Necrotizing fasciitis caused by Vibrio vulnificus: Epidemiology, clinical findings, treatment and prevention

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Necrotizing fasciitis is a soft-tissue infection with a high risk of fatality. Infection with Vibrio vulnificus can lead to development of necrotizing fasciitis and primary septicemia, and occurs mostly in immunocompromised host-associated diseases such as hepatic disease, diabetes mellitus, chronic renal insufficiency, and adrenal insufficiency. Early recognition and treatment of the infection, which are unclear, are vital to patient welfare. We studied the disease epidemiology and reviewed the prognosis and clinical features of patients treated using our developed protocol. Clinical manifestations and outcomes were retrospectively analyzed for 67 patients with V. vulnificus-mediated necrotizing fasciitis and sepsis. All patients who had contacted seawater or raw seafood with positive culture for vibrio were included. Patients were divided into two groups based on the timing of first fasciotomy and injury; within 24 h (group A) and beyond 24 h (group B). Twenty-three of the 67 patients (40%) had hepatic disease, 17 (25.4%) had chronic renal insufficiency, and 12 (17.9%) exhibited adrenal insufficiency. The most common site of infection was the upper extremity (74.7%). Group B presented with more clinical symptoms including fever (p=0.02), hemorrhagic bullae (p<0.0001), and shock (p=0.007). Group A patients exhibited enhanced survival compared to group B (in hospital mortality: 4.9% vs. 23%; p=0.005). We conclude that early and appropriate diagnosis for V. vulnificus infection should be made, especially in patients presenting with atypical clinical findings. Early fasciotomy within 24 h remains the highest priority and decreases the mortality rate.

Original languageEnglish
Pages (from-to)785-792
Number of pages8
JournalEuropean Journal of Clinical Microbiology and Infectious Diseases
Volume26
Issue number11
DOIs
Publication statusPublished - 2007 Nov 1

Fingerprint

Vibrio vulnificus
Necrotizing Fasciitis
Epidemiology
Adrenal Insufficiency
Therapeutics
Chronic Renal Insufficiency
Sepsis
Seafood
Soft Tissue Infections
Vibrio
Liver
Seawater
Immunocompromised Host
Blister
Hospital Mortality
Infection
Upper Extremity
Early Diagnosis
Shock
Diabetes Mellitus

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

@article{4d8eb0e16c93408fb91d9b3f9a7daa2c,
title = "Necrotizing fasciitis caused by Vibrio vulnificus: Epidemiology, clinical findings, treatment and prevention",
abstract = "Necrotizing fasciitis is a soft-tissue infection with a high risk of fatality. Infection with Vibrio vulnificus can lead to development of necrotizing fasciitis and primary septicemia, and occurs mostly in immunocompromised host-associated diseases such as hepatic disease, diabetes mellitus, chronic renal insufficiency, and adrenal insufficiency. Early recognition and treatment of the infection, which are unclear, are vital to patient welfare. We studied the disease epidemiology and reviewed the prognosis and clinical features of patients treated using our developed protocol. Clinical manifestations and outcomes were retrospectively analyzed for 67 patients with V. vulnificus-mediated necrotizing fasciitis and sepsis. All patients who had contacted seawater or raw seafood with positive culture for vibrio were included. Patients were divided into two groups based on the timing of first fasciotomy and injury; within 24 h (group A) and beyond 24 h (group B). Twenty-three of the 67 patients (40{\%}) had hepatic disease, 17 (25.4{\%}) had chronic renal insufficiency, and 12 (17.9{\%}) exhibited adrenal insufficiency. The most common site of infection was the upper extremity (74.7{\%}). Group B presented with more clinical symptoms including fever (p=0.02), hemorrhagic bullae (p<0.0001), and shock (p=0.007). Group A patients exhibited enhanced survival compared to group B (in hospital mortality: 4.9{\%} vs. 23{\%}; p=0.005). We conclude that early and appropriate diagnosis for V. vulnificus infection should be made, especially in patients presenting with atypical clinical findings. Early fasciotomy within 24 h remains the highest priority and decreases the mortality rate.",
author = "Kuo, {Y. L.} and Shieh, {S. J.} and Chiu, {H. Y.} and Lee, {J. W.}",
year = "2007",
month = "11",
day = "1",
doi = "10.1007/s10096-007-0358-5",
language = "English",
volume = "26",
pages = "785--792",
journal = "European Journal of Clinical Microbiology and Infectious Diseases",
issn = "0934-9723",
publisher = "Springer Verlag",
number = "11",

}

TY - JOUR

T1 - Necrotizing fasciitis caused by Vibrio vulnificus

T2 - Epidemiology, clinical findings, treatment and prevention

AU - Kuo, Y. L.

AU - Shieh, S. J.

AU - Chiu, H. Y.

AU - Lee, J. W.

PY - 2007/11/1

Y1 - 2007/11/1

N2 - Necrotizing fasciitis is a soft-tissue infection with a high risk of fatality. Infection with Vibrio vulnificus can lead to development of necrotizing fasciitis and primary septicemia, and occurs mostly in immunocompromised host-associated diseases such as hepatic disease, diabetes mellitus, chronic renal insufficiency, and adrenal insufficiency. Early recognition and treatment of the infection, which are unclear, are vital to patient welfare. We studied the disease epidemiology and reviewed the prognosis and clinical features of patients treated using our developed protocol. Clinical manifestations and outcomes were retrospectively analyzed for 67 patients with V. vulnificus-mediated necrotizing fasciitis and sepsis. All patients who had contacted seawater or raw seafood with positive culture for vibrio were included. Patients were divided into two groups based on the timing of first fasciotomy and injury; within 24 h (group A) and beyond 24 h (group B). Twenty-three of the 67 patients (40%) had hepatic disease, 17 (25.4%) had chronic renal insufficiency, and 12 (17.9%) exhibited adrenal insufficiency. The most common site of infection was the upper extremity (74.7%). Group B presented with more clinical symptoms including fever (p=0.02), hemorrhagic bullae (p<0.0001), and shock (p=0.007). Group A patients exhibited enhanced survival compared to group B (in hospital mortality: 4.9% vs. 23%; p=0.005). We conclude that early and appropriate diagnosis for V. vulnificus infection should be made, especially in patients presenting with atypical clinical findings. Early fasciotomy within 24 h remains the highest priority and decreases the mortality rate.

AB - Necrotizing fasciitis is a soft-tissue infection with a high risk of fatality. Infection with Vibrio vulnificus can lead to development of necrotizing fasciitis and primary septicemia, and occurs mostly in immunocompromised host-associated diseases such as hepatic disease, diabetes mellitus, chronic renal insufficiency, and adrenal insufficiency. Early recognition and treatment of the infection, which are unclear, are vital to patient welfare. We studied the disease epidemiology and reviewed the prognosis and clinical features of patients treated using our developed protocol. Clinical manifestations and outcomes were retrospectively analyzed for 67 patients with V. vulnificus-mediated necrotizing fasciitis and sepsis. All patients who had contacted seawater or raw seafood with positive culture for vibrio were included. Patients were divided into two groups based on the timing of first fasciotomy and injury; within 24 h (group A) and beyond 24 h (group B). Twenty-three of the 67 patients (40%) had hepatic disease, 17 (25.4%) had chronic renal insufficiency, and 12 (17.9%) exhibited adrenal insufficiency. The most common site of infection was the upper extremity (74.7%). Group B presented with more clinical symptoms including fever (p=0.02), hemorrhagic bullae (p<0.0001), and shock (p=0.007). Group A patients exhibited enhanced survival compared to group B (in hospital mortality: 4.9% vs. 23%; p=0.005). We conclude that early and appropriate diagnosis for V. vulnificus infection should be made, especially in patients presenting with atypical clinical findings. Early fasciotomy within 24 h remains the highest priority and decreases the mortality rate.

UR - http://www.scopus.com/inward/record.url?scp=35348891462&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=35348891462&partnerID=8YFLogxK

U2 - 10.1007/s10096-007-0358-5

DO - 10.1007/s10096-007-0358-5

M3 - Article

C2 - 17674061

AN - SCOPUS:35348891462

VL - 26

SP - 785

EP - 792

JO - European Journal of Clinical Microbiology and Infectious Diseases

JF - European Journal of Clinical Microbiology and Infectious Diseases

SN - 0934-9723

IS - 11

ER -