Correlations between Clinical Features and Mortality in Patients with Vibrio vulnificus Infection
Hong ZhaoLichen XuHuihui DongJianhua HuHainv GaoMeifang YangXuan ZhangXiaohong ChenJun FanWeihang Ma
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Abstract:
Vibrio vulnificus is a common gram-negative bacterium, which might cause morbidity and mortality in patients following consumption of seafood or exposure to seawater in Southeast China. We retrospectively analyzed clinical data of patients with laboratory confirmed V. vulnificus infection. Twenty one patients were divided into a survival group and a non-surviving (or death) group according to their clinical outcome. Clinical data and measurements were statistically analyzed. Four patients (19.05%) died and five patients gave positive cultures from bile fluid, and 16 other patients gave positive culture from blood or blisters. Ten patients (47.62%) had an underlying liver disease and marine-related events were found in sixteen patients (76.2%). Patients with heavy drinking habits might be at increased mortality (p = 0.028). Clinical manifestations of cellulitis (47.6%), septic shock (42.9%) and multiple organ failure (28.6%) were statistically significant when comparing survivors and non-survivors (p = 0.035, p = 0.021 and p = 0.003, respectively). The laboratory results, including hemoglobin < 9.0 g/L (p = 0.012), platelets < 2.0×109 /L, prothrombin time activity (PTA) <20%, decreased serum creatinine and increased urea nitrogen were statistically significant (p = 0.012, p = 0.003, p = 0.028 and p = 0.028, respectively). Patients may be at a higher risk of mortality under situations where they have a history of habitual heavy alcoholic drink consumption (p = 0.028, OR = 22.5, 95%CI 1.5–335.3), accompanied with cellulitis, shock, multiple organ failure, and laboratory examinations that are complicated by decreased platelets, hemoglobin and significantly prolonged prothrombin time (PT).Keywords:
Vibrio vulnificus
Blood urea nitrogen
Prothrombin time
Procalcitonin
This case report describes a unique transmission of Vibrio vulnificus infection. A 38-year-old woman with recurrent cellulitis and chronic ulcer on her leg developed necrotizing cellulitis and sepsis caused by V. vulnificus. Meticulous history investigation revealed the link to contaminated fish blood that had been applied on the ulcer by a traditional healer. Through this case, it may be stressed that a traditional remedy can sometimes be harmful and life-threatening.
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Vibrio vulnificus
Eastern oyster
Ostreidae
Vibrio Infections
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Vibrio vulnificus is a naturally occurring, salt-water bacteria found in estuarine and coastal waters worldwide. It prefers low salinity and warm water temperatures for optimum growth. Infection from Vibrio vulnificus is uncommon, although it has been reported from many locations (e.g. southern United States of America, Israel, Republic of Korea, Japan, Taiwan, Spain, Turkey). It can be serious and life threatening, causing septicaemia and wound infections. This paper reports a case of septicaemia secondary to Vibrio vulnificus cellulitis in an elderly woman. The infection was acquired after wading in a coastal lagoon with a pre-existing superficial leg wound.
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Aims: To determine the occurrence of the human pathogen, Vibrio vulnificus, in south Texas coastal waters. Methods and Results: Coastal waters were sampled monthly between August 2006 and July 2007. Water temperature, dissolved oxygen, pH, salinity, conductivity and turbidity were measured during each sampling event. Culture-based techniques utilizing Vibrio vulnificus agar (VVA) and membrane-Enterococcus indoxyl-β-d-glucoside agar (mEI) were used to assess the occurrence and levels of V. vulnificus and the faecal contamination indicator group, enterococci, respectively. Vibrio vulnificus isolates were confirmed using colony-blot hybridization with the species-specific VVAP probe. Vibrio vulnificus was isolated at all sites throughout the year even when the water temperature dropped to 9·71°C. Significant correlations were found between concentrations of V. vulnificus and the abiotic factors, water temperature (P = 0·002) and dissolved oxygen (P = 0·028), as well as between concentrations of V. vulnificus and enterococci (P < 0·001). Conclusions: This study demonstrated the year-round presence of V. vulnificus in coastal waters of south Texas. Significance and Impact of the Study: These findings indicate that the potential for human exposure to the pathogen, V. vulnificus, exists throughout the year. It also suggests that routinely monitored data might be used to predict the occurrence of the pathogen.
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Objective To evaluate the value of procalcitonin and CRP as prognostic markers in surgery infections.Methods 72 patients who were treated in our hospital's surgery from 2007 to 2008.Those patents were divided into 3 groups:non-infection,intensive infection and partially infection respectively.Serum procalcitonin and CRP levels were measured in the first 3 days or before using antibiotics.Results procalcitonin and CRP levels were significantly higher than the other two groups(P 0.05),especially the procalcitonin level.Taking procalcitonin≥2 μg/L as the diagnostic standards for intensive infection,its sensitivity and specifity are higher than CRP.Conclusion Compared to CRP,Procalcitonin is a marker for the diagnosis of bacterial infections in surgery,especially for the early diagnosis.
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Background Community-acquired pneumonia (CAP) is one of the leading causes of death among the elderly. Several studies have reported the clinical usefulness of serum procalcitonin, a biomarker of bacterial infection. However, the association between the levels of procalcitonin and the severity in the elderly with CAP has not yet been reported. The aim of this study was to evaluate usefulness of procalcitonin as a predictor of severity and mortality in the elderly with CAP. Methods This study covers 155 CAP cases admitted to Pusan National University Hospital between January 2010 and December 2010. Patients were divided into two groups (≥65 years, n=99; <65 years, n=56) and were measured for procalcitonin, C-reactive protein (CRP), white blood cell, confusion, uremia, respiratory rate, blood pressure, 65 years or older (CURB-65) and pneumonia severity of index (PSI). Results The levels of procalcitonin were significantly correlated with the CURB-65, PSI in totals. Especially stronger correlation was observed between the levels of procalcitonin and CURB-65 in the elderly (procalcitonin and CURB-65, ρ=0.408 with p<0.001; procalcitonin and PSI, ρ=0.293 with p=0.003; procalcitonin and mortality, ρ=0.229 with p=0.023). The correlation between the levels of CRP or WBC and CAP severity was low. The existing cut-off value of procalcitonin was correlated with mortality rate, however, it was not correlated with mortality within the elderly. Conclusion The levels of procalcitonin are more useful than the levels of CRP or WBC to predict the severity of CAP. However, there was no association between the levels of procalcitonin and mortality in the elderly. Keywords: Community-Acquired Infections; Aged; Pneumonia; Procalcitonin
Procalcitonin
White blood cell
Pneumonia severity index
Neopterin
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Vibrio vulnificus (V. vulnificus), a Gram-negative marine bacterium, can cause life-threatening primary septicemia, especially in patients with liver diseases. How V. vulnificus affects the liver and how it acts on macrophages are not well understood. In this report, we demonstrated that V. vulnificus infection causes a strong inflammatory response, marked expansion of liver-resident macrophages, and liver damage in mice. We demonstrated further that V. vulnificus activates mTOR in macrophages and inhibition of mTOR differentially regulates V. vulnificus induced inflammatory responses, suggesting the possibility of targeting mTOR as a strategy to modulate V. vulnificus induced inflammatory responses.
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Vibrio vulnificus is a gram-negative marine bacterium that may cause local wound infection, distinctive soft tissue infection, gastroenteritis and septicaemia with a high mortality rate. A healthy man presented with severe abdominal pain, diarrhoea and fever followed by development of multiple blisters, cellulitis and necrotizing fasciitis of the lower limbs, who progressed rapidly to fulminant sepsis caused by this organism. Vibrio vulnificus septicaemia should be suspected in the presence of sepsis and progressive soft-tissue infection with recent history of raw seafood consumption.
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Fulminant
Vibrio Infections
Cellulite
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Vibrio vulnificus is a Gram negative motile bacterium known to cause fatal septicaemia and wound infection. It is commonly associated with the consumption of under-cooked seafood or exposure to marine environment. We report a case of a 55 year old male patient, who was presented with right lower limb cellulitis and septicaemia due to V. vulnificus. V. vulnificus infection in India are rare. However, increasing reports of V. vulnificus from India recommends considering the pathogen while dealing necrotising fasciitis especially in the proximity of marine environment.
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Cellulite
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Objective To evaluate the value of procalcitonin and CRP as prognostic markers in surgery infections.Methods 72 patients who were treated surgically in our hospital from 2007 to 2008.All the patents were divided into 3 groups:non-infection,intensive infection and partially infection respectively.Serum procalcitonin and CRP levels were measured in the first 3 days or before the using of antibiotics.Results Procalcitonin and CRP levels were significantly higher than that of the other two groups(P0.05),especially the procalcitonin level.Taking procalcitonin≥2μg/L as the diagnostic standards for intensive infection,its sensitivity and specifity are higher than CRP.Conclusion Compared to CRP,Procalcitonin is a marker for the diagnosis of bacterial infections in surgery,especially for the early diagnosis.
Procalcitonin
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