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.

Clinical features of Vibrio vulnificus infections in the coastal areas of the Ariake Sea, Japan

“…Our results showed a significant effect of extensive skin lesions on mortality of patients with V. vulnificus infection. The most common site of skin lesions is the right upper extremity (49.3%) in Taiwan, whereas almost all patients in this study had skin lesions of the lower limbs [13]. The reason for this difference is unclear.…”

Genotype Is Correlated with but Does Not Predict Virulence of Vibrio vulnificus Biotype 1 in Subcutaneously Inoculated, Iron Dextran-Treated Mice

“…The mortality rate for sepsis is greater than 50%, even with administration of antibiotics; however, the mortality rate for wound infection and necrotizing fasciitis is significantly lower (approximately 25%) (20,21,31,34). Just as is the case for mice in our model, it is possible for human patients to have severe skin infections without systemic involvement leading to death.…”

Vibrio vulnificus outbreaks in Dutch eel farms since 1996: strain diversity and impact

“…Typically, disease in humans occurs after in gestion of contaminated shellfish (Baker-Austin et al 2010) or after contact of injured skin with contaminated seawater or fish. The result may be primary wound infection, gastro enteritis and septicaemia, including necrotic fasciitis (Dalsgaard et al 1996, Chiang & Chuang 2003, Kuo et al 2007, Dijkstra et al 2009, with a mean lethality of > 50% when septicaemia occurs (Koenig et al 1991, Chuang et al 1992 Strains of Vibrio vulnificus have been classified into 3 biotypes based on biochemical characteristics (Tison et al 1982, Bisharat et al 1999. Biotypes 1 and 2 include environmental (e.g.…”