Vibrio vulnificus Infection in a Patient with Chronic Liver Disease: A Case Report

創傷弧菌在一位慢性肝臓疾病病人的感染：個例報告

黃家俊(Chia-Chun Huang) ； 楊浚銘(Chun-Ming Yang) ； 劉尊榮(Chun-Eng Liu)

《The Changhua Journal of Medicine》 7卷4期 (2002/10) Pp. 250-254

摘要

創傷弧菌感染往往會在初期症狀表現後的36小時內造成猛爆性敗血症，且常導致高死亡率，特別是有慢性肝臓疾病的病人。近幾年來，創傷弧菌感染在台灣似乎有比以前增多的趨勢。我們報告了一位創傷弧菌感染的病人，病人是39歲有慢性B型肝炎病史的男性，以養殖蛤維生。初期表現是下肢腫脹並有小水泡分布。病程很快進展成出血性水泡，病人不久即出現低血壓，腸胃道出血，代謝性酸中毒，最後敗血症休克。Cefotaxime與minocycline當時立即投予，然而病人依舊在12小時後死亡。血液培養結果爲創傷弧菌。後來得知：病人在入院前4天工作時會被蛤殼割傷下肢。在查閱了有關任憑弧菌感染的期刊論文之後，我們得知：平均年齡大約是50歲；男性病人比女性多；大部分病人都有食海鮮或接觸海水的病史；常見的症狀包括發燒，皮膚徵候與敗血症；陽性培養主要來自於血液與傷口培養；既有疾病則包含慢性肝臓疾病與糖尿病。這些都摘要於表格1。台灣本身是個島嶼，且弧菌生長在亞熱帶海水中。許多人民以養殖漁業維生，且常有生食海鮮的習慣。而肝硬化也恰巧是台灣大多數人最常見的慢性疾病之一。這些因素造就了台灣容易感染創傷弧菌的高盛行率，並使得這項健康問題在台灣益顯重要，且值得我們注意。

關鍵字

創傷弧菌 ； 生食海鮮 ； 慢性肝臟疾病 ； 出血性水泡

並列摘要

Vibrio vulnificus infection, which can cause fulminant septicemia within 36 hours after initial symptoms, results in high mortality, especially in patients with chronic liver disease. The infection appears to be increasing in prevalence in Taiwan. We report a case of Vibrio vulnficus infection in a 39-year-old male, with a history of chronic hepatitis B infection, who worked as a clam raiser. The initial presentation was leg swelling with vesicles, which quickly progressed to hemorrhagic bullae. He rapidly developed hypotension, gastrointestinal hemorrhage, metabolic acidosis, and septic shock. Despite immediate administration of cefotaxime and minocycline, the patient died 12 hours after admittance. Blood cultures yielded Vibrio vu1nficus. His legs had been injured by clamshells at work 4 days before his hospitalization. A literature review of Vibrio vulnficus infection revealed that the mean age of infection is approximately 50 years and infection is more common in males than in females. Major sources of infection include eating raw seafood or contacting seawater with an open wound. Typical clinical symptoms include fever, cutaneous lesions and sepsis. Positive cultures generally can be grown from blood or wound specimens. Underlying diseases include chronic liver diseases and diabetes mellitus. Characteristics of Vibrio vulnificus infection are summarized in Table 1. Taiwan is an island where Vibrionaceae exists and people engage in high-risk activities such as raising sea animals and eating raw seafood. Moreover, liver cirrhosis is a common disease in this country. All these factors contribute to an increasing prevalence of Vibrio vulnificus infection, which is becoming an important health problem in Taiwan and deserves our attention.

並列關鍵字

Vibrio vulnificus ； raw seafood ； chronic liver disease ； hemorrhagic bullae