Lower extremity infections by vibrio vulnificus

BACKGROUND

Vibrio vulnificus is a Gram-negative pathogen which is found in seawater and shellfish during warm months and can cause local infections in healthy individuals or septicemia in patients with chronic liver disease.

MATERIALS-METHODS

Clinical and laboratory records of four complicated cases are presented, with a 4.2 mean year follow-up.

RESULTS

Three patients underwent urgent leg amputation because of of irreversible necrotic changes with septic complications and failure of incisional drainage to control the infection. Another one patient underwent only excision of necrotic soft tissue but he developed calcaneus osteomyelitis after three years of the initial fish bone injury.

DISCUSSION

Clinicians must maintain a high index of suspicion, especially in regions endemic for vibrio necrotising fasciitis and antibiotic prophylaxis must be given to swimmers before or during bathing.

Vibrio vulnificus endophthalmitis occurring after ingestion of raw seafood

Ocular Vibrio vulnificus infections are quite rare, and all previously reported cases have been associated with exposure to seafood and seawater. Here, we report a case of endogenous endophthalmitis caused by V. vulnificus, occurring after the ingestion of raw seafood. This case was not associated with any cutaneous or other severe systemic manifestations.

Ilizarov technique in the treatment of chronic osteomyelitis caused by Vibrio alginolyticus

We present a case of 26-year-old woman with posttraumatic chronic osteomyelitis caused by Vibrio alginolyticus, contracted after contamination of a tibial fracture with seawater. The patient underwent bone resection and bifocal osteosynthesis according to Ilizarov and was treated with a combination of ciprofloxacin and tetracycline. The patient responded in the same way to distraction osteogenesis as any other patient with chronic osteomyelitis with large defects.

Primary skin infections secondary to Vibrio vulnificus: the role of operative intervention

BACKGROUND

Vibrio vulnificus can cause rapidly spreading skin and soft tissue infections with significant associated morbidity and mortality. Patients with underlying chronic illness, such as cirrhosis, diabetes mellitus, or immunosuppression, have been noted to be at high risk for rapid progression of this infection. The importance of early antibiotic therapy has been reported but the role of operative intervention in these patients is less clear.

STUDY DESIGN

We report seven patients who were operatively treated from April 28, 1991 to September 22, 1995 for primary skin and soft tissue infections secondary to Vibrio vulnificus. We have also reviewed the recent literature. The impact of several variables including shock, increased white blood cell count, fever, and the timing of operative intervention on the length of hospital stay and intensive care unit stay was analyzed using the Spearman rank correlation. The impact of early compared with late operative intervention was analyzed using the Mann-Whitney U test. All patients had a history of underlying chronic illness and presented with skin infections in association with recent exposure to saltwater and to shellfish. No patient presented earlier than 24 hours from the time of initial infection. All patients underwent operative exploration within 46 hours of admission with thorough operative debridement of all necrotic tissue. Infection was confined to the skin and subcutaneous tissue.

RESULTS

There was no mortality among our patients. The presence of perioperative shock, fever, or elevated white blood cell count did not correlate with an increased intensive care unit stay or an increased hospital stay. Earlier operative exploration and debridement correlated with a decrease in the intensive care unit stay (p < 0.02, correlation coefficient = 0.991) and in the hospital stay (p < 0.02, correlation coefficient = 0.929). Patients who underwent debridement within 72 hours from the time of the infection had a significantly shorter intensive care unit stay (p = 0.0323) and total hospital stay (p = 0.0339).

CONCLUSIONS

We advocate operative exploration and thorough debridement of all necrotic tissue in high-risk patients with primary Vibrio vulnificus skin and soft tissue infections.

Necrotizing fasciitis of the foot caused by an unusual organism, Vibrio vulnificus

In modern medicine, there are very few infectious disease processes occurring in the foot that can cause death within 48 hr. and have an overall mortality rate of 50% despite appropriate antibiotic and surgical treatment. Such a condition must be regarded as being potentially deadly. The authors report a case of necrotizing fasciitis of the left foot resulting from an unusual organism of Vibrio vulnificus.

Vibrio hand infections: a case report and review of the literature

A case of Vibrio vulnificus infection of the hand is presented. The role of Vibrio species as primary pathogens in infections associated with exposure to a marine environment is discussed.

Vibrio parahaemolyticus endophthalmitis

A healthy child developed V. parahaemolyticus endophthalmitis after receiving a perforating corneal injury while swimming in the Gulf of Mexico. Peculiar greenish anterior chamber and vitreous exudates were a striking feature of the infection. A history of ocular injury in a salt water environment should alert the clinician to the possibility of infection due to a marine Vibrio, and appropriate means should be employed for the isolation and identification of such organisms.