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題 名 | 創傷弧菌感染症--臨床表現、致病機轉及抗生素療法=Vibrio Vulnificus Infection--Clinical Manifestation, Pathogenesis and Antimicrobial Therapy |
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作 者 | 莊銀清; | 書刊名 | 內科學誌 |
卷 期 | 13:4 2002.08[民91.08] |
頁 次 | 頁189-193 |
分類號 | 415.15 |
關鍵詞 | 創傷弧菌; 致病機轉; 抗生素療法; 敗血性休克; 傷口感染; Vibrio vulnificus; Pathogenesis; Anti-microbial therapy; Septic shock; Wound infection; |
語 文 | 中文(Chinese) |
中文摘要 | 創傷弧菌是一種嗜鹼性的革蘭氏陰性菌,由於對鹽份具有相當耐受性,故利於它存在廣泛的海洋環境中,尤其是海灣附近的港口。此菌自1976年被報告可引起人體嚴重的感染且大部分發生在太平洋沿岸及美洲、歐洲等沿海國家。由於此菌引起的感染病程發展非常快速,發病後之死亡率高達50%以上,近年來逐漸引起臨床醫師的重視。臺灣地區自民國74年第一個病例被發現後,病例數有顯著的增加,南臺灣的總病例數應在200例以上。創傷弧菌的感染造成臨床上的病癥主要有兩種一為原發性敗血症(primary septicemia):此由胃腸道感染引起,其感染原因是由於吃入生的或未煮熟的海鮮,病人會有發熱、寒顫、皮膚病變及敗血症休克等症狀,死亡率高達50%以上,其中大部分在住院48小時以內死亡;另一為傷口感染(wound infection):通常是因傷口接觸到含有病菌的海水或被蝦、蟹類所刺傷,在感染部位有腫脹、紅斑,進而形成水泡,之後出現組織壞死 或嚴重的蜂窩組織 炎,會發展成嚴重的續發性敗血症(secondary septicemia)造成死亡,死亡率約為24%。我們的臨床研究顯示,79%的病人有皮膚病灶,大部分為出血性水泡、壞死性肌膜炎及蜂窩組織炎。75%以上的病例有潛在性疾病,其中65%是慢性肝炎。50%以上病例可找到明顯的誘因, 如生吃海鮮、為海鮮所刺傷或傷口接觸海水,敗血症患者的死亡率為55%。在臨床治療方面過去認為首選藥物是tetracycline。但我們的研究顯示ceftaxime及minocycline二者有加成作用,而在動物實驗in vivo的研究亦證實合併療法比單一藥物來得好。此項治療目前不但在國內採用治療效果良好,且已為國際上所公認採用。臺灣地區地處熱帶,四面環海養殖漁業發達,民眾喜歡生吃海鮮且為B型肝炎盛行區域,符合創傷弧菌感染的條件。臨床醫師對於慢性肝炎或有其他潛在性疾病的病患,若有快速進展的皮膚軟組織發炎或是併發出血性水泡的敗血性休克病患,應考慮此類感染的可能性。 |
英文摘要 | There has been a dramatic increase in the number of reported cases of infection due to Vibrio vulnificus in Taiwan. Although the organism has been etiologically implicated in a variety of clinical syndromes, most cases of V vulnificus infection either are associated with wound infection or are categorized as primary septicemia. In reviewing the literature, 193 cases were available for analysis. For the patients with primary bacteremia, 89 ( 94.7% ) of 94 had underlying diseases, especially chronic liver diseases. Causes of infection could be found in 41 ( 78.8%) of 52 cases. All of them were related to seafood consumption. The incubation periods were very short, and the most striking clinical manifestations were skin lesions. Secondary skin lesions were found on 61.5% ( 69 of 106 ) of the patients with primary septicemia. The mortality rate was as high as 54.2% ( 51 of 94 ). More than one-half of cases of wound infection ( 44 of 80 ) were associated with underlying diseases. For all but seven cases ( 91 %) causes for the infection were determined. All of these patients had injuries due to fish bites or seafood handling or wounds that were exposed to salt water. The mortality rate was low ( 25.3% ) compared with that for patients with primary bacteremia. Our in vitro data showed that cefotaxime and minocycline acted synergistically in inhibiting V vulnificus. Furthermore, our in vivo results indicated that combination therapy with cefotaxime and minocycline is distinctly more advantageous than therapy with the single antibiotic regimen for the treatment of severe experimental murine V vulnificus infections. |
本系統中英文摘要資訊取自各篇刊載內容。