Angel Michael F, Zhang Feng, Jones Matthew, Henderson James, Chapman Stanley W
Division of Infectious Disease, University of Mississippi Medical Center, Jackson 39216, USA.
South Med J. 2002 Sep;95(9):1090-4.
Aeromonas hydrophila infection has been described as the cause of necrotizing fasciitis in patients with suppressed immune systems, burns, or trauma in an aquatic setting. We report a case in which severe necrotizing fasciitis involving hand, arm, chest, and lateral side of trunk, along with toxic shock, developed after the patient was bitten by a venomous snake. Mixed aerobic and anaerobic bacteria, including A hydrophila, were isolated from the wound culture. The patient was treated with antivenom, a diuretic regimen, broad spectrum antibiotics, and 18 separate surgical procedures. After the application of skin grafts, the wound completely healed. This case illustrates that a venomous snakebite may result in infection with A hydrophila and can cause severe necrotizing fasciitis. Early and aggressive surgical intervention should be implemented as soon as the necrotizing fasciitis is diagnosed.
嗜水气单胞菌感染被认为是免疫功能低下、烧伤或在水生环境中受过创伤的患者发生坏死性筋膜炎的病因。我们报告一例患者被毒蛇咬伤后，手部、手臂、胸部和躯干侧面发生严重坏死性筋膜炎并伴有中毒性休克的病例。从伤口培养物中分离出包括嗜水气单胞菌在内的需氧菌和厌氧菌混合菌群。患者接受了抗蛇毒血清、利尿方案、广谱抗生素治疗，并进行了18次单独的外科手术。在进行皮肤移植后，伤口完全愈合。该病例表明，毒蛇咬伤可能导致嗜水气单胞菌感染，并可引起严重的坏死性筋膜炎。一旦诊断出坏死性筋膜炎，应尽早进行积极的手术干预。
