Vibrio vulnificus Septicemia
Summary/Definition
Vibrio vulnificus Septicemia is a disease that develops when a person is infected with bacteria of this species. Infection can occur after eating infected fish or shellfish, as well as through a wound on the skin. This disease is widespread all over the world, and even in the Republic of Korea, less than 100 patients from the high-risk group, for example, those with liver disease or immunosuppression, are diagnosed with sepsis caused by Vibrio vulnificus every year. This virus continues to pose a threat. Despite the relatively small number of cases, this is a serious and dangerous disease with a high mortality rate exceeding 50%, so it is important to take measures to prevent it. Vibrio vulnificus Septicemia is most common in coastal areas from June to September. Vibrio vulnificus bacteria themselves are gram-negative organisms living in the marine environment. Infection usually occurs as a result of contact with seawater and mudflats, as well as when eating raw or undercooked fish and shellfish. This is especially true for coastal areas in summer, when the sea water temperature rises above 18 °C. Groups at increased risk include people with chronic liver diseases, such as chronic hepatitis, cirrhosis and liver cancer, as well as people suffering from alcohol dependence and people with weakened immune systems.
Symptoms
After 16-24 hours after the incubation period, the following symptoms begin to appear: abdominal pain, acute fever, chills, decreased blood pressure, vomiting, diarrhea, weakness and general malaise. Approximately 36 hours after the onset of fever, skin lesions are observed. Already at the time of hospitalization, hypotension is observed in about 30% of patients. This is a serious disease that progresses rapidly, and the characteristic symptoms of skin lesions develop in almost all patients within 24 hours after the first signs appear. The skin lesion mainly begins on the lower extremities and is manifested by a rash and swelling, followed by the formation of blisters. In most cases, these blisters are accompanied by bleeding and expand, turning into necrotic lesions, as a result of which skin cells and hypoderma die. If the infection is caused by a wound, then ulcers on the skin or necrotic areas may appear. There is swelling and redness on the affected area, which progresses rapidly and, in most cases, leads to the formation of bullous necrotic areas. In the case of wound infection without signs of sepsis, the development of bullous necrotic areas is possible, but with the timely use of antibiotics and surgical intervention, full recovery is possible.
Diagnostics
Vibrio vulnificus Septicemia can be diagnosed by isolating Vibrio vulnificus bacteria from blood, feces, affected areas of skin or tissues obtained during surgery. In most cases, the diagnosis is confirmed by the release of bacteria from the blood. However, since this disease progresses very quickly and reaches the stage of severe sepsis, with a sharp decrease in blood pressure and the development of multiple organ failure before the bacteria can be grown in culture and analyzed, in case of suspected Vibrio vulnificus Septicemia, based on epidemiological characteristics (for example, reduced immunity, consumption of fish and shellfish, contact with seawater and other factors) and if there are signs of skin damage, it is necessary to immediately begin active treatment.
Treatment and course of the disease
It is important to start treatment immediately if Vibrio vulnificus Septicemia is suspected. This includes the empirical administration of antibiotics, aggressive necrectomy (removal of necrotic areas), if surgically possible, and general conservative treatment. Despite rapid and aggressive therapy, the mortality rate from Vibrio vulnificus Septicemia remains very high, amounting to more than 50%, and increases to more than 90% with a decrease in blood pressure. Medical treatment includes the empirical administration of appropriate antibiotics, for example, 3rd generation cephalosporins, fluoroquinolones and tetracyclines. Non-drug methods include aggressive necrectomy, which involves the removal of necrotic areas, fasciotomy to remove necrotic tissue and cutting the necrosis zone around the muscle (to prevent further necrosis due to increased pressure in the tissues due to swelling in the wound area). In cases of extensive and severe necrosis, surgical intervention may be required, including amputation of a limb. However, in most cases, surgical intervention is complicated due to multiple organ failure syndrome, for example, a sharp decrease in blood pressure due to sepsis.
Complications
Complications include uncontrolled septic shock, acute respiratory distress syndrome due to acute lung injury, acute renal failure and multiple organ failure syndrome, for example, liver damage.
