Wu C H, Hu W H, Hung D Z, Peng Y C, Yang D Y
Department of Emergency Medicine, Taichung Veterans General Hospital, Taiwan.
Vet Hum Toxicol. 2001 Oct;43(5):283-5.
Snakebite may be complicated with bacteria infections, most of which are Gram-negative bacillus. Snakebite complicated with Vibrio vulnificus infection has not been reported previously. Vibrio vulnificus infection is characterized by a necrotizing wound infection similar to the local lesion of severe snakebite. In Vibrio infections, aggressive debridement with the administration of strong antibiotics as early as possible is the only effective treatment. We report a 79-y-o man who suffered from snakebite on the right palm with rapid progression of hemorrhagic bulla, necrotizing fasciitis, compartment syndrome, and septic shock. Vibrio vulnificuswas cultured from necrotic tissue after aggressive debridement and fasciotomy. The patient recovered from antibiotic treatment and several courses of reconstruction surgery. Severe bacteria infection, such as caused by Vibrio vulnificus, should be considered in snakebite cases refractory to antivenin dosage.
蛇咬伤可能并发细菌感染,其中大多数为革兰氏阴性杆菌。此前尚未有蛇咬伤并发创伤弧菌感染的报道。创伤弧菌感染的特征是出现类似于严重蛇咬伤局部病变的坏死性伤口感染。对于弧菌感染,尽早进行积极清创并使用强效抗生素是唯一有效的治疗方法。我们报告一例79岁男性,其右手掌被蛇咬伤,随后迅速出现出血性水疱、坏死性筋膜炎、骨筋膜室综合征和感染性休克。在积极清创和筋膜切开术后,从坏死组织中培养出创伤弧菌。患者经抗生素治疗及多次重建手术后康复。对于抗蛇毒血清治疗无效的蛇咬伤病例,应考虑严重细菌感染,如创伤弧菌感染所致。