Pan Zhaojun, Guo Xiaohui, Huang Pianpian, Duan Li, Hong Wei, Xie Yong Wu, Li Shengcheng
Department of Paediatric Intensive Care Unit, Zhuhai Center for Maternal and Child Health Care, Zhuhai, 519001, China.
Department of Orthopedics, Zhuhai Center for Maternal and Child Health Care, Zhuhai, 519001, China.
BMC Infect Dis. 2025 Feb 27;25(1):286. doi: 10.1186/s12879-025-10691-2.
Vibrio vulnificus (V. vulnificus) is a halophilic marine Gram-negative bacterium. Necrotizing fasciitis caused by V. vulnificus is a rapidly progressing clinical emergency often accompanied by septic shock. Despite advances in antibiotics and infection control measures, it remains a highly fatal and disabling infection. The incidence of V. vulnificus infection has increased due to climate warming and expanded global seafood trade in recent years. However, pediatric cases of V. vulnificus infection remain rare, leading to limited clinical experience in their management.
This report analyzes the clinical data of a pediatric case of V. vulnificus necrotizing fasciitis with septic shock, treated at Zhuhai Center for Maternal and Child Health Care in April 2024. The report also reviews the literature on pediatric V. vulnificus infection.
A 26-month-old boy developed a V. vulnificus infection after being scratched by a sea bass. The patient experienced an acute onset of illness that quickly worsened, presenting with a fever, mental fatigue, soft tissue edema, and pain, necrosis of the fascia and foot, coagulation dysfunction, and even shock. Laboratory results revealed white blood cell count(5.0 × 10/L), neutrophilia %(65%), thrombocytopenia (56 × 10/L), elevated CRP (200 mg/L), PCT (67.4 ng/mL), and IL-6 (> 4000 pg/mL), hypoalbuminemia (17.4 g/L), prolonged PT (17.5 s), reduced total T and NK cell counts, and a significantly reduced proportion of Treg cells. Initial treatment included surgical debridement and drainage, empirical antibiotic therapy, and rapid diagnosis of V. vulnificus via bacterial wound culture. Next-generation sequencing (NGS) of the blood microbial macrogenome and high-throughput sequencing of wound microbial pathogens (MetCap) were performed. Antibiotics were selected based on drug sensitivity testing, accompanied by hemopurification and measures to prevent disseminated intravascular coagulation. The patient's condition stabilized gradually post-treatment, and he was discharged.
Prompt diagnosis is important for children with seafood exposure. Early hemopurification, surgical intervention, effective antibiotic therapy, and DIC prevention significantly improve prognosis and survival rates. These findings provide a practical reference for managing pediatric V. vulnificus infections.
创伤弧菌是一种嗜盐性海洋革兰氏阴性菌。由创伤弧菌引起的坏死性筋膜炎是一种进展迅速的临床急症，常伴有感染性休克。尽管在抗生素和感染控制措施方面取得了进展，但它仍然是一种高致命性和致残性的感染。近年来，由于气候变暖和全球海鲜贸易的扩大，创伤弧菌感染的发病率有所上升。然而，儿童创伤弧菌感染病例仍然罕见，导致其治疗的临床经验有限。
本报告分析了2024年4月在珠海市妇幼保健院治疗的1例患有感染性休克的儿童创伤弧菌坏死性筋膜炎病例的临床资料。该报告还回顾了有关儿童创伤弧菌感染的文献。
一名26个月大的男孩在被海鲈鱼划伤后发生了创伤弧菌感染。患者发病急，病情迅速恶化，出现发热、精神萎靡、软组织水肿和疼痛、筋膜和足部坏死、凝血功能障碍，甚至休克。实验室检查结果显示白细胞计数（5.0×10/L）、中性粒细胞百分比（65%）、血小板减少（56×10/L）、CRP升高（200mg/L）、PCT（67.4ng/mL）和IL-6（>4000pg/mL）、低白蛋白血症（17.4g/L）、PT延长（17.5s）、总T细胞和NK细胞计数减少，以及调节性T细胞比例显著降低。初始治疗包括手术清创引流、经验性抗生素治疗，以及通过伤口细菌培养快速诊断创伤弧菌。对血液微生物宏基因组进行了二代测序（NGS），并对伤口微生物病原体进行了高通量测序（MetCap）。根据药敏试验选择抗生素，同时进行血液净化和预防弥散性血管内凝血的措施。患者治疗后病情逐渐稳定并出院。
对于有海鲜接触史的儿童，及时诊断很重要。早期血液净化、手术干预、有效的抗生素治疗和预防弥散性血管内凝血可显著改善预后和生存率。这些发现为儿童创伤弧菌感染的管理提供了实用参考。
