A fatal case of Vibrio vulnificus meningoencephalitis

The objective of this paper is to report a rare case of Vibrio vulnificus presenting as meningoencephalitis without a wound infection. Vibrio vulnificus is capable of causing severe and often fatal infections in susceptible individuals. It commonly causes necrotizing wound infections, primary septicemia, and gastroenteritis. A 69-year-old man had meningoencephalitis with lesion on the red nucleus, substantia nigra, basal ganglia, and dentate nucleus as the initial clinical manifestation of a V. vulnificus infection. This is the first case of V. vulnificus infection in which MRI demonstrated the involvement of deep nuclei of the brain.     

A fatal case of Vibrio vulnificus septicemia.

A fatal case of Vibrio vulnificus septicemia in a 60 yr old man is described. This man displayed many of the classical features seen in fulminant infections with this organism. The epidemiology of V. vulnificus infections is discussed in this report.     

A rare glimpse into the morbid world of necrotising fasciitis: Flesh-eating bacteria Vibrio vulnificus

Necrotising fasciitis is one of the fatal skin and soft tissue infections. Vibrio vulnificus is a rare cause of necrotising fasciitis; however, the disease is one of the major manifestations of the bacteria. Here, we report one such case in a middle-aged male patient. He presented with the signs of bilateral lower limb cellulitis and altered sensorium. V. vulnificus was isolated from blood culture and also from debrided tissue. Though the organism is well characterised, it is a rare causative agent of necrotising fasciitis. This case is a re-emphasis on active look out for this bacterium in patients presenting with necrotizsing fasciitis.     

Quantification of Vibrio parahaemolyticus,Vibrio vulnificus and Vibrio cholerae in French Mediterranean coastal lagoons

Vibrio parahaemolyticus, Vibrio vulnificus and Vibrio cholerae are human pathogens. Little is known about these Vibrio spp. in the coastal lagoons of France. The purpose of this study was to investigate their incidence in water, shellfish and sediment of three French Mediterranean coastal lagoons using the most probable number-polymerase chain reaction (MPN-PCR). In summer, the total number of V. parahaemolyticus in water, sediment, mussels and clams collected from the three lagoons varied from 1 to >1.1 × 10³ MPN/l, 0.09 to 1.1 × 10³ MPN/ml, 9 to 210 MPN/g and 1.5 to 2.1 MPN/g, respectively. In winter, all samples except mussels contained V. parahaemolyticus, but at very low concentrations. Pathogenic (tdh- or trh2-positive) V. parahaemolyticus were present in water, sediment and shellfish samples collected from these lagoons. The number of V. vulnificus in water, sediment and shellfish samples ranged from 1 to 1.1 × 10³ MPN/l, 0.07 to 110 MPN/ml and 0.04 to 15 MPN/g, respectively, during summer. V. vulnificus was not detected during winter. V. cholerae was rarely detected in water and sediment during summer. In summary, results of this study highlight the finding that the three human pathogenic Vibrio spp. are present in the lagoons and constitute a potential public health hazard.     

Autopsy cases of fulminant-type bacterial infection with necrotizing fasciitis: group A (beta) hemolytic Streptococcus pyogenes versus Vibrio vulnificus infection

Two autopsy cases of fulminant-type infection associated with necrotizing fasciitis were analyzed clinicopathologically. Both cases involved 57-year-old alcohol abusers. The former was a woman with group A (beta) hemolytic Streptococcus pyogenes infection, and the latter was a man with Vibrio vulnificus infection. The sudden onset of shock with high fever resulted in sepsis, decreased clotting, and hepatorenal symptoms, followed by death within a few days. Post-mortem examination showed widespread congestion and bleeding, and alcoholic liver cirrhosis was observed. Necrotizing fasciitis was identified in both cases. Bacteria from the pharynx or intestinal tract invaded the blood, and marked bacterial proliferation produced sepsis, resulting in necrotizing fasciitis. Despite the presence of sepsis, bilateral pulmonary congestion and bleeding were observed without pneumonia. Due to the rapid progression of sepsis, there was no time for granulocyte migration from the bone marrow. It seems that almost all mature granulocytes which had already existed in the bone marrow accumulated at the focus of necrotizing fasciitis because the bone marrow had few mature granulocytes and lacked hypercellularity. The cause of death in each case was circulatory collapse due to septic shock. It was difficult to distinguish the type of infection on histopathology. Cultures were necessary to determine the bacterial agents involved.     

Intravascular fasciitis of the forearm vein: A case report with immunohistochemical characterization

Intravascular fasciitis is a very unusual variant of nodular fasciitis. A unique case of this lesion occurring in the proximal portion of the superficial vein of the forearm in an otherwise healthy 26-year-old man is reported. The intravascular polypoid lesion grew longitudinally along the vascular lumen, was loosely attached to the intimal layer, and was partly anchored beyond the internal elastic lamina into the medial smooth muscle layer. However, extravascular involvement was absent. The histological features were identical to those observed in ordinary cellular nodular fasciitis. Because of its myofibroblastic phenotype exhibited by highly proliferative spindle cells, certain intimomedial myofibroblasts are thought to be the indigenous source of this unique fibroproliferative lesion. Unless the diagnosis of intravascular fasciitis is considered and appropriate differential markers examined, it may be confused with other intravascular lesions, such as intravascular leiomyoma, intravenous pyogenic granuloma, organized thrombus and, even, fibromuscular dysplasia if it arises in the arteries. A simple excision is considered curable. Even so, two recurrent cases have been documented to date.     

A chromogenic substrate culture plate for early identification of Vibrio vulnificus and isolation of other marine Vibrios

Vibrio vulnificus infection can result in necrotizing fasciitis and sepsis, which have short latentcy periods and high mortality rates. Thus, an easy and quick detection method is needed to improve the outcome. To distinguish V. vulnificus from other pathogens that cause necrotizing fasciitis, we developed a selective isolation culture agar plate (Chromochecker Vibrio Agar-1; CVA-1) for use in environmental monitoring and in the clinical setting. One hundred four strains of V. vulnificus, already identified biochemically, showed typical colony form and color when grown on CVA-1. Thirty-six of 51 marine bacteria samples suspected to be V. vulnificus on CVA-1 were subsequently identified as V. vulnificus by a biochemical identification system. Of 8 bacteria known to cause necrotizing fasciitis, only V. vulnificus grew on CVA-1. In addition, growth on CVA-1 allowed ready differentiation of Vibrio species. CVA-1 can be used to distinguish pathogenic Vibrios according to colony form and chromatic differences.     

Nodular fasciitis in the parotid gland: A case report and review of the literature

Nodular fasciitis (NF) is a benign, reactive lesion with a self‐limiting process. Because NF is rare in the parotid gland and has many cytological similarities to other benign or malignant tumors, cytological misinterpretation is common. The patient, a 30‐year‐old woman, had a painless mass in her right parotid gland. Fine needle aspiration cytology (FNAC) was performed. Spindle cells with basophilic and well‐demarcated cytoplasm were observed in a mucoid‐like background. The mucoid‐like substance was metachromatic and appeared to be the matrix of PA. Histopathologically, spindle‐shaped cells with intervening birefringent mature collagen were arranged in short irregular bundles. Prominent mucoid‐like matrixes as well as few infiltrating neutrophils and lymphocytes were found in the background. Lesional cells were positive for CD10 and β‐catenin in the cytoplasm, but negative for cytokeratin, the S‐100 protein, CD34, and neurofilament. Ultimately, this patient was diagnosed with NF. In FNAC of the parotid gland region, distinguishing NF from other real tumors is important for deciding treatment strategies. Diagn. Cytopathol. 2013;41:829–833. © 2013 Wiley Periodicals, Inc.     

The cytolysin gene of Vibrio vulnificus: sequence and relationship to the Vibrio cholerae E1 Tor hemolysin gene.

A cytolysin of ca. 56 kilodaltons has been suggested as a possible virulence factor in Vibrio vulnificus infections. We sequenced the DNA encoding cytolytic activity and found that the sequence contained two open reading frames, vvhA and vvhB. vvhA encoded the structural gene for the cytolysin and contained the N-terminal amino acid sequence previously reported for the protein. Regions of the vvhA gene showed homology to the structural gene for the Vibrio cholerae E1 Tor hemolysin.     

The extracellular cytolysin of Vibrio vulnificus: inactivation and relationship to virulence in mice.

The ca. 51-kDa extracellular cytolysin of Vibrio vulnificus has been proposed as a virulence factor. We inactivated the structural gene for cytolysin in fully virulent, clinical V. vulnificus strains by both transposon mutagenesis and marker exchange techniques. Inactivation of the cytolysin did not affect virulence in our mouse models. The 50% lethal dose of cytolysin-negative strains was comparable to that of the cytolysin-positive parent strains after intraperitoneal inoculation with and without iron loading. Similar results were obtained after intradermal injection: cytolysin-positive and -negative strains had the same 50% lethal dose and caused comparable tissue damage. While we cannot say that the cytolysin has no effect on the pathogenesis of V. vulnificus infections, its role appears to be of much less importance than are other factors, such as encapsulation.     

乳腺结节性筋膜炎1例及文献复习

目的探讨乳腺结节性筋膜炎的临床病理特征。方法对1例乳腺结节性筋膜炎的临床表现、组织形态和免疫表型进行研究,并文献复习。结果该例肿块3cm×2cm,边界不清,向周围乳腺及脂肪组织浸润。肿块主要由梭形细胞组成,其中含少量破骨样巨细胞。梭形细胞表达Vim、SMA和MSA,破骨样巨细胞表达CD68(KP-1),未发现CK阳性细胞。结论结节性筋膜炎很少复发,也不转移,组织学形态易与一些良恶性肿瘤混淆,需做免疫组化检测以明确其性质。     

A fatal case of severe hemolytic disease of newborn associated with anti-Jk(b)

The Kidd blood group is clinically significant since the Jk antibodies can cause acute and delayed transfusion reactions as well as hemolytic disease of newborn (HDN). In general, HDN due to anti-Jk(b) incompatibility is rare and it usually displays mild clinical symptoms with a favorable prognosis. Yet, we apparently experienced the second case of HDN due to anti-Jk(b) with severe clinical symptoms and a fatal outcome. A female patient having the AB, Rh(D)-positive blood type was admitted for jaundice on the fourth day after birth. At the time of admission, the patient was lethargic and exhibited high pitched crying. The laboratory data indicated a hemoglobin value of 11.4 mg/dL, a reticulocyte count of 14.9% and a total bilirubin of 46.1 mg/dL, a direct bilirubin of 1.1 mg/dL and a strong positive result (+++) on the direct Coomb's test. As a result of the identification of irregular antibody from the maternal serum, anti-Jk(b) was detected, which was also found in the eluate made from infant's blood. Despite the aggressive treatment with exchange transfusion and intensive phototherapy, the patient died of intractable seizure and acute renal failure on the fourth day of admission. Therefore, pediatricians should be aware of the clinical courses of hemolytic jaundice due to anti-Jk(b), and they should be ready to treat this disease with active therapeutic interventions.     

A huge nodular fasciitis in parapharygneal space in a 7-year-old girl: a case report and review of literature

Nodular fasciitis (NF) is a benign and reactive fibroblastic growth extending from the superficial fascia into the subcutaneous tissue or muscle, with a morbidity of less than 20% in children. We report a case of a 7-year-old girl presented with a 3-month history of snore and mouth breathing. Image findings demonstrated a large soft-tissue mass in the right parapharyngeal space. The lesion was successfully eradicated by surgical removal. Pathological analysis established NF as the final diagnosis. Histopathological findings were notable for a reactive spindle-cell process composed of proliferative fibroblasts with extravasated red blood cells and interstitial edema. Immunohistochemical stains showed that the lesional cells were positive for smooth muscle actin (SMA), muscle-specific actin (HHF35), and epithelial membrane antigen (EMA), and negative for S100 protein. No clinical evidence of recurrence was noticed after 2 months of follow-up. Being the first report of NF in the parapharyngeal space of a child, this rare pediatric case points out the importance for otolaryngologists to keep NF in mind for differential diagnosis to avoid unnecessary wide resection.     

Epidemiologic Characteristics and Case Fatality Rate of Vibrio vulnificus Infection: Analysis of 761 Cases From 2003 to 2016 in Korea

Background Vibrio vulnificus infection is a highly fatal disease resulting from the consumption of raw or undercooked seafood and exposure to seawater containing the organism. It has been a nationally notifiable disease since 2000 in Korea. The aims of this study were to assess the trends in the incidence of V. vulnificus infection and its case fatality rate and to determine the epidemiologic characteristics to effectively prevent infection and lower mortality.MethodsWe analyzed the incidence trends of V. vulnificus infection by year, month, and region in 913 cases reported to the Korea Centers for Disease Control and Prevention (KCDC, currently Korea Disease Control and Prevention Agency) by the National Infectious Disease Surveillance System from 2001 to 2016. We analyzed the number of patients with V. vulnificus infection who were under the National Health Insurance Service (NHIS) and whose coastal seawater temperature data were provided by the Korea Oceanographic Data Center of the National Institute of Fisheries Science. Epidemiological investigations were followed up and analyzed for 761 patients from 2003 to 2016. A total of 152 patients who were not followed up were excluded from the analysis. The case fatality rate was analyzed for 325 cases reported to the KCDC from 2011 to 2016.ResultsThe mean incidence of V. vulnificus infection was 0.12 per 100,000 people, and the highest incidence was reported in September (41.1%) during the study period. The incidence rate per 100,000 people was the highest in Jeonnam (8.23). The number of patients who claimed to the NHIS was the highest in September (105 patients). The average seawater temperature was the highest at 24.1°C in August, and the average seawater temperature from August to October, when many cases occurred, was 22.4°C. The male-to-female ratio was 6:1, and 96.4% of the patients were aged ≥ 40 years. Of the patients, 96.1% had underlying diseases, the most common of which was liver cirrhosis (56.3%). The case fatality rate was 48.9%.ConclusionThe occurrence of V. vulnificus infection showed distinct seasonality, with a large number of cases occurring in the months when the seawater temperature was high; there were also distinct geographical characteristics. The incidence of V. vulnificus infection and mortality rates have not decreased for decades, and it is still an important public health problem with a high fatality rate.     

创伤弧菌脓毒症大鼠肝组织CD14和促/抗炎细胞因子基因表达及抗生素干预研究

目的 探讨创伤弧菌脓毒症大鼠肝组织内毒素受体CD14和促/抗炎细胞因子(TNF-α/IL-10)的基因表达及抗萧药物头孢哌酮钠联用乳酸左旋氧氟沙星的干预效应.方法 注射创伤弧菌构建创伤弧菌脓毒症模型及药物干预模型,RT-PCR检测大鼠肝组织CD14、TNF-α和IL-10的基因表达水平.结果 与正常对照组(NC组)相比,创伤弧菌脓毒症组(VV组)感染细菌2、6、9、12、16 h的CD14mRNA和TNF-α mRNA表达量均明显升高(P<0.05),IL-10 mRNA表达昔在感染后9、12、16 h也明显升高(P<0.05).创伤弧菌脓毒症联用抗生素干预组(AA组)CD14 mRNA表达在感染后9 h,TNF-αmRNA表达在感染后9、12 h,IL-10 mRNA表达在感染后9、12、16 h仍明显高于NC组(P<0.05).与相同时间点的VV组相比,从组感染后9、12、16 h的CD14 mRNA表达量,16 h的TNF-α mRNA和IL-10mRNA表达最均明显降低(P<0.05).结论 创伤弧菌脓毒症大鼠肝组织CD14 mRNA表达在脓毒症早期即达高峰,脓毒症过程中表现为持续增高,脓毒症早期肝组织TNF-α mRNA明显升高,脓毒症中后期肝组织IL-10 mRNA才逐渐增多.及早使用头孢哌酮钠和乳酸左氧氟沙星可明显减低创伤弧菌脓毒症大鼠肝组织CD14 mRNA、TNF-α mRNA和IL-10 mRNA表达水平.头孢哌酮钠联用乳酸左氧氟沙星可显著减少创伤弧菌脓毒症肝组织的内毒素受体的表达,有利于机体致炎/抗炎平衡恢复.     

Rifampicin-isoniazid induced fatal fulminant hepatitis during treatment of latent tuberculosis: A case report and literature review

A 42-year-old Indian man received 450 mg rifampicin (RIF) and 150 mg isoniazid (INH) daily after being diagnosed of a latent tuberculosis infection. Baseline serum aminotransferase and total bilirubin levels were within normal limits. On day 31 of treatment, the patient experienced epigastric discomfort and general malaise and one week later he developed nausea and episodic vomiting. The patient missed his first scheduled clinic appointment and he continued taking RIF-INH despite his symptoms. He visited the tuberculosis clinic on day 47 of treatment where he was found to be jaundiced and his liver enzymes were elevated. RIF-INH was stopped and the patient was admitted to our hospital as a case of RIF-INH induced hepatitis. On the 7th day of hospitalization, the patient developed consciousness disturbance with flapping tremor and high ammonia level. The patient was diagnosed with fulminant hepatic failure and transferred immediately to the medical intensive care unit, where he died 4 days later.     

Production of pristane and phytane in the marine environment: role of prokaryotes

This paper reviews studies dealing with the formation of pristane and phytane in the marine environment and focuses on the role played by prokaryotes in these processes. Prokaryotes may notably: (i) contribute to the formation of pristane during invertebrate feeding; (ii) hydrogenate isomeric pristenes and phytenes arising from degradation of the chlorophyll phytyl side-chain and/or α-tocopherol (vitamin E) to pristane and phytane, respectively; and (iii) convert trimeric oxidation products of α-tocopherol (produced abiotically in the water column and in the oxic zone of sediments) to pristane. Moreover, thermal maturation of isoprenoid components of archaea (isopranyl glyceryl ethers) also constitutes another potential source of pristane and phytane in thermally mature sediments. Prokaryotes thus appear to play a key role in formation of these isoprenoid alkanes in the marine environment.