼丽,吴青青,魏智艺,等.进食海鲜致创伤弧菌坏死性筋膜炎3例并文献复习[J].中华全科医师杂志,2022,21(3):264-267.DOI: 10.3760/cma.j.cn114798-20210921-00715.
    [10]
    孙传伟,曾红科,卞徽宁,等.创伤弧菌脓毒性休克死亡三例[J].中华急诊医学杂志,2020,29(9):1226-1228.DOI: 10.3760/cma.j.issn.1671-0282.2020.09.016.
    [11]
    MadhounHY,TanB,FengY,et al.Task-based mirror therapy enhances the upper limb motor function in subacute stroke patients: a randomized control trial[J].Eur J Phys Rehabil Med,2020,56(3):265-271.DOI: 10.23736/S1973-9087.20.06070-0.
    [12]
    蔡瑞昭,祁少海.创伤弧菌生物特性及临床研究进展[J/CD].中华损伤与修复杂志(电子版),2020,15(6):490-494.DOI: 10.3877/cma.j.issn.1673-9450.2020.06.012.
    [13]
    翁成杰,王玉萍,施若霖,等.创伤弧菌脓毒症患者的预后影响因素分析[J].中华急诊医学杂志,2021,30(5):612-616.DOI: 10.3760/cma.j.issn.1671-0282.2021.05.018.
    [14]
    李璐璐,李彤,泮辉,等.创伤弧菌感染误诊为蛇胆中毒一例[J].中华临床感染病杂志,2016,9(1):69-71.DOI: 10.3760/cma.j.issn.1674-2397.2016.01.013.
    [15]
    陈幼丽,魏智艺,吴青青,等.创伤弧菌坏死性筋膜炎5例报告并文献复习[J].福建医药杂志,2022,44(2):80-82.DOI: 10.3969/j.issn.1002-2600.2022.02.029.
    [16]
    顾静,孙蔚,甘建和.二代测序快速诊断上肢创伤弧菌感染一例[J].中华传染病杂志,2019,37(7):436-437.DOI: 10.3760/cma.j.issn.1000-6680.2019.07.010.
    [17]
    洪广亮,卢才教,赵光举,等.创伤弧菌脓毒症诊疗方案(2018)[J].中华急诊医学杂志,2018,27(6):594-598.DOI: 10.3760/cma.j.issn.1671-0282.2018.06.005.
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