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 CME 4: October, November, December 2004
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The Journal of Bone and Joint Surgery (American). 2004;86:2497-2502
© 2004 The Journal of Bone and Joint Surgery, Inc.

Systemic Vibrio Infection Presenting as Necrotizing Fasciitis and Sepsis

A Series of Thirteen Cases

Yao-Hung Tsai, MD1, Robert Wen-Wei Hsu, MD1, Kuo-Chin Huang, MD1, Chih-Hung Chen, MD1, Chin-Chang Cheng, MD1, Kuo-Ti Peng, MD1 and Tsung-Jen Huang, MD1

1 Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chia-Yi, No. 6, West Sec, Chia-Pu Road, Putz City, Chia-Yi County, 613, Taiwan. E-mail address for Y.H. Tsai: orma2244{at}adm.cgmh.org.tw

Investigation performed at Chang Gung Memorial Hospital, Chia-Yi, Taiwan

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Vibrio species are an uncommon cause of necrotizing fasciitis and primary septicemia, which are likely to occur in patients with hepatic disease, diabetes mellitus, adrenal insufficiency, and immunocompromised conditions. These organisms are found in warm sea waters and are often present in raw oysters, shellfish, and other seafood. The purposes of the present report were to describe a series of patients who had this potentially lethal infection and to identify clinical features associated with a poor prognosis.

Methods: We retrospectively reviewed the records of thirteen patients (ten men and three women) who had necrotizing fasciitis and sepsis caused by Vibrio species. All patients had a history of contact with seawater or raw seafood. Eight patients had a hepatic disease such as hepatitis or cirrhosis of the liver, three had diabetes mellitus (without hepatic disease), and two had chronic renal or adrenal insufficiency (without hepatic disease).

Results: Twelve patients underwent fasciotomy or limb amputation. Five patients (38%) died within two to six days after admission, and eight patients survived. Patients with a systolic blood pressure of ≤90 mm Hg and leukopenia in the emergency room had a significantly higher mortality rate (p < 0.05).

Conclusions: The diagnosis of Vibrio necrotizing fasciitis should be suspected when a patient has the appropriate clinical findings and a history of contact with seawater or raw seafood. The treatment should begin as early as possible, essentially when the patient has symptoms of sepsis. Although emergency fasciotomy or limb amputation did not reduce the mortality rate in this series, we consider such operations to be an important aspect of treatment.

Level of Evidence: Prognostic study, Level IV (case series). See Instructions to Authors for a complete description of levels of evidence.


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