猛爆性海洋霍乱弧菌坏死性筋膜炎课件.ppt

猛爆性海洋霍亂弧菌壞死性筋膜炎 Necrotizing Fasciitis and Sepsis as Initial Symptoms of Systemic Vibrio Infection 骨科系一般骨科 蔡燿鴻醫師 Yao-Hung Tsai, M.D. Department of Orthopaedic Surgery Division of General Orthopaedics Chang Gung Memorial Hospital, Chia-Yi Special Thanks to 骨科同仁 – 許副院長、黃聰仁主任、黃國欽、李晏瑤、許維修、鄭錦昌、彭國狄、翁怡然 急診科同仁 – 蕭政廷主任、陳志聰醫師 整形外科同仁 – 楊文圭醫師、陳建銘主任 ICU – 呂明憲主任 護理同仁 – 6D、6C、ICU、OR Necrotizing Fasciitis Group A beta-hemolytic streptococci (Streptococcus pyogens) - causes fulminating necrotizing fascitis Staphylococcus –OSSA ORSA (our hospital) 海洋霍亂弧菌一直存在溫暖海水中，大多生活在生蠔、蚵仔、魚和蝦蟹中，很少引起人類皮膚發炎感染，也不會像鏈球菌(Streptococcus pyogens) 容易引起壞死性筋膜炎和敗血症。 Vibrio –大部分為 cellulitis Vibrio necrotizing fascitis progressive sepsis :Rare Introduction Vibrio species - warm sea waters and often in raw oyster, shellfish and other seafood. 主要症狀以腸胃炎 Diarrhea 少數引起 Wound infection and primary septicemia. 有肝功能不好，如B型或C型肝炎、肝硬化或肝癌，糖尿病和慢性腎病等病症 Hepatic disease, diabetes, adrenal insufficiency and immunocompromised. 大部分為身上已有傷口或是被魚蝦剌傷過，再泡到海中，因而引起海洋霍亂弧菌引起的壞死性筋膜炎 海洋霍亂弧菌壞死性筋膜炎 內毒素 皮膚潰爛腫脹 - hemorrhagic bullae, subcutaneous bleeding, purpura, necrosis gangrene 多重器官衰竭 - septicemia leads to rapid multi-organ failure Mortality was up to 50% in septic patients with hypotension (SBP 90 mm Hg) on admission Most of them dying within 48 hours of admission. Vibrio 菌種 (1) V. cholerae O1 - GI problems (2) V. vulnificus - Skin infection (3) V. cholerae non-O1, V. parahaemolyticus, (4) V. fluvialis, V. alginolyticus, V. furnissii, V. mimicus, V. metschnikovii, V. hollisae Vibrio Infection Baffone ( Food Microbiology, 2001) High cytotoxicity: cholerae non-O1, vulnificus, parahaemolyticus, metschnikovii Moderate cytotoxicity: alginolyticus Low cytotoxicity: fluvialis, furnissii Vibrio Species (USA 1999) Species GI Wound Septicemia V. Cholera Epidemic(O1) ++ (+) - Nonepidemic ++ + + V. mim