Necrotizing fasciitis is a life-threatening skin and soft tissue infection associated with high morbidity and mortality in adult patients. This infection can present as either type 1 infection caused by a mixed microflora (Streptococci, Enterobacteriacae, Bacteroides sp., and Peptostreptococcus sp.), most commonly developing in patients after surgery or in diabetic patients, or as type 2. The latter type is monomicrobial and, usually, caused by group A Streptococci. Rarely, this type can be also caused by other pathogens, such as Vibrio vulnificus. V vulnificus is a small mobile Gram-negative rod capable of causing 3 types of infections in humans-gastroenteritis, primary infection of the vascular bed, and wound infections. If infecting a wound, V vulnificus can cause a life-threatening condition-necrotizing fasciitis. We present a rare case of necrotizing fasciitis developing after an insect bite followed by exposure to the seawater. Rapid propagation of the infectious complication in the region of the right lower limb led to a serious consideration of the necessity of amputation. Due to the clearly demarcated necroses and secondary skin and soft tissue infection caused by a multiresistant strain of Acinetobacter baumannii, we, however, resorted to the use of selective chemical necrectomy using 40% benzoic acid-a unique application in this kind of condition. The chemical necrectomy was successful, relatively gentle and thanks to its selectivity, vital parts of the limb remained preserved and could have been subsequently salvaged at minimum blood loss. Moreover, the antimicrobial effect of benzoic acid led to rapid decolonization of the necrosis and wound bed preparation, which allowed us to perform defect closure using split-thickness skin grafts. The patient subsequently healed without further complications and returned to normal life.
- MeSH
- Acinetobacter baumannii * MeSH
- dospělí MeSH
- fasciitida nekrotizující * diagnóza MeSH
- infekce bakteriemi rodu Vibrio * komplikace MeSH
- infekce měkkých tkání * diagnóza komplikace MeSH
- lidé MeSH
- Vibrio vulnificus * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Due to the development of Marine aquaculture, infections caused by Vibrio vulnificus are common all over the world. Symptoms of V. vulnificus infection vary from gastrointestinal illness to septicemia. After infection with V. vulnificus, some patients showed gastrointestinal symptoms, including vomiting, fever, diarrhea, and so on. Others appeared wound infection at the site of contact with bacteria, and even developed sepsis. Once it develops into sepsis, the prognosis of patients is very poor. However, its underlying pathogenic mechanism remains largely undetermined. Growing evidence shows that it can induce primary septicemia mainly via essential virulence factors and regulators. Therefore, it is important to identify the factors that play roles in sepsis. In this review, we systematically expounded the role of V. vulnificus virulence factors and regulators in its infection-induced sepsis in order to provide useful information for the treatment and prevention of V. vulnificus.
- MeSH
- bakteriální proteiny genetika metabolismus MeSH
- faktory virulence genetika metabolismus MeSH
- infekce bakteriemi rodu Vibrio mikrobiologie MeSH
- lidé MeSH
- sepse mikrobiologie MeSH
- Vibrio vulnificus genetika metabolismus MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Due to the nature of Vibrio vulnificus infections (i.e., gastroenteritis and septicemia), only very few studies of a biofilm-associated form in this pathogen's life cycle have been conducted. We proposed that biofilm production by clinical strains of V. vulnificus would be higher than by environmental strains. Biofilm formation by clinical and environmental reference strains was tested under different temperatures (24, 30, and 37 °C), pH (5.5, 7.5, and 8.5) and iron concentrations (18, 30, 50, 100, and 200 μM). Biofilm production by clinical strains was consistently higher (p < 0.001) at 24 °C than by environmental strains. Higher biofilm production was observed at pH 5.5 by all strains. Growth rates were lowest at pH 5.5 for environmental strains but for clinical strains there were no differences at pH 5.5, 7.5, and 8.5, demonstrating a tolerance to acidic and alkaline conditions. There was a strong, direct correlation between iron concentration in the growth medium and biofilm production by all strains tested. The current study indicates that biofilm formation might be important for the survival of V. vulnificus in vivo as well as in the marine environment. With regard to temperature and pH, higher biofilm production appears to be a trait of clinical strains and could be considered a virulence determinant in V. vulnificus.
