Vibrio vulnificus 패혈증의 임상적 연구 = Clinical Study of Vibrio vulnificus SepsisVibrio vulnificus 패혈증의 임상적 연구

다국어 초록 (Multilingual Abstract)

Background: Vibrio (V.) vulnificus is a pathogenic marine bacterium that can cause rapid progression of a life-threatening infection. Although V. vulnificus sepsis is well-known to Koreans and was designated as a legal communicable disease in August 2000, many people still become infected each year. Objective: The purpose of this study was to investigate the clinical features of V. vulnificus sepsis, in order to offer basic data for the treatment and prevention of this disease. Methods: We reviewed the available data of 141 patients with V. vulnificus sepsis, which were obtained from 105 patients admitted to hospital and 36 case reports published in the Korean medical journals between 1982 and 2004. Results: Eighty-five percent of patients were 40 to 60 years old. Men were affected 10.5 times more often than women. Patients with underlying chronic diseases (94%) such as alcohol abuse and liver diseases displayed primary sepsis starting with fever, chills, and/or diarrhea, often within 2.3 days of consumption of various kinds of raw seafood. Skin lesions appeared initially as a painful, localized swelling like a bee-sting, followed by edema, blisters, purpura, necrosis and, less commonly, maculopatch, cyanosis, papules, wheals, pustules or erythema multiforme-like lesions. The cutaneous lesions that were present in 91.5% of patients on admission, appeared on the lower extremities in 88.9% of the cases. Of the 141 patients, 88 patients (62.4%) died. The mortality rate increased as initiation of treatment was delayed. Laboratory findings revealed thrombocytopenia and elevated levels of liver enzymes in many tested cases. V. vulnificus was cultivated more easily from the skin lesion (95%) than blood (69%). There were significant differences in systolic blood pressure, leukocyte count and creatinine between survivors and nonsurvivors (p<0.05). V. vulnificus was highly susceptible to several kinds of antibiotics such as ampicillin, ciprofloxacin, and 3rd generation cephalosporins. Mortality rate increased as the delay from the onset of illness to the initiation of treatment was prolonged. Conclusion: Clinicians should promptly initiate appropriate therapy for patients with underlying chronic disease if they exhibit unexplained fever and diarrhea after ingesting raw seafood. (Korean J Dermatol 2006;44(6):696~707)

참고문헌 (Reference)

1 "Vibrio vulnificus septicemia:report of four cases" 4 : 307-313, 1986

2 "Vibrio vulnificus septicemia of unknown source" 17 : 187-191, 1985

3 "Vibrio vulnificus septicemia in Korea:clinical and epidemiologic findings in seventy patients" 24 : 397-403, 1991

4 "Vibrio vulnificus infection:strategy for diagnosis and treatment" 109 : 875-884, 1999

5 "Vibrio vulnificus infection" Koryo Medical Co 202-232, 1996

6 "Vibrio vulnificus infection" 31 : 289-304, 1993

7 "Two cases of V.vulnificus infection with cutaneous lesion" 7 : 420-428, 1996

8 "Three cases of septicemia by Vibrio vulnificus" 29 : 112-118, 1985

9 "The role of the cytokines in the generalized Shwartzman reaction induced by Vibrio vulnificus cytolysin" 38 : 622-628, 2000

10 "The role of Gulf Coast oysters harvested in warmer months in Vibrio vulnificus infections in the United States,1988-1996" 178 : 752-759, 1998

11 "The importance of serum creatine phosphokinase level in the early diagnosis,and as a prognostic factor,of Vibrio vulnificus infection" 145 : 280-284, 2001

12 "The clinical study of Vibrio vulnificus infection occurred in the region of the southwest coast" 10 : 242-249, 1999

13 "The analysis of the clinical characteristics and prognosis of Vibrio vulnificus septicemia" 15 : 350-359, 2004

14 "The C-terminal domain promotes the hemorrhagic damage caused by Vibrio vulnificus metalloprotease" 39 : 1883-1886, 2001

15 "Syndromes of Vibrio vulnificus infections Clinical and epidemiologic features in Florida cases" 318-323, 1981-1987

16 "Simultaneous isolation of Vibrio vulnificus and Vibrio parahaemolyticus in blood from a liver cirrhosis patient:importance of detection and identification of both species" 24 : 173-176, 2004

17 "Severe sepsis and septic shock" McGraw-Hill 1606-1612, 2005

18 "Proinflammatory cytokine profile in Vibrio vulnificus septicemic patients’ sera" 33 : 133-138, 2002

19 "National surveillance of Vibrio vulnificus infections in 1988" 31 : 232-236, 1999

20 "Minocycline and cefotaxime in the treatment of experimental marine Vibrio vulnificus infection" 42 : 1319-1322, 1998

21 "Lactose fermenting Vibrio septicemia.Report of five cases" 16 : 463-469, 1982

22 "Isolation of Vibrio vulnificus from clinical specimens:report of eight cases" 9 : 459-467, 1989

23 "Inteleukin-1 enhances pain reflexes.Mediation through increased prostaglandin E2 levels" 25 : 246-251, 1988

24 "Induction of nitric oxide synthase expression by Vibrio vulnificus cytolysin" 290 : 1090-1095, 2002

25 "Hemorrhagic disorders: disseminated intravascular coagulation, liver failure, and vitamin K deficiency" Saunders 1078-1082, 2004

26 "Halophilic Vibrio species isolated from blood cultures" 3 : 425-431, 1976

27 "Generalized erythema multiforme-like eruption in the novel cutaneous manifestation of Vibrio vulnificus septicemia" 15 : 75-77, 2003

28 "Four cases of fulminating gangrenous dermatitis syndrome due to Vibrio vulnificus which was named as the so-called" 1-, koreanjdermatol1983

29 "Four cases of Vibrio vulnificus septicemia,including two misidentified cases as Aeromonas hydrophila infection" 4 : 11-122, 1984

30 "Four cases of Vibrio vulnificus infection" 24 : 837-843, 1986

31 "Essential role for estrogen in protection against Vibrio vulnificus-induced endotoxic shock" 69 : 6119-6122, 2001

32 "Disease caused by a marine Vibrio.Clinical characteristics and epidemiology" 300 : 1-5, 1979

33 "Clinical characteristics of ninety-two cases of Vibrio vulnificus infection" 27 : 355-364, 1995

34 "Cases for diagnosis - 3 cases" 18 (18): 16-, 1980

35 "Bleeding and thrombosis" McGraw-Hill 337-343, 2005

36 "Bactericidal activity of tetracycline against Vibrio vulnificus" 30 : 769-777, 1987

37 "A fatal case of Vibrio vulnificus meningoencephalitis" 9 : 568-571, 2003

38 "A case of septicemia without skin lesion by serovar 01 type of Vibrio vulnificus infection" 20 : 194-197, 2000

39 "A case of septicemia caused by Vibrio cholerae non O1 with Vibrio vulnificus" 11 : 111-115, 1989

40 "A case of primary wound infection caused by Vibrio vulnificus" 26 : 93-97, 1994

41 "A case of endophthalmitis associated with V.vulnificus septicemia" 45 : 686-690, 2004

42 "A case of acute gastroenteritis caused by Vibrio parahaemolyticus and Vibrio vulnificus" 30 : 493-496, 1998

43 "A case of Vibrio vulnificus septicemia" 6 : 395-398, 1986

44 "A Review of Vibrio vulnificus infection in recent 5 years at Chonnam area" 35 : 573-583, 1999