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Zaghi I, Tebano G, Vanino E, Vandi G, Cricca M, Sambri V, Fantini M, Di Antonio F, Terzitta M, Russo E, Cristini F, Bassi P, Biagetti C, Tatarelli P. Non-cholera Vibrio spp. invasive infections in the summer following May 2023 flood disaster in Romagna, Italy: a case series. Eur J Clin Microbiol Infect Dis 2024:10.1007/s10096-024-04842-7. [PMID: 38735888 DOI: 10.1007/s10096-024-04842-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/02/2024] [Indexed: 05/14/2024]
Abstract
Non-cholera Vibrio spp. includes ubiquitous organisms living in aquatic environments. Their occurrence is associated with global warming and meteorological disasters. In May 2023 the Romagna region, Italy, was affected by severe floods. In the following 15 weeks we observed 5 patients with invasive infections caused by V. vulnificus (3/5) and V. harveyi (2/5). All patients (median age 77 years) had medical comorbidities and shared exposure to seawater. Two patients needed surgery; 2 died. In conclusion, we observed an increased burden of Vibrio spp. invasive infections after May 2023 floods, affecting old patients with predisposing medical conditions.
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Affiliation(s)
- I Zaghi
- Infectious Diseases Unit, Ravenna Hospital, Ravenna, Italy.
- Unit of Microbiology, The Greater Romagna Area Hub Laboratory, 47522, Cesena, Italy.
| | - G Tebano
- Infectious Diseases Unit, Ravenna Hospital, Ravenna, Italy
| | - E Vanino
- Infectious Diseases Unit, Ravenna Hospital, Ravenna, Italy
| | - G Vandi
- Infectious Diseases Unit, Rimini Hospital, Rimini, Italy
| | - M Cricca
- Unit of Microbiology, The Greater Romagna Area Hub Laboratory, 47522, Cesena, Italy
- Department of Medical and Surgical Sciences (DIMEC)-Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy
| | - V Sambri
- Unit of Microbiology, The Greater Romagna Area Hub Laboratory, 47522, Cesena, Italy
- Department of Medical and Surgical Sciences (DIMEC)-Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy
| | - M Fantini
- Clinical and Organizational Research Unit, Romagna AUSL, Ravenna, Italy
| | - F Di Antonio
- Anesthesia and Intensive Care Unit, Ravenna Hospital, Ravenna, Italy
| | - M Terzitta
- Anesthesia and Intensive Care Unit, Ravenna Hospital, Ravenna, Italy
| | - E Russo
- Department of Surgery and Trauma, Anesthesia and Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, AUSL Della Romagna, Italy
| | - F Cristini
- Infectious Diseases Unit, Forlì and Cesena Hospitals, Forlì and Cesena, Italy
| | - P Bassi
- Infectious Diseases Unit, Ravenna Hospital, Ravenna, Italy
| | - C Biagetti
- Infectious Diseases Unit, Rimini Hospital, Rimini, Italy
| | - P Tatarelli
- Infectious Diseases Unit, Ravenna Hospital, Ravenna, Italy
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Hsieh CM, Hu SY, Hsieh MS, Huang SC, Shen CH, Tsai YC. Better Performance of Modified Scoring Systems to Predict the Clinical Outcomes of Vibrio Bacteremia in the Emergency Department: An Observational Study. J Pers Med 2024; 14:385. [PMID: 38673012 PMCID: PMC11051138 DOI: 10.3390/jpm14040385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Vibrio is a genus of Gram-negative bacteria found in various aquatic environments, including saltwater and freshwater. Vibrio bacteremia can lead to sepsis, a potentially life-threatening condition in which the immune system enters overdrive in response to the disease, causing widespread inflammation and damage to tissues and organs. V. vulnificus had the highest case fatality rate (39%) of all reported foodborne infections in the United States and a high mortality rate in Asia, including Taiwan. Numerous scoring systems have been created to estimate the mortality risk in the emergency department (ED). However, there are no specific scoring systems to predict the mortality risk of Vibrio bacteremia. Therefore, this study modified the existing scoring systems to better predict the mortality risk of Vibrio bacteremia. METHODS Cases of Vibrio bacteremia were diagnosed based on the results from at least one blood culture in the ED. Patient data were extracted from the electronic clinical database, covering January 2012 to December 2021. The primary outcome was in-hospital mortality.This study used univariate and multivariate analyses to evaluate the mortality risk. RESULTS This study enrolled 36 patients diagnosed with Vibrio bacteremia, including 23 males (63.9%) and 13 females (36.1%), with a mean age of 65.1 ± 15.7 years. The in-hospital mortality rate amounted to 25% (9/36), with 31.5% in V. vulnificus (6/19) and 17.6% in V. non-vulnificus (3/17). The non-survivors demonstrated higher MEDS (10.3 ± 2.4) than the survivors (6.2 ± 4.1) (p = 0.002). Concerning the qSOFA, the survivors scored 0.3 ± 0.5, and the non-survivors displayed a score of 0.6 ± 0.7 (p = 0.387). The AUC of the ROC for the MEDS and qSOFA was 0.833 and 0.599, respectively. This study modified the scoring systems with other predictive factors, including BUN and pH. The AUC of the ROC for the modified MEDS and qSOFA reached up to 0.852 and 0.802, respectively. CONCLUSION The MEDS could serve as reliable indicators for forecasting the mortality rate of patients grappling with Vibrio bacteremia. This study modified the MEDS and qSOFA to strengthen the predictive performance of mortality risk for Vibrio bacteremia. We advocate the prompt initiation of targeted therapeutic interventions and judicious antibiotic treatments to curb fatality rates.
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Affiliation(s)
- Chia-Ming Hsieh
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-M.H.); (C.-H.S.); (Y.-C.T.)
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
| | - Sung-Yuan Hu
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-M.H.); (C.-H.S.); (Y.-C.T.)
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11217, Taiwan;
| | - Ming-Shun Hsieh
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11217, Taiwan;
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan 330, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Shih-Che Huang
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Lung Cancer Research Center, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Chia-Hui Shen
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-M.H.); (C.-H.S.); (Y.-C.T.)
| | - Yi-Chun Tsai
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-M.H.); (C.-H.S.); (Y.-C.T.)
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Davidson N, Edwards F, Harris PNA, Laupland KB. Vibrio species bloodstream infections in Queensland, Australia. Intern Med J 2024; 54:157-163. [PMID: 37497569 DOI: 10.1111/imj.16187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/28/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Vibrio species bloodstream infections have been associated with significant mortality and morbidity. Limited information is available regarding the epidemiology of bloodstream infections because of Vibrio species in the Australian context. AIMS The objective of this study was to define the incidence and risk factors for developing Vibrio species bloodstream infections and compare differences between different species. METHODS All patients with Vibrio spp. isolated from positive blood cultures between 1 January 2000 and 31 December 2019 were identified by the state-wide Pathology Queensland laboratory. Demographics, clinical foci of infections and comorbid conditions were collected in addition to antimicrobial susceptibility results. RESULTS About 100 cases were identified between 2000 and 2019 with an incidence of 1.2 cases/1 million person-years. Seasonal and geographical variation occurred with the highest incidence in the summer months and in the tropical north. Increasing age, male sex and multiple comorbidities were identified as risk factors. Vibrio vulnificus was isolated most frequently and associated with the most severe disease. Overall case fatality was 19%. CONCLUSIONS There is potential for increasing cases of Vibrio species infections globally with ageing populations and climate change. Ongoing clinical awareness is required to ensure optimal patient outcomes.
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Affiliation(s)
- Natalie Davidson
- Department of Microbiology, Pathology Queensland, Brisbane, Queensland, Australia
| | - Felicity Edwards
- Faculty of Health, Queensland University of technology (QUT), Brisbane, Queensland, Australia
| | - Patrick N A Harris
- Department of Microbiology, Pathology Queensland, Brisbane, Queensland, Australia
- Faculty of Medicine, UQ Center for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - Kevin B Laupland
- Faculty of Health, Queensland University of technology (QUT), Brisbane, Queensland, Australia
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Prithvisagar KS, Gollapalli P, D’Souza C, Rai P, Karunasagar I, Karunasagar I, Ballamoole KK. Genome analysis of clinical genotype Vibrio vulnificus isolated from seafood in Mangaluru Coast, India provides insights into its pathogenicity. Vet Q 2023; 43:1-17. [PMID: 37478018 PMCID: PMC10438861 DOI: 10.1080/01652176.2023.2240389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/23/2023] Open
Abstract
Vibrio vulnificus an opportunistic human pathogen native to marine/estuarine environment, is one of the leading causes of death due to seafood consumption and exposure of wounds to seawater worldwide. The present study involves the whole genome sequence analysis of an environmental strain of V. vulnificus (clinical genotype) isolated from seafood along the Mangaluru coast of India. The sequenced genome data was subjected to in-silico analysis of phylogeny, virulence genes, antimicrobial resistance determinants, and secretary proteins using suitable bioinformatics tools. The sequenced isolate had an overall genome length of 4.8 Mb and GC content of 46% with 4400 coding DNA sequences. The sequenced strain belongs to a new sequence type (Multilocus sequence typing) and was also found to branch with a phylogenetic lineage that groups the most infectious strains of V. vulnificus. The seafood isolate had complete genes involved in conferring serum resistance yet showed limited serum resistance. The study identified several genes against the antibiotics that are commonly used in their treatment, highlighting the need for alternative treatments. Also, the secretory protein analysis revealed genes associated with major pathways like ABC transporters, two-component systems, quorum sensing, biofilm formation, cationic antimicrobial peptide (CAMP) resistance, and others that play a critical role in the pathogenesis of the V. vulnificus. To the best of our knowledge, this is the first report of a detailed analysis of the genomic information of a V. vulnificus isolated from the Indian subcontinent and provides evidence that raises public health concerns about the safety of seafood.
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Affiliation(s)
- Kattapuni Suresh Prithvisagar
- Department of Infectious Diseases and Microbial Genomics, Nitte University Centre for Science Education and Research, Nitte (Deemed to be University), Mangaluru, India
| | - Pavan Gollapalli
- Center for Bioinformatics and Biostatistics, Nitte (Deemed to be University), Mangaluru, India
| | - Caroline D’Souza
- Department of Infectious Diseases and Microbial Genomics, Nitte University Centre for Science Education and Research, Nitte (Deemed to be University), Mangaluru, India
| | - Praveen Rai
- Department of Infectious Diseases and Microbial Genomics, Nitte University Centre for Science Education and Research, Nitte (Deemed to be University), Mangaluru, India
| | - Iddya Karunasagar
- Department of Infectious Diseases and Microbial Genomics, Nitte University Centre for Science Education and Research, Nitte (Deemed to be University), Mangaluru, India
| | - Indrani Karunasagar
- Department of Infectious Diseases and Microbial Genomics, Nitte University Centre for Science Education and Research, Nitte (Deemed to be University), Mangaluru, India
| | - Krishna Kumar Ballamoole
- Department of Infectious Diseases and Microbial Genomics, Nitte University Centre for Science Education and Research, Nitte (Deemed to be University), Mangaluru, India
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Klapproth H, Klapproth L, Ruegamer T, Uhl F, Jantsch J, Fabri M. [Bacterial infections of the skin in the context of climate change and migration]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:851-857. [PMID: 37812206 DOI: 10.1007/s00105-023-05231-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND In the context of climate change and migration, both common and previously less common pathogens are gaining importance as cutaneous bacterial infections. OBJECTIVE To inform medical professionals about challenges to dermatology posed by climate change and migration. MATERIALS AND METHODS Review of the current literature on emerging antimicrobial resistance and emerging pathogens in general and on the epidemiological situation in Germany in particular. RESULTS Climate change has a direct impact on microbiological ecosystems in Germany's warming coastal waters leading to an increase of marine V. vulnificus counts and human infections. Secondary to global warming, transmitting vectors of, for example, Lyme disease, rickettsioses and tularemia are also increasing. In addition, infectious diseases like cutaneous diphtheria and mycobacteriosis have been diagnosed in migrants, mostly likely acquired before migration or on the migration route and first diagnosed in Germany. In this context, antimicrobial resistance (e.g. methicillin-resistant Staphylococcus aureus [MRSA] and multidrug-resistant gram-negative bacteria) is gaining importance. CONCLUSION Due to progressive changes in global climate and ongoing migration, the aforementioned pathogens of infectious skin diseases and changes in antimicrobial resistance patterns have to be expected. Physicians should be aware of these developments in order to offer appropriate diagnostics and treatment. Epidemiological and biogeographic monitoring will be indispensable for managing emerging changes.
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Affiliation(s)
- Henning Klapproth
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinik Köln und Universität zu Köln, Köln, Deutschland.
- Klinik und Poliklinik für Dermatologie und Venerologie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Laurenz Klapproth
- Earth Observation and Modelling, Geographisches Institut, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - Tamara Ruegamer
- Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinik Köln und Universität zu Köln, Köln, Deutschland
| | - Florian Uhl
- Earth Observation and Modelling, Geographisches Institut, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - Jonathan Jantsch
- Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinik Köln und Universität zu Köln, Köln, Deutschland
- Center for Molecular Medicine Cologne (CMMC), Medizinische Fakultät, Universität zu Köln, Köln, Deutschland
| | - Mario Fabri
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinik Köln und Universität zu Köln, Köln, Deutschland
- Center for Molecular Medicine Cologne (CMMC), Medizinische Fakultät, Universität zu Köln, Köln, Deutschland
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Lu HY, Gao YB, Qiu XW, Wang Q, Liu CM, Huang XW, Chen HY, Zeng K, Li CX. Successful surgical treatment of polybacterial gas gangrene confirmed by metagenomic next-generation sequencing detection: A case report. World J Clin Cases 2022; 10:13064-13073. [PMID: 36568998 PMCID: PMC9782953 DOI: 10.12998/wjcc.v10.i35.13064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/02/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We report on a case of Vibrio vulnificus (V. vulnificus) detected by metagenomics next-generation sequencing (mNGS) in a 53-year-old male patient with polymicrobial gas gangrene and successful treatment by surgery. This report raises awareness among dermatologists that when a patient is clinically suspected of a special type of pathogenic infection, the mNGS method should be preferred to identify the patient’s pathogen infection as soon as possible and then take effective treatment in time to save patients’ lives.
CASE SUMMARY A 53-year-old male who worked in the aquatic market complained of redness and swelling of the lower limbs, blisters and ulcers with fever for 3 d. We used mNGS to test the pathogens in ulcer secretions. The results were returned in 24 h and indicated: V. vulnificus, Fusobacterium necrophorum, Staphylococcus haemolyticus, Staphylococcus aureus, Streptococcus dysgalactiae and Klebsiella aerogenes. This patient was diagnosed with V. vulnificus infection. The emergency operation was performed immediately under combined lumbar and epidural anesthesia: Left leg expansion and exploration (August 10, 2021). After surgery, we continued to use piperacillin sodium tazobactam sodium 4.5 g every 8 h and levofloxacin 0.5 g for anti-infection treatment. The patient underwent further surgery under lumbar anesthesia on August 17, 2021 and August 31, 2021: Left leg deactivation and skin grafting, negative pressure closed drainage and right thigh skin removal. After treatment, the transplanted flap survived.
CONCLUSION We could confirm the diagnosis of Vibrio vulnificus infection within 24 h through mNGS detection and then immediately performed emergency surgery.
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Affiliation(s)
- Hong-Yan Lu
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Yan-Bin Gao
- Department of Burns Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Xue-Wen Qiu
- Department of Burns Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Qi Wang
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Chen-Mei Liu
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Xiao-Wen Huang
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Hong-Yu Chen
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Kang Zeng
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Chang-Xing Li
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
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Chuang YC, Liu PY, Lai KL, Tseng CH. Bilateral Lower Limbs Cellulitis: A Narrative Review of an Overlooked Clinical Dilemma. Int J Gen Med 2022; 15:5567-5578. [PMID: 35707739 PMCID: PMC9191579 DOI: 10.2147/ijgm.s356852] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022] Open
Abstract
Bilateral lower limbs cellulitis is a rare clinical condition, which has been overlooked for a long time. In daily clinical practice, bilateral cellulitis is a sporadically encountered condition; however, it remains a clinical challenge. There is a broad differential diagnosis for this clinical entity, and there is a lack of accepted international diagnostic criteria. Unnecessary antibiotic prescription is common, which has led to an emerging problem. In this review, we summarize case reports of bilateral lower limbs cellulitis and common pathogens that have been documented.
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Affiliation(s)
- Yu-Chuan Chuang
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Po-Yu Liu
- Division of Infectious Disease, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan.,Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Kuo-Lung Lai
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chien-Hao Tseng
- Division of Infectious Disease, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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Phitsamai A, Chueansuwan W, Changpradub D. Vibrio vulnificus Necrotizing Fasciitis in Upper Limbs and Septicemia Following Pinch Injury by Mud Crab: A Case Report. Cureus 2022; 14:e24393. [PMID: 35619836 PMCID: PMC9126442 DOI: 10.7759/cureus.24393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 11/05/2022] Open
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Aksak-Wąs BJ, Ripa A, Szakoła P, Horbacka K, Niścigorska-Olsen J, Witak-Jędra M, Zając-Marczewska M, Karasińska-Cieślak M, Kot J, Parczewski M. Septic Shock Induced by Vibrio Vulnificus in Northern Poland, a Case Report. Infect Drug Resist 2021; 14:5027-5033. [PMID: 34880631 PMCID: PMC8645607 DOI: 10.2147/idr.s340991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/30/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Vibrio vulnificus infections are a growing problem worldwide. In recent years, infections with this bacteria have been reported in Central Europe, especially in the German Baltic coast but also in France and Italy. Climate warming causes the sea temperature to increase every year, which translates to an increased risk of infections from the Vibrio group. Most of these are mild and present as wound infections, but some patients develop life-threatening sepsis from either ingestion of infected mollusks or wound lesions that develop into generalized infections. Illness may be associated with necrotizing fasciitis and may require several weeks of therapy, often based on a surgical operation, demarcation of necrosis or limb amputation. A case such as the one described in this manuscript has not been previously described in Poland and demonstrates the need for a multidisciplinary approach to infection with Vibrio vulnificus. CASE PRESENTATION A 68-year-old patient was pricked with an unknown object in the side of a lower limb during his stay at the Polish seaside. He developed a life-threatening infection in the form of severe sepsis with multiple organ failure. He required broad-spectrum antibiotic therapy, and after obtaining results for Vibrio vulnificus targeted therapy, a surgical operation with skin lesion decompression and fasciotomy was performed. Finally, hyperbaric chamber therapy was given. The patient's general condition improved, and local changes and his vital parameters stabilized. CONCLUSION Vibrio vulnificus infection may be confused with other causes of skin and subcutaneous tissue infection, although it requires a different approach and different targeted antibiotic therapies. This infection may take the form of a life-threatening disease requiring a multidisciplinary approach.
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Affiliation(s)
- Bogusz Jan Aksak-Wąs
- Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Agnieszka Ripa
- Department of Infectious, Tropical Diseases and Immune Deficiency, Provincial Hospital, Szczecin, Poland
| | - Paweł Szakoła
- Department of General and Transplant Surgery, Department of Vascular Surgery, Provincial Hospital, Szczecin, Poland
| | - Karolina Horbacka
- Department of General and Transplant Surgery, Department of Vascular Surgery, Provincial Hospital, Szczecin, Poland
| | - Jolanta Niścigorska-Olsen
- Department of Infectious, Tropical Diseases and Immune Deficiency, Provincial Hospital, Szczecin, Poland
| | - Magdalena Witak-Jędra
- Department of Infectious, Tropical Diseases and Immune Deficiency, Provincial Hospital, Szczecin, Poland
| | | | - Malwina Karasińska-Cieślak
- Department of Infectious, Tropical Diseases and Immune Deficiency, Provincial Hospital, Szczecin, Poland
| | - Jacek Kot
- National Center for Hyperbaric Medicine, University Center for Maritime and Tropical Medicine in Gdynia, Medical University of Gdansk, Gdansk, Poland
| | - Miłosz Parczewski
- Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University in Szczecin, Szczecin, Poland
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Elnahla A, Attia AS, Toraih E, Guidry C, Akkera M, Schroll R, Killackey M, Nichols R, Kandil E. Prognostic Factors of Mortality in Vibrio vulnificus Sepsis and Soft Tissue Infections: Meta-Analysis. Surg Infect (Larchmt) 2021; 22:928-939. [PMID: 33970025 DOI: 10.1089/sur.2020.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Vibrio vulnificus is a rare but life-threatening infection that effects the population near warm coastal areas. This infection could be fulminant and rapidly progress to severe sepsis and necrotizing soft tissue infection. Early diagnosis and treatment are critical to saving patients' lives. With multiple studies reporting discrepancies in prognostic factors and different treatment protocols, we aimed through this meta-analysis to assess these factors and protocols and the impact on the outcome of the infection. Materials and Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search of PubMed, Embase, and Cochrane Library databases by two independent reviewers was reported. Studies evaluating prognostic factors and treatment outcomes of Vibrio vulnificus infections were included. Comprehensive Meta-Analysis, version 3.0 was used. Results: Two hundred eleven studies were identified. Of those, eight studies met our inclusion criteria. The following factors on presentation were associated with higher mortality rates; concomitant liver disease (odds ratio [OR], 4.38; 95% confidence interval [CI], 2.43-7.87; p < 0.001), renal disease (OR, 3.90; 95% CI, 1.37-11.12; p = 0.011), septic shock (OR, 2.82; 95% CI, 1.84-4.31; p < 0.001), higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR, 3.40; 95% CI, 2.26-5.12; p < 0.001), elevated band cells count (OR, 2.61; 95% CI, 1.13-6.0; p = 0.024), hypoalbuminemia (OR, 3.41; 95% CI, 1.58-7.35; p = 0.002), and infection involving multiple limbs (OR, 4.36; 95% CI, 1.72-11.07; p = 0.002). Interestingly, different antibiotic regimens did not have any impact on outcomes, however, delayed surgical intervention after the first 12 or 24 hours was associated with higher mortality rates (OR, 2.64; 95% CI, 1.39-5.0; p = 0.003 and OR, 2.99; 95% CI, 1.54-5.78; p = 0.001, respectively). Conclusion: The presence of liver or renal disease, higher APACHE II scores, septic shock, hypoalbuminemia, or elevated band cell on presentation should alert the physician to the higher risk of mortality. Different antibiotic regimens did not impact the outcomes in these patients and delayed surgical intervention is associated with worsening of mortality.
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Affiliation(s)
| | | | - Eman Toraih
- Tulane University, New Orleans, Louisiana, USA.,Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | | | | | | | | | | | - Emad Kandil
- Tulane University, New Orleans, Louisiana, USA
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Lee YW, Kim JH. A Case of Vibrio Vulnificus Infection Presenting with Fatal Bacterial Encephalitis. J Clin Neurol 2021; 17:128-130. [PMID: 33480208 PMCID: PMC7840328 DOI: 10.3988/jcn.2021.17.1.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Yong Woo Lee
- Department of Neurology, Dankook University Hospital, Cheonan, Korea
| | - Jee Hyun Kim
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea.
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Abstract
BACKGROUND The prevalence of Vibrio vulnificus heavily depends on the temperature and salinity of the sea water. In the course of climate change an increase in cases of fatal sepsis caused by V. vulnificus at the German Baltic Sea coast could be detected. OBJECTIVE To generate awareness for a life-threatening infection with increasing incidence in Germany. MATERIAL AND METHODS This article presents an overview of the current state of the literature followed by an exemplary description of cases with V vulnificus sepsis caused by contact with water in the Baltic Sea, which were treated at the Medical University in Greifswald in summer 2018. RESULTS In the presence of risk factors, such as liver and kidney diseases, immunosuppression and male sex, there is a danger of severe sepsis if damaged skin comes into contact with contaminated sea water. A pronounced organ dysfunction can frequently be found on admission. In these cases the diagnosis must be made promptly and timely surgical cleansing and antibiotic treatment should be initiated (e.g. a combination of tetracyclines and third generation cephalosporins). CONCLUSION Sepsis due to V. vulnificus will probably increase over the coming years. Because there is a latency in some cases between infection and onset of sepsis, physicians beyond the coastal region must also be informed about this disease.
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