投稿分類 微生物

主委發表種類: 壁報

投稿標題(中): 在山區檢出海洋創傷弧菌的個案報導

投稿標題(英): The case report: The infection of Vibrio vulnificus in mountain areas.

投稿摘要: Introduction
Vibrio vulnificus is an opportunistic gram-negative bacillus that can lead to illness ranging from fever, diarrhea, cellulitis to fatal septicemia. However, it is the normal microbiota in estuaries and coastal areas [1]. Additionally, preliminary evidence suggested that those with liver disease, such as chronic hepatitis and liver cirrhosis, or immunocompromised conditions (e.g., diabetes) are at higher risk of developing severe symptoms [2, 3]. It can be differentiated from other members of Vibrio genus via its characteristics of fermentation of lactose, cellobiose and salicin [4]. Transmission of the pathogen primarily through two routes: one is consumption of uncooked seafood (mainly causing septicemia); the other is exposure to seawater where V. vulnificus is present (mostly resulting in wound infection) [5]. Nevertheless, in Cishan hospital, Ministry of Health and Welfare, it is reported that several infected cases dwell in mountain towns rather than seaside areas; furthermore, their occupations are agriculture instead of fishery. Thus, the case is worthy of discussion.

Case description
Mr. Wong, aged 72, his occupation is a farmer. He lives in Cishan district, a mountain town situated in Kaohsiung city. His medical history is diabetes (HbA1C 6.7 %; normal range between 4%~6%). In the past months, he has never consumed uncooked sea products, such as Sashimi and sushi. One day, he came to emergency room due to wound ulcers on his upper right limb. He undertook regular blood test and blood culture. Subsequently, he was diagnosed with cellulitis and received further treatments (e.g., intravenous injection of antibiotics).

Laboratory results
The outcome of blood culture from this patient demonstrated the infected microorganism is V. vulnificus and its antibiotics susceptibility was sensitivity to Gentamycin, Amoxicillin, Piperacillin, Ceftazidime, Ciprofloxacin and Sulfame/ Trimethoprim. His blood routine report showed higher inflammatory index── CRP (67 mg/dL; normal range＜5mg/dL) ── and white blood cell count of 12000/μL (normal range: 4000~10000/μL). Moreover, according to his biochemistry report, the patient was with high value of blood glucose (155mg/dL; normal range＜65~126mg/dL).

Discussion
Cishan district is a mountain town located in Kaohsiung city, R.O.C.
V. vulnificus is primarily present in seaside and coastal areas. Getting infected is mainly through consumption of uncooked seafood and exposure to seawater where V. vulnificus is present. However, the patient engages in agriculture and furthermore Cishan is far from ocean; hence, there is little chance for him to be infected with V. vulnificus. In conclusion, those who dwell in mountain areas still have opportunities to get infected with V. vulnificus.

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