乙型海洋性貧血併發創傷弧菌敗血症：一病例報告

β-Thalassemia Major Complicated with Vibrio vulnificus Septicemia: Report of One Case

施永泰(Yung-Tai Shih) ； 彭慶添(Ching-Tain Peng) ； 蔡長海(Chang-Hai Tsai) ； 蔡輔仁(Fuu-Jen Tsai)

《Acta Paediatrica Sinica》 35卷1期 (1994/02) Pp. 84-89

https://doi.org/10.7097/APS.199402.0084

摘要

創傷弧菌(vibrio vulnificus)是一種嗜鹽性弧菌，常可在海水及甲殼類生物中分离出來。臨床上常造成嚴重的敗血症及肢體壞死，過程相當迅速且死亡率高。本病例為一患有重度乙型海洋性貧血β-thalassemia major的13歲男孩，有明顯的鐵質沉積症(hemochromatosis)，臨床上有嘔吐，腹瀉、高燒、低血壓，以及左下肢皮膚出現瘀血、水疱、潰瘍等症狀。血液培養長出創傷弧菌(Vibrio vulnificus)。給予適當的抗生素治療後并不見起色，後來經由擴創術處理，病情逐漸好轉并於第17天出院。因此臨床醫師對於海洋性貧血、鐵質沉積症以及慢性肝病患者，一有出現此種出血性水疱的皮膚特徵，加上有海水或海產物的接觸史時，必須警覺到此種致命性感染的可能，并且立刻給予適當的處置（中兒醫誌1993;35;84-9）。

並列摘要

Vibrio vulnificus is a halophilic Vibrio that has been isolated repeatedly from seawater and shellfish during the warm months of the year. It’s a virulent pathogen for men and is frequently associated with overwhelming infections including sepsis, gangrene of extrimities and high mortality rate.
We encountered a 13-year-old boy who had a history of 13-thalassemia major with secondary hemochromatosis, sufferring from vomiting, diarrhea, fever and hypotension. Physical examination revealed that ecchymosis, bullae and ulceration were noted over the left leg. Vibrio vulnificus was isolated
from the blood. Initially, the patient did not respond to the appropriate antibiotics treatment, subsequently surgical debridement was performed. After that, the patient recovered gradually, and discharged home after 17 days of admission. In conclusion, when patients present with sepsis and/or characteristic skin lesion-hemorrhagic bullae, particularly those with thalassemia major, hemochromatosis or underlying liver disease and a history of marine exposure, clinicians should be alerted to this potentially fatal infection and should commence appropriate assessment and treatment immediately.

並列關鍵字

Vibrio vulnificus ； β-thalassemia major ； hemochromatosis