Overview
Infectious disease caused by Vibrio traumaticus through food or wound exposure
Acute necrotizing fasciitis, acute gastroenteritis, and sepsis are common.
Often caused by contact with seawater or raw food contaminated seafood.
Treatment is based on antimicrobial therapy, supplemented by symptomatic supportive care.
Definition
Vibrio traumaticus is a salty, thermophilic, conditionally pathogenic gram-negative bacterium belonging to the genus Vibrio.
Vibrio traumaticus infection is an infectious disease caused by consumption of Vibrio traumaticus-contaminated seafood or wound contact with Vibrio traumaticus seawater.
Vibrio traumaticus infection is an acute and severe disease with rapid onset and aggressive progression, making treatment very difficult, and about 50% to 70% of patients die of septic shock and multiple organ failure within 48 hours.
Morbidity
Vibrio traumaticus infection is most common from May to October.
The male to female ratio of patients with Vibrio traumaticus infection is about 3 to 8:1.
Causes
Causes
Vibrio traumaticus infections are caused by Vibrio traumaticus and there are three basic conditions that lead to epidemics.
Source of infection
Vibrio traumaticus infected seafood or seawater with Vibrio traumaticus.
Route of transmission
Consumption of Vibrio traumaticus-infected seafood or wound contact with seawater with Vibrio traumaticus.
Susceptible people
Chronic liver disease (cirrhosis, alcoholic liver disease, etc.), hemochromatosis, diabetes mellitus, chronic alcoholism, immunocompromised people.
Risk factors
The following factors increase the risk of developing Vibrio traumaticus infections and are high risk factors for the disease.
Having special dietary habits: consuming undercooked or raw seafood.
Working in the field of seafood salvaging, butchering and cooking.
Pathogenesis
It is generally believed that the disease caused by Vibrio traumaticus is the result of the joint action of multiple pathogenic factors and multiple pathways. In addition to the following major pathogenic factors, the bacterial hair, flagellum, lipopolysaccharide and phospholipase are also related to the pathogenicity of Vibrio traumaticus.
Vibrio traumaticus hemolysin
Vibrio traumaticus hemolysin is a toxin produced by Vibrio traumaticus.
Vibrio traumaticus hemolysin binds to the membranes of human cells to form pores that lead to the efflux of intracellular potassium ions, thus causing cell rupture and apoptosis.
It can also lead to massive nitric oxide synthesis, which ultimately causes cell and tissue damage, leading to hypotension and shock.
Vibrio traumaticus protease
Vibrio traumaticus protease is a protease produced by Vibrio traumaticus.
Vibrio traumaticus protease triggers severe hemorrhagic skin injury by causing capillary destruction.
It also induces the release of histamine from mast cells, which can lead to edema.
Vibrio traumaticus pods
Pods are surface structures of Vibrio traumaticus and are important pathogenic components (virulence and antigenic components) that play an important role in the pathogenic process of Vibrio traumaticus.
Vibrio vulnificus pods resist the immune response, resisting the bactericidal action of the organism and avoiding the activation of non-specific immune responses.
Vibrio traumaticus
Vibrio traumaticus is a substance synthesized by Vibrio traumaticus that binds to iron ions.
It can lead to an increase in free iron ions in the patient’s body, which can increase the reproduction of Vibrio traumaticus, enhance its pathogenicity, and increase its lethality.
Symptoms
Main Symptoms
Vibrio traumaticus infection can manifest as local skin symptoms (acute necrotizing fasciitis), digestive tract symptoms (acute gastroenteritis) or even systemic symptoms (primary sepsis) depending on the pathway of the pathogen invading the organism.
Symptoms of acute necrotizing fasciitis
Usually direct contact with a skin wound, most often on the extremities, and usually starts in the lower extremities and rapidly spreads to the thighs and above.
In the early stages, it tends to present as small red papules, hard texture or as subcutaneous nodules.
In the middle stage, the skin is brown petechiae or maculopapular, with dark red edges or unclear borders, swelling with depressed edema, pain, and enlarged and painful peripheral lymph nodes.
In the later stages (within 24 hours), tension blisters appear, then become bloody blisters until they ulcerate and rupture, with flaky scald-like damage to the skin, localized skin necrosis, and subcutaneous twinges (rupture sounds produced by crushing of air under the skin) may be present.
The disease develops rapidly, and the inflammation spreads from the toes to the thighs in only 1 to 2 days.
Symptoms of acute gastroenteritis
Acute gastroenteritis symptoms can occur after eating contaminated seafood or drinking seawater. The incidence is 7% to 11%.
Common symptoms include nausea, vomiting, diarrhea, and cramping abdominal pain.
Stools are yellow-green watery in the early stages and black bloody in the later stages, suggesting gastrointestinal bleeding.
Symptoms of sepsis
Infection usually due to eating, associated with raw seafood etc.
It often develops 24 hours after eating.
Symptoms of sepsis such as high fever, chills, confusion and hypotension may be present.
It can progress to infectious shock and multiple organ failure in 24-48 hours.
If not timely resuscitation (untreated within 72 hours), it can die in a short period of time, and the case fatality rate reaches 100%.
Complications
Multi-organ dysfunction syndrome
Bacteria invade into the patient’s bloodstream and can induce multiple organ dysfunction when not treated in time, and in severe cases, multiple organ failure can occur.
The functions of circulation, liver, kidney, respiration, and coagulation are often severely impaired, and symptoms such as decreased blood pressure, yellowing of the skin, anuria, respiratory distress, and hemorrhage may occur.
Consultation
Department
General Surgery
When there are symptoms such as brown petechiae or blotchy skin, pain when pressed, blisters or blood blisters on the skin, or the skin breaks down and becomes scalded, it is necessary to consult a doctor promptly.
Infectious diseases
When symptoms such as diarrhea and fever appear, it is recommended to consult the Department of Infectious Diseases.
Emergency Medicine
When symptoms such as black bloody stools, high fever, low blood pressure, confusion and other critical symptoms occur, it is recommended to consult the Emergency Department or call 120 emergency immediately.
Preparation
Preparation for medical consultation: registration, preparation of documents, common problems
Tips for medical treatment
It is recommended that you wear loose clothing before seeking medical attention.
For characteristic skin manifestations, such as pimples, blisters, blood blisters, etc., you can take photos and keep them for your records, and seek medical attention and treatment as soon as possible.
Preparation List
Symptom list
Particular attention should be paid to the time of symptom onset, special manifestations, etc.
Are there any skin abnormalities such as redness, swelling, blisters, burn-like ulcers, pain, etc.?
Is there nausea, vomiting, diarrhea, cramping abdominal pain?
What is the color of the stool?
Is there high fever, chills, confusion, low blood pressure, etc.?
How often do these symptoms come on? What aggravates or relieves them?
Medical History Checklist
Have you ever eaten undercooked or raw seafood? When did it start?
Have there been any seafood stings and exposure to seawater? When did it begin?
Any chronic liver disease (cirrhosis, alcoholic liver disease, etc.), diabetes, chronic alcoholism, hemochromatosis, immunocompromised?
Checklist
Test results from the last six months, which can be brought to the doctor’s office
Laboratory tests: blood gas analysis, blood routine, C-reactive protein, blood biochemistry, coagulation function test, stool routine + occult blood test, pathogenicity test.
Imaging examination: abdominal ultrasound, lung CT, abdominal CT examination.
Medication list
Medication used in the last 3 months, if there is a box or package of medication, you can bring it with you to the doctor’s office
Cephalosporins: cefoperazone, cefuroxime, etc.
Quinolones: levofloxacin, ciprofloxacin, etc.
Other antimicrobials: imipenem, tinidazole, piperacillin, etc.
Diagnosis
Diagnosis is based on
Medical history
Previous consumption of undercooked or raw seafood.
Has had seafood stings or localized skin breaks and exposure to seafood and seawater.
Have chronic liver disease (cirrhosis, alcoholic liver disease, etc.), diabetes mellitus, chronic alcoholism, immunocompromised.
Clinical manifestations
There are localized red papules in the early stage of the skin, brown petechiae or florid spots in the middle stage, accompanied by edema and pressure pain, and blisters, blood blisters and scald-like ulceration in the late stage.
There may be nausea, vomiting, diarrhea, cramping abdominal pain.
Stools are yellow-green watery stools in the early stage and black bloody stools in the later stage.
In severe cases, there may be high fever, chills, confusion, hypotension and other symptoms of sepsis.
Laboratory Tests
Blood gas analysis
Can be used to determine whether there is hypoxia and other conditions.
Vibrio traumaticus infection blood gas analysis can detect hypoxemia, hypocapnia and metabolic acidosis.
Blood routine, C-reactive protein
Used to determine the presence or absence of infection, anemia, and other conditions.
When infection occurs, the test results often show increased white blood cell counts and increased C-reactive protein.
Complicated gastrointestinal bleeding can cause anemia, which is manifested by a significant decrease in red blood cell count and hemoglobin concentration.
Blood biochemistry
It is used to determine whether there are abnormalities in liver and kidney function, creatine kinase, blood glucose, blood sodium and so on.
When combined with impaired liver function, there may be elevated bilirubin, decreased albumin, and elevated alanine aminotransferase and glutamine aminotransferase.
In severe cases, renal impairment may be combined, and creatinine may be elevated.
Creatine kinase is significantly elevated, suggesting possible muscle damage and necrosis.
In severe cases of Vibrio traumaticus infection, there may be a decrease in blood sodium and an increase in blood glucose.
Coagulation function test
Used to determine whether there are coagulation abnormalities.
Vibrio traumaticus infection coagulation function test can often appear thrombocytopenia, prothrombin time, activated partial thromboplastin time significantly prolonged, increased fibrinogen, D-dimer increased.
Urine routine
Determine whether there is renal impairment.
Urine routine in Vibrio traumaticus infection can often show cloudy urine, occult blood (+), proteinuria, etc.
Stool routine + occult blood test
Check to determine whether there are stool abnormalities.
If the occult blood test is positive, it suggests that there is blood in the feces, which can assist in the diagnosis of the disease.
Female patients should avoid fecal examination during menstruation.
Pathogenetic examination
Check for the presence of Vibrio traumaticus in blood, wound secretions, and feces.
If a bacterial culture can isolate Vibrio traumaticus or a genetic test is positive, the diagnosis of the disease is confirmed.
Antibiotics such as penicillin and amoxicillin should not be taken before the test.
Imaging tests
Ultrasound of the abdomen, CT of the lungs, CT of the abdomen
To view the patient’s lungs, liver, spleen, pancreas and other organs.
Some patients with Vibrio traumaticus infection may have enlarged liver and spleen, necrosis and inflammatory exudation of lungs, pancreas and other tissues.
Fasting is required before abdominal ultrasound, and high density or metal objects on the body, such as hard buckles of belts, are removed before CT examination.
Differential Diagnosis
When nausea, vomiting, and diarrhea are present and Vibrio traumaticus infection is considered, care should be taken to differentiate it from the following diseases.
Cholera
Similarities: both can have nausea, vomiting, and diarrhea.
Differences
Cholera is caused by Vibrio cholerae and can be transmitted by Vibrio cholerae contaminated food, water, Vibrio cholerae infected mosquitoes and flies.
Cholera is mainly characterized by gastrointestinal symptoms and does not show abnormal skin and mucous membrane manifestations, and the two can be distinguished by pathogenetic examination.
Treatment
Aim of treatment: relieve skin, gastrointestinal and systemic symptoms, remove Vibrio traumaticus, and reduce the occurrence of complications.
Treatment principle: Once Vibrio traumaticus infection is diagnosed, rapid rehydration, blood transfusion, intravenous input of sensitive antimicrobial drugs as soon as possible, surgical treatment of the infected foci, and supportive treatment of damaged organs are needed.
Symptomatic treatment
Fasting and water fasting
When acute gastroenteritis symptoms appear, fasting and water are required.
When vomiting is severe, gastrointestinal decompression can be applied.
Rehydration and blood transfusion
Use Ringer’s solution, saline, albumin, etc. for rehydration to improve circulatory status and resist shock.
Plasma and whole blood need to be supplemented when hematocrit is low, and platelets are supplemented when platelets are low.
Attention to acid-base balance and liver and kidney function is needed when replenishing fluids.
Intravenous administration of sensitive antimicrobial drugs
Because of the rapid development of the disease, early anti-infective treatment is needed, and antibacterial drugs can be applied empirically first. When the causative organisms are clearly identified, sensitive antibacterial drugs can be injected intravenously as early as possible.
Commonly used drugs: three generations of cephalosporins (cefoperazone, cefuroxime, etc.) + quinolones (levofloxacin, ciprofloxacin, etc.), imipenem, tinidazole, piperacillin.
The treatment lasts about 7 to 10 days, using the principles of early, combined and adequate dosage.
The doctor should be informed of any history of allergy before using the medication.
Other medications
In case of low blood pressure, pressure-raising drugs (dopamine, etc.) can be applied to raise blood pressure and improve circulation.
Small doses of heparin, scopolamine, ustekine, etc. can be used to inhibit inflammatory mediators, scavenge oxygen free radicals, and stabilize lysosomal membranes.
Localized treatment
If there is blister formation that has not yet broken, the blister fluid can be aspirated after iodine-vapor disinfection, and surgical decompression and drainage should be carried out for those with severe swelling.
Treatment of blisters
For blisters that have formed but not yet ruptured, topical povidone-iodine can be used to sterilize the blisters, aspirate the fluid inside the blisters, and expose the wound.
Surgical decompression and drainage
Indications
Emergency surgical management should be considered immediately if one of the following conditions is present.
Localized manifestations
Tension blisters or bloody blisters.
Swelling with skin ecchymosis or skin necrosis.
Subcutaneous hard knots (cannot tell if they are fascia or muscle by touch).
Subcutaneous twists and turns.
Systemic manifestations
Symptoms of severe sepsis and infectious shock such as high fever, chills, confusion, and hypotension.
Progressive deterioration of the general condition, difficult to correct.
Laboratory tests
Creatine kinase is markedly elevated.
LIRNEC score >6 (LIRNEC score includes C-reactive protein, white blood cell count, hemoglobin, blood sodium, creatinine, and blood glucose, which are scored by the results of laboratory indicators).
Objective
Early debridement is critical to slow progression and improve prognosis.
Surgical approach
The surgical approach is emergency incision and reduction and drainage.
Postoperative precautions
After surgery, the affected limb can be elevated 15°, the wound can be left open, and infrared radiation can be used to keep the wound dry.
If the wound is large and oozing, saline irrigation can be used in the postoperative period.
The medication can be changed after surgery to accelerate the shedding of necrotic tissue.
Wound drainage, skin color and blood supply need to be closely observed after surgery.
Amputation
Indications
For patients with severe localized necrosis, such as severe muscle necrosis.
Purpose
To amputate the necrotic limb, to prevent infection from aggravating and causing infectious shock, and to reduce the mortality rate.
Surgical procedure
The necrotic limb is amputated by surgery.
Postoperative precautions
Observe the vital signs (blood pressure, respiration, pulse, temperature) closely after surgery.
Take plenty of rest and bed rest after surgery.
Do not do substantial activities to avoid wound disintegration.
Pay attention to the cleanliness and hygiene of the wound site.
Observe the amputation site for symptoms of redness, swelling and pain.
Other treatments
Hyperbaric Oxygen Therapy
For those who are in good condition, without active gastrointestinal bleeding or serious coagulation disorder, it is better to cooperate with hyperbaric oxygen therapy.
Hyperbaric oxygen can improve hypoxia and has certain bactericidal and antibacterial effects.
Prognosis
Cure
Untreated can not be self-cured.
The prognosis of Vibrio traumaticus infection is related to the symptoms it presents.
Acute gastroenteritis only, usually has a good prognosis after active treatment.
Sepsis and acute necrotizing fasciitis have a poorer prognosis and can be life-threatening in severe cases.
Hazard
When Vibrio traumaticus infection presents with acute necrotizing fasciitis, surgical treatment is required, and in severe cases, amputation may be necessary, which affects life.
Vibrio traumaticus infection in severe cases can appear multi-organ dysfunction syndrome, or even multi-organ failure, if not timely and effective treatment, may be life-threatening.
Daily
Daily Management
Dietary management
Eating can be started during the recovery period, with small and frequent meals, transitioning from liquid food to general food.
Eat more foods rich in vitamins and high quality protein, such as vegetables and fruits, as well as fish, shrimp and meat, which can increase the immune ability of the body.
Keep the diet light and do not eat spicy and stimulating foods, such as chili peppers.
Ensure that the body has sufficient water intake every day, not less than 1500ml.
Do not eat uncooked or raw seafood.
Life management
Daily life ability training such as leg lifting and standing can be carried out in bed and beside the bed during the rehabilitation period.
Strengthen outdoor physical exercise in daily life, such as walking, brisk walking, etc., to maintain physical health.
Pay attention to personal hygiene and develop good hygiene habits.
Prevention
Avoid contact with seafood and seawater for those who already have broken skin, especially during the warm season (e.g. May to October).
Do not eat undercooked or raw seafood, especially for people with chronic liver disease (e.g. cirrhosis, alcoholic liver disease, etc.), diabetes mellitus, chronic alcoholism, hemochromatosis, and people with low immunity.
Boil seafood for at least 3 to 5 minutes before consumption.