以皮肤损害为特征表现的创伤弧菌感染23例

目的 探讨以皮肤损害为特征表现的创伤弧菌感染患者的临床特点、治疗和转归.方法 回顾性分析1996-2008年以皮肤损害为特征表现的创伤弧菌感染23例患者的临床资料.结果 23例患者中,男15例,女8例.其中15例有慢性乙型病毒性肝炎、酒精性肝病史.17例发病前1周有生吃牡蛎等海鲜史.该病起病急,初发症状以下肢肿胀、疼痛、大疱、血疱.13例疱液培养检出创伤弧菌,9例同时血培养检出创伤弧菌;2例坏死组织培养出创伤弧菌.病理组织学特点为细胞空泡样变性、坏死,间质可见中性粒细胞浸润,血管壁呈炎症性改变,细胞内可见细菌.电镜:真皮细胞内外见众多散在分布的圆形或弧形微生物及细菌鞭毛.1996年5月至2000年5月共收治7例,无1例存活.2000年7月至2003年10月收治6例,死亡4例,存活2例.2004年5月至2008年10月共收治10例,6例存活.结论 早期识别皮肤损害,及早、及时处理是治疗创伤弧菌感染的关键,能够提高患者生存率.     

以皮肤损害为特征表现的创伤弧菌感染23例

目的 探讨以皮肤损害为特征表现的创伤弧菌感染患者的临床特点、治疗和转归.方法 回顾性分析1996-2008年以皮肤损害为特征表现的创伤弧菌感染23例患者的临床资料.结果 23例患者中,男15例,女8例.其中15例有慢性乙型病毒性肝炎、酒精性肝病史.17例发病前1周有生吃牡蛎等海鲜史.该病起病急,初发症状以下肢肿胀、疼痛、大疱、血疱.13例疱液培养检出创伤弧菌,9例同时血培养检出创伤弧菌;2例坏死组织培养出创伤弧菌.病理组织学特点为细胞空泡样变性、坏死,间质可见中性粒细胞浸润,血管壁呈炎症性改变,细胞内可见细菌.电镜:真皮细胞内外见众多散在分布的圆形或弧形微生物及细菌鞭毛.1996年5月至2000年5月共收治7例,无1例存活.2000年7月至2003年10月收治6例,死亡4例,存活2例.2004年5月至2008年10月共收治10例,6例存活.结论 早期识别皮肤损害,及早、及时处理是治疗创伤弧菌感染的关键,能够提高患者生存率.     

原发性创伤弧菌感染12例

目的 :　报道 12例原发性创伤弧菌感染。方法 :　总结 1995～ 2 0 0 0年间的 12例原发性创伤弧菌感染的临床资料。结果 :　 12例原发性创伤弧菌感染 ,其中男 8例 ,女 4例。年龄 40～ 6 7岁 ,平均48.6岁。 6例有肝硬变史。好发盛夏、初秋 ,起病急。初发症状为双下肢红肿、疼痛、大疱、血疱。疱液培养发现表皮葡萄球菌 1例 ,弧菌 2例。皮损活检 :局灶性棘细胞松解 ,真皮胶原凝固性坏死 ,血管内皮坏死、脱落 ,血管壁可见纤维蛋白样坏死 ,组织内出血明显 ,可见嗜中性细胞浸润。真皮内可见众多散在分布的淡嗜伊红的近圆点状微生物。透射电镜观察 :真皮细胞内外见众多散在分布的弧形微生物可见细菌鞭毛。 1例痊愈 ,3例自动出院 ,8例死亡。 1例死于血小板减少引起的颅内出血 ,7例死于多脏器功能衰竭。死亡时间最短在发病后 5天 ,最长 10天 ,平均 6 .3天。结论 :　 (1)接触海水或生食贝壳类海鲜往往是造成感染的先决条件 ;(2 )肝硬化、糖尿病等慢性病易引起创伤弧菌感染 ;(3)常规培养致病菌发现率不高 ;(4 )双下肢出血性水肿是原发性创伤弧菌感染特征性病变之一 ;(5 )皮损病理改变 :表皮细胞灶性松解 ,表皮下水疱 ,真皮水肿、胶原纤维变性坏死 ,明显的血管炎改变、血管栓塞 ,真皮内可见细菌。 (6 )早期用抗菌素     

创伤弧菌感染引起的坏死性筋膜炎2例

 创伤弧菌引起的坏死性筋膜炎具有高度的侵袭性和致命性，早期识别皮疹和干预可降低死亡率。本文报告创伤弧菌引起的坏死性筋膜炎2例。病例1，男，44岁，双下肢肿痛伴皮肤淤斑4天，既往有高血压病史和酗酒史。皮肤科查体：双下肢肿胀、广泛大片淤斑，部分张力性水疱、大疱和血疱。病例2，女，62岁，右上肢淤斑1天，腹痛和意识障碍半天。皮肤科查体：右上肢9 cm×10 cm大小的淤斑，上有个别水疱和血疱。2例患者的皮损分泌物培养均为创伤弧菌，结合临床症状，均诊断为创伤弧菌感染引起的坏死性筋膜炎。1例治疗无效死亡，1例放弃治疗，自动出院。提示四肢进行性淤斑和其上水疱或血疱可能是创伤弧菌引起的坏死性筋膜炎较早的危险信号。     

原发性创伤孤菌感染12例

目的：报道12例原发性创伤孤菌感染。方法：总结1995－2000年间的12例原发性创伤孤菌感染的临床资料。结果：12例原发性创伤孤菌感染,其中男8例,女4例。年龄40－67岁,平均48.6岁。6例有肝硬变史。好发盛夏、初秋,起病急。初发症状为双下肢红肿、疼痛、大疱、血疱。疱液培养发现表皮葡萄球菌1例,孤菌2例。皮损活检：局灶性棘细胞松解,真皮胶原凝因性坏死,血管内皮坏死、脱落,血管壁可见纤维蛋白样坏死,组织内出血明显,可见嗜中性细胞浸润,真皮内可见众多散在分布的淡嗜伊红的近圆点状微生物。透射电镜观察：真皮细胞内外见众多散在分布的孤形微生物可见细胞鞭毛。1例痊愈,3例自动出院,8例死亡。1例死于血小板减少引起的颅内出血,7例死于多脏器功能衰竭,死亡时间最短在发病后5天,最长10天,平均6.3天。结论：（1）接触海水或生食贝壳类海鲜往往是造成感染的先决条件;（2）肝 经、糖尿病等慢性病易引起创伤孤菌感染;（3）常规培养致病菌发现率不高;（4）双下肢出血性水肿是原发性创伤孤菌感染特征性病变之一;（5）皮损病理改变：表皮细胞灶性松解,表皮下水疱,真皮水肿、胶原纤维变性坏死,明显的血管炎改变、血管栓塞,真皮内可见细菌。（6）早期用抗菌素的治疗是关键,清创可改善病人预后;（7）本病病死率较高,常死于多脏器功能衰竭。     

以泛发性血疱为表现的皮肤血管炎1例

患者女,34岁,躯干、四肢起血疱,伴轻度瘙痒及疼痛半个月。既往高血压病史2年。皮肤科检查:躯干、四肢泛发大量紫色瘀点、瘀斑,其上有血疱,皮疹以血疱为主,于躯干处密集成片,部分血疱结痂,无溃疡及坏死痂。皮肤组织病理:表面角化过度,棘层水肿,真皮乳头层水肿,血管扩张充血,真皮内大量白细胞及白细胞碎屑。诊断:皮肤血管炎。     

重症变应性血管炎1例

<正>1临床资料患者女,54岁。四肢出现瘀点、瘀斑、血疱和溃疡,伴瘙痒3个月,加重20h。3个月前,无明显诱因患者四肢皮肤出现瘀点、瘀斑、血疱和溃疡,以"变应性皮肤血管炎"予常规非激素治疗12d,皮疹消退。20h前,无明显诱因皮疹复发,伴气短,静滴"头孢曲松钠、病毒唑、氨茶碱、复方甘草酸单胺"无效,且四肢皮疹呈暴发性增多趋势,伴剧烈疼痛。患慢性支气管炎30年;否认药物和食物过敏史。体检:咽略赤,双肺可闻及喘鸣音及少许湿啰音,余正常。皮肤科情况:四肢可见密集对称分布的针尖至指甲大瘀点、瘀斑、大量血疱、糜烂、浅溃疡及大片坏死,部分     

皮肤炭疽3例报告及文献复习

报道3例皮肤炭疽并对相关文献进行复习。例1,男,75岁,在宰杀病羊后,左手背出现水疱、血疱、坏死、溃疡。例2和例3为夫妻,男50岁,女48岁,均接触死牛后,右手和上肢皮肤肿胀其上水疱、血疱及坏死糜烂。三例患者水疱疱液培养均发现炭疽杆菌,诊断：皮肤炭疽,转入传染病院隔离、用青霉素等药物治疗后结疤愈合。     

皮肤炭疽三例及文献复习

报道三例皮肤炭疽并对相关文献进行复习。例1,男,75岁。在宰杀病羊后,左手背出现水疱、血疱、坏死、溃疡。例2和例3为夫妻,男50岁,女48岁。均接触死牛后,右手和上肢皮肤肿胀其上水疱、血疱及坏死糜烂。三例患者水疱疱液培养均发现炭疽杆菌,诊断:皮肤炭疽,转传染病院隔离、用青霉素等药物治疗后结疤愈合。     

皮肤炭疽并发混合感染

报告1例皮肤炭疽并发混合感染。患者男,49岁。患者6 d前屠宰病牛后出现右前臂肿胀、血疱、坏死及溃疡。分泌物涂片革兰染色示革兰阳性球菌、革兰阴性球菌及粗大革兰阳性杆菌,培养出炭疽芽孢杆菌、青霉菌属及金黄色葡萄球菌,诊断为皮肤炭疽并发混合感染。     

The importance of serum creatine phosphokinase level in the early diagnosis, and as a prognostic factor, of Vibrio vulnificus infection

BACKGROUND: Vibrio vulnificus infection causes rapidly progressive skin lesions and sepsis in compromised hosts with liver cirrhosis, and is often fatal. Early diagnosis and rapid treatment are important. OBJECTIVES: To clarify the characteristics of V. vulnificus infection that distinguish it from other cutaneous and soft-tissue bacterial infections and to confirm that serum creatine phosphokinase (CPK) levels are useful in early diagnosis, and are a prognostic factor for, V. vulnificus infection. METHODS: We analysed the clinical and laboratory findings (especially serum CPK levels) in eight patients with V. vulnificus infection who were treated at the Saga Medical School Hospital between January 1989 and December 1999. RESULTS: All eight patients had liver dysfunction and typical skin manifestations. Six had eaten raw seafood before onset. Seven patients had initial skin manifestations in their legs or feet and eventually died, despite prompt therapy in the intensive care unit. CPK levels of six of these seven patients were already elevated at their initial presentation. Only one patient, with skin manifestations solely on his left hand, showed and maintained a normal CPK level and survived. In 23 patients with cutaneous and soft-tissue infections (10 with necrotizing fasciitis, three with erysipelas, 10 with cellulitis), only three patients with necrotizing fasciitis and streptococcal toxic shock syndrome (STSS) showed CPK elevation. CONCLUSIONS: A high level of serum CPK in cutaneous or soft-tissue bacterial infection is considered useful for an early diagnosis of V. vulnificus infection and STSS. A history of eating raw seafood, underlying liver disease and multiple lesions suggest a diagnosis of V. vulnificus infection, rather than STSS.     

Hemorrhagic bullae associated with Vibrio vulnificus septicemia. Report of two cases

Bullous lesions associated with Vibrio vulnificus infection developed in two patients, both of whom had hepatic cirrhosis. One patient had a recent history of ingestion of raw oysters, while the other patient had recently exposed skin lacerations to sea water. Both patients died within 24 hours of hospitalization, in spite of antibiotic treatment. Vibrio vulnificus was isolated from blood and bullae in both patients. Histologic examination of skin biopsy specimens revealed epidermal/dermal separation and clusters of bacteria within dermal vessels with a negligible inflammatory response.     

Study on the T-helper cell 1/2 cytokine profile in blister fluid of patients with herpes zoster and its clinical significance

Herpes zoster (HZ) is a Varicella zoster virus infection disease. Previous studies have presumed the connection between development of HZ and involvement of cellular immunity in peripheral blood. However, whether cellular immunity plays a role in the local skin lesion has not been addressed. To explore the levels of T-helper cell (Th)1/Th2 type cytokine profiles in the blister fluid of the skin lesions from the patients with HZ and its role in pathogenesis, we used the cytometric bead array kit to compare the levels of cytokines (interleukin [IL]-2, tumor necrosis factor [TNF]-α, IL-10 and IL-4) in blister fluid from 46 patients with those from the suction blister fluids from 20 volunteers without any infectious disease (the control group). The results indicated that the levels of Th1 cytokines, IL-2 and TNF-α in the blister fluid from the patients' skin lesions were significantly lower than those from the control group, whereas the levels of Th2 cytokines IL-10 and IL-4 were significantly higher than those in the control group. Moreover, significant variation of the levels of Th1/Th2 cytokines (IL-2, TNF-α, IL-10 and IL-4) in the blister fluid from the HZ patients' lesions was also observed among different stages of the disease. It is concluded that a cytokine imbalance was present in the local lesions of patients with HZ during disease development. Our data suggested that the Th immunity was associated with disease activity, which may play an important role in the pathogenesis of HZ.     

Decreased specific anti-elastase activity in the uninvolved skin of patients with psoriasis

Summary Inhibitory activities against elastase, chymotrypsin and trypsin were studied in the fluid from experimentally developed suction blisters in the uninvolved skin of patients with psoriasis. These activities determined by spectrophotometry of specific synthetic low molecular weight substrates were compared with respective antiproteinase activities in sera of 32 patients with psoriatic lesions, ten patients in remission, and ten healthy volunteers. A marked reduction (29.2%) in the specific elastase inhibitory activity of blister fluid was found in patients with psoriasis when compared with normal subjects (p<0.05), since neither chymotrypsin nor trypsin inhibitory activities were altered. This reduction was despite about a 30% increase in the elastase inhibitory activity in the sera of these patients, which was related presumably to their increased activity of ₁-proteinase inhibitor, the main serum antiserine proteinase inhibitor. A decreased blister fluidserum elastase inhibition ratio was shown in a large majority of patients with psoriasis, even in symptomless patients. The deficiency in specific elastase inhibitory activity of suction blister fluid was predominantly associated with early onset of psoriasis, guttate lesions and inactive lesions, skin involvement less than 20% of body surface, duration of relapse shorter than 2 months, and frequent relapses. These data indicate that the uninvolved skin of patients with psoriasis contains low concentrations of specific elastase tissue inhibitor, which deficiency might result in an excessive in vivo hydrolytic activity of neutrophil elastase released from migrating cells in the psoriatic skin.     

Necrotizing dermatitis due to Vibrio Vulnificus]

BACKGROUND: Vibrio vulnificus is a Gram-negative halophilic pathogen for man that can cause septicemia in patients with chronic liver disease. In healthy subjects, infections are generally local or regional. We report two cases of necrotizing dermo-hypodermitis due to Vibrio vulnificus. CASE REPORTS: The first patient was a 21-year-old fisherman who developed extensive necrotizing dermo-hypodermitis 24 hours after a penetrating scratch with a fish bone. The second patient was also a fisherman. This 35-year-old man developed a massive area of necrotic tissue on the left leg, also 48 hours after a penetrating fish bone scratch. Both patients exhibited neutrophil hyperleukocytosis and thrombocytopenia. Bacteriological study of the pus and damaged tissue identified Vibrio vulnificus. Blood cultures were negative. Liver tests and liver ultrasound were normal. The course was favorable in both cases with antibiotic treatment and excision of the necrotic tissue. DISCUSSION: For these two cases of Vibrio vulnificus necrotizing dermo-hypodermitis, the diagnosis was based on epidemiological, clinical and bacteriological arguments. Neither of these patients had liver disease, explaining the limited locoregional nature of the infection. The severity of the skin necrosis and its rapid course are related to the toxins produced by V. vulnificus. Curative medical and surgical care is generally effective in cases without septicemia and prognosis is good. Education of exposed subjects, fishermen and patients with chronic liver disease, should be helpful for prevention.     

Vibrio vulnificus septicemia in Korea: clinical and epidemiologic findings in seventy patients

We studied the clinical characteristics and the epidemiology of primary septicemia associated with Vibrio vulnificus in 70 patients. All patients came from the western and southern coastal areas of Korea. Most cases (96%) occurred during the summer months, in men (96%), and in persons 40 or more years of age (90%). The illness of 46 patients (66%) began with septicemia, often within 2 days of the consumption of raw seafood. Forty-seven patients (67%) had preexisting hepatic disease, and 49 (70%) had a history of alcoholism. Of the 70 patients, 45 (79%) died. The cutaneous lesions that were present on admission in 64 patients (91%) appeared on the legs in 51 of the cases. V. vulnificus was isolated from the blood of 65 patients tested and from the skin lesions of 51 of 55 patients tested. The histopathologic findings differed according to the clinical stage of lesions. Because V. vulnificus septicemia is a highly fatal disease, persons with liver disease or alcoholism should avoid eating or handling raw seafood.     

Isolation of human immunodeficiency virus type 1 in cutaneous blister fluid.

The human immunodeficiency virus type 1 (HIV-1) has been isolated from a number of body fluids, including semen, tears, cerebrospinal fluid, saliva, breast milk, alveolar fluid, and vaginal fluid, but it has not been isolated from fluid-containing skin lesions. We report the isolation of HIV-1 from cutaneous blister fluid in a patient with concomitant HIV-1 infection and porphyria cutanea tarda. Although transmission of HIV-1 through casual contact has not been reported, appropriate precautions should be taken to avoid direct contact with cutaneous fluid-containing lesions in HIV-1-positive patients.