Necrotizing Soft-Tissue Infections and Primary Sepsis Caused by Vibrio vulnificus and Vibrio cholerae non-O1

Abstract

Vibrio necrotizing soft-tissue infections should be suspected in patients with appropriate clinical findings and history of contact with seawater or seafood. V. cholerae non-O1 may cause bacteremia more often than V. vulnificus in patients with liver cirrhosis. Early fasciotomy and culture-directed antimicrobial therapy are aggressively recommended in patients with hypotensive shock, leukopenia, high band forms of white blood cells, decreased platelet counts, severe hypoalbuminemia, and underlying chronic illness, such as hepatic dysfunction and diabetes mellitus.

Laboratory Indicators for Early Detection and Surgical Treatment of Vibrio Necrotizing Fasciitis

“…Skin presentations of Vibrio necrotizing fasciitis are characterized by swelling, hemorrhagic bullae, subcutaneous bleeding, skin necrosis, expanding purpura, and gangrene at the time of presentation, which is considered an ominous sign for early surgical intervention at our institution [12,13,27,29]. All imaging modalities reportedly have a low sensitivity for detecting necrotic soft tissue infections and a low specificity [1,5,9,23,24].…”

“…Débridement of the necrotic fascia or immediate limb amputation was performed initially in all 70 patients. Thirty-four of these 70 patients were reported previously [26][27][28][29]. The minimum followup was 2 days (mean, 6 months; range, 2 days-16 months).…”

“…Hypotensive shock, leukopenia, higher counts of band forms of leukocytes, decreased platelet counts, and severe hypoalbuminemia at the time of presentation were associated with mortality in patients with Vibrio necrotizing fasciitis [15,[27][28][29]. However, there are no known laboratory parameters that specifically can detect and make an early diagnosis of Vibrio necrotizing fasciitis.…”

“…In 2004, we reported a treatment algorithm for patients with suspected Vibrio necrotizing soft tissue infections that includes emergency fasciotomy or amputation, antibiotic therapy with a third-generation cephalosporin plus tetracycline, and admission to the intensive care unit [28]. However, our mortality rates of patients with Vibrio infections were still as much as 35% to 44% [15,27,29]. The lack of specific disease characteristics and diagnostic tools during the initial examination might have delayed the diagnosis and resulted in failure to initiate early aggressive surgery.…”

“…Based on previous small series and case reports of 34 patients with Vibrio necrotizing fasciitis, 13 died and 21 survived, resulting in a mortality rate of 38% [15,16,[26][27][28][29]. Hypotensive shock, leukopenia, higher counts of band forms of leukocytes, decreased platelet counts, and severe hypoalbuminemia at the time of presentation were associated with mortality in patients with Vibrio necrotizing fasciitis [15,[27][28][29].…”