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。

Vibrio vulnificus infection characterized by skin lesions: a report of 23 cases

Objective To investigate the clinical features,treatment and prognosis of Vibrio vulnificus infection in patients with characteristic skin lesions.Methods Clinical data on 23 cases of Vibrio vulnificus infection with characteristic skin lesions collected from 1996 to 2008 in Second Affiliated Hospital Affiliated to Wenzhou Medical College,were analyzed retrospectively.Results There were 23 patients including 15 males and 8 females.Of them,15 had a history of chronic type B viral hepatitis or alcoholic liver disease;17 ate raw oysters before the onset.A rapid onset Was observed in all of these patients,and initial symptoms were dominated by swelling and pain of,as well as bullae and hemorrhagic bulla in lower extremities.Vibrio vulnificus was isolated by culture from blister fluid of 13 patients,from both blood and blister fluid of 9 patients,and from necrotic tissue of 2 patients.Histopathologic examination revealed vacuolar degeneration and necrosis of cells,interstitial neutrophilic infiltrates,and vasculitis.Bacteria were seen in infiltrated neutrophiles.Electromicroscopy showed numerous round or arcuated microorganisms and bacterial flagella in hypodermal cells.Seven patients diagnosed from May 1996 to May 2000 died from this infection,and survival WaS observed after treatment only in 2 out of 6 patients collected from July 2000 to October 2003 and 6 out of 10 patients from May 2004 to October 2008.Conclusions Early recognition of skin eruptions and timely management are essential for the control of Vibrio vulnificus infection and for the improvement in survival among pafients infected with this bacterium.