Ｖｉｂｒｉｏ ｖｕｌｎｉｆｉｃｕｓによる壊死性軟部組織感染症の２例

Abstract

Vibrio vulnificus is a gram-negative halophilic marine bacterium which can cause life-threatening illness with sepsis. Two cases, 74-and 46-year old men, with V. vulnificus infection and the clinical and histopathological characteristics of soft tissue are reported. Men were infected from an injured finger during raw fish preparation or by eating raw fish and shellfish, respectively. Suppurative inflammatory skin lesions, initial tenderness, redness and swelling of the upper or lower limb, progressively extended and septic shock developed within 24 hours after the onset. On admission, the patients had hepato-renal dysfunction and disseminated intravascular coagulation with circulatory insufficiency. Skin lesions were diffuse. Mechanical ventilation, fluid resuscitation, administration of catecholamines and antibiotics, as well as surgical debridement of necrotic soft tissues, were performed. The patient with the wound infection survived with upper limb amputation and intensive care, but the other patient who had been infected via the gastrointestinal tract died. Histopathological examination of infected soft tissues showed extensive necrosis of subcutaneous fat cells, the underlying fascia and muscle. Inflammatory cell infiltration was remarkable in skin layers, but slight in the fascia and muscle. Soft tissue infection caused by V. vulnificus progresses rapidly and is often lethal. It is important for physicians to suspect this infectious disease upon encountering patients with soft tissue infection. Understanding the clinical characteristics of this disease and early suspicion can lead to efficacious, life-saving therapy.