頁籤選單縮合
題 名 | Vibrio Vulnificus Infection--Report of 8 Cases and Review of Cases in Taiwan=創傷性弧菌感染--病例報告及文獻回顧 |
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作 者 | 張家昌; 沈一嫻; 彭世明; 陳邦基; 吳正雄; 呂學重; | 書刊名 | 長庚醫學 |
卷 期 | 17:4 1994.12[民83.12] |
頁 次 | 頁339-346 |
分類號 | 415.15 |
關鍵詞 | Vibrio vulnificus; |
語 文 | 英文(English) |
中文摘要 | 創傷性弧菌是一種罕見,但可造成嚴重而致命的疾病。臨床表可分成原發性敗血症及創傷感染,原發性敗血症通常在發症二十四小時前曾生吃或食用未耆熟之海產食物,常發生在已有肝臟疾病或其他潛在疾病的病人。大多數患者會有出血性水皰的特殊促膚病灶,死亡率很高。創傷感染常發生在患者因處理蝦、蟹、牡蠣等產食物,不慎造成之傷口或原已存在之創傷被海水污染而引起感染,病人通常染有潛在的疾病,死亡率較原發生敗血症低。 回顧文獻,臺灣曾有28例創傷弧菌感染報告,其中10例有詳細的病歷描述。過去五年來,本院也有8例患者經血液或作口培養證實有窗傷弧菌感染。所以合併討論如下:這18例患者年齡從23到75歲(平均56.4±14.2歲),其中14例(83%)年齡超過55歲。原發或敗血症的14例中,13例有潛在的肝臟疾病(93%),另外一例有消化性潰瘍,症狀以發燒、畏寒為主,86%有皮膚病灶,死亡率約57%(8例)。在發病48小時內發生休克者死亡率較高(77%),沒有休搭者都存活。在創傷感染的四例中,75%有潛在的疾病(肝臟疾病、消化性潰瘍、濫用類固醇),死亡率為50%。 創傷性弧菌感染病程發展迅速而嚴重,死亡率很高。早期診斷並迅速給予有效的抗生素治療(第三代頭孢黴素)和積極的外科廓創術,才能有效的降低死亡率。慢性肝炎及肝硬化是臺灣常見的疾病,此地居民又有生吃及食用半熟海鮮食物的習慣,是感染創傷弧菌的高危險群。臨床臨師要特吸注意這類病人,若出現敗血症及典型的皮膚病灶,必須想到是否是創初或弧菌感染,而迅速給予正確的治療。在預防醫學點上,我們要教育高危險群患者避免生吃或處理海鮮食物。 |
英文摘要 | Vibrio vulnificus infection, which is a rare and fatal disease, can be categorlized clinically as either primary septicemia or wound infection. The clinical presentation of patients with primary septicemia can vary from fever alone to a more severe illness including high-grade bullous lesions, hypotemison, and shock. Wound infection typically results from either injury to the skin in a marine environment or contact of a preexisting wound with sea water. We reported eight cases with Vibrio vulnificus infection in Chang gung Mermorial Hospital and reviewed ten other cases previously reported with details in Taiwan. Fourtenn patients presented with primary septicemia, and four with wound infection. Thirteen patients had alcoholism or chronic liver disease, two had peptic ulcer disease, one was steroids abuser, and one patient had thalassemia and chronic liver disease. Overall mortality was 55.6% (ten patients). Patients with hypotension within 48 hours of admission had higher mortality than normotensive patients (77% vs. 0%m P=0.007). patients with chronic liver disease or liver chirrhosis also had tendency t o a higher mortality than not (64% vs. 25%, P=0.274). Chronic liver disease and liver cirrhosis are common disease in Taiwan. They take a high risk for Vibrio vulnificus infection. Clinician should keep in mind of this potentially fatal infection in these patients reporting a history of recent raw oyster consumption and presented with sepsis and characterized skin lesions. Prompt empirical antibiotics treatment and aggressive surgical treatment may be lifesaving for this acute and fatal disease. |
本系統中英文摘要資訊取自各篇刊載內容。