报道1例于山西省汾阳医院确诊的由创伤弧菌引起的血流感染病例,为创伤弧菌感染诊治提供参考依据.患者男性,系环卫工人,工作时不慎划伤右前臂,因右前臂肿痛伴发热入院,该患者近期居住当地,无外出务工史,无近期接触海水或生食海鲜史,入院第2天上午4瓶血培养瓶均报阳,对阳性血培养瓶肉汤直接涂片,同时转种至血平板、嗜血巧克力平板,镜下为革兰阴性杆菌,菌体呈弯曲杆状,下午(培养约7h)取菌膜经基质辅助激光解析电离飞行时间质谱仪(matrix-assisted laser desorption ionization-time of flight mass spectrometer,MALDI-TOF MS)鉴定后为创伤弧菌.创伤弧菌所致的败血症死亡率较高,还可引起坏死性筋膜炎,在多学科的相互配合下,患者好转出院.通过此病例,对于发热和肢体红肿疼痛(肢体有外伤史)患者应将创伤弧菌感染纳入鉴别诊断,通过血培养等技术,及时找到病原菌,尽早手术干预,并成立多学科联合小组,可改善患者预后.
A case of Vibrio vulnificus detected in the blood of a sanitation workers and successfully cured
A confirmed case of blood flow infection caused by Vibrio vulnificus at Fenyang Hospital in Shanxi Province is reported to provide a reference for the diagnosis and treatment of Vibrio vulnificus infection.The patient is a male sanitation worker who accidentally scratched his right forearm while working and was admitted to the hospital due to swelling and pain in his right forearm accompanied by fever.The patient had recently resided in the local area,and had no history of working outside,or recent exposure to seawater or raw seafood.On the morning of the second day of admission,all four blood culture bottles tested positive.The positive blood culture bottle broth was directly smeared and transferred to a blood plate or a hemophilic chocolate plate.Under the microscope,it was Gram-negative bacilli,and the bacteria body was curved and rod-shaped.In the afternoon(about 7 hours of cultivation),the bacteria membrane was identified as Vibrio vulnificus by matrix-assisted laser desorption ionization-time of flight mass spectrometer(MALDI-TOF MS).Sepsis caused by Vibrio vulnificus has a high mortality rate,and it can also cause necrotizing fasciitis.With the cooperation of multiple disciplines,the patient improved and was discharged.Through this case,Vibrio vulnificus infection should be included in the differential diagnosis for patients with fever,redness,swelling,and pain in the limbs(with a history of trauma).The patient's prognosis can be improved with the timely finding of the pathogenic bacteria through blood culture and other techniques,early surgical intervention and establishment of an MDT(multidisciplinary joint)team.
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