Dataset Information

Necrotizing fasciitis induced by Vibrio vulnificus in patients without marine contact in Hong Kong.

ABSTRACT: Necrotizing fasciitis caused by Vibrio species is a life-threatening soft tissue infection with rapid progression and high mortality. The classic history of Vibrio species-induced necrotizing fasciitis is the infection of wounds by direct invasion or contact with contaminated seawater or raw seafood, especially in immunocompromised patients. We present two cases of Vibrio vulnificus necrotizing fasciitis in the upper limb without any wounds or seawater contact and with good past medical history. Both underwent timely surgical debridement and resulted with good functional outcome. Although rare, as clinicians, we need to have a high index of suspicion for the possibility of V. vulnificus necrotizing fasciitis despite no risk factors and give timely and appropriate treatment and, more importantly, patient survival.

SUBMITTER: Wong RMY

PROVIDER: S-EPMC6896480 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Necrotizing fasciitis induced by <i>Vibrio vulnificus</i> in patients without marine contact in Hong Kong.

Wong Ronald M Y RMY Chau Leo T-C LT Mak Michael C-K MC Tse Wing-Lim WL Ho Pak-Cheong PC

Journal of orthopaedic translation 20190404

Necrotizing fasciitis caused by Vibrio species is a life-threatening soft tissue infection with rapid progression and high mortality. The classic history of Vibrio species-induced necrotizing fasciitis is the infection of wounds by direct invasion or contact with contaminated seawater or raw seafood, especially in immunocompromised patients. We present two cases of <i>Vibrio vulnificus</i> necrotizing fasciitis in the upper limb without any wounds or seawater contact and with good past medical h ...[more]

PMID: 31844623

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Project description:BackgroundMaintaining effective contact tracing to control COVID-19 is challenging. Rapid growth in the number of infected cases can overload tracing and testing capacity, resulting in failure to trace contacts and delays in confirming an infection until after symptom onset (confirmation delay), hence increasing transmissibility. A substantial outbreak in Hong Kong, which was suppressed with non-pharmaceutical interventions (NPIs), provided an opportunity to assess the impact of overloading contact tracing and of efforts to improve its efficiency.MethodsUsing epidemiological-link (epi-link) data, we calculated the probability and duration of confirmation delay for cases with and without an epi-link, among all 3,148 confirmed cases between 5 July and 15 August 2020. Logistic regression was performed to determine the relationship between the number of recently confirmed infections and the probability of confirmation delay for epi-linked (contact-traced) cases. We estimated the impact on this relationship of targeted testing of at-risk groups.FindingsThe probability and duration of confirmation delay were associated with the rise in daily case number during growth of the outbreak. The proportion with confirmation delay among contact-traced cases increased from about 60% to nearly 85% as the number of cases grew from 1 to 50 per day (p-value = 0.003). The subsequent introduction of testing services for at-risk groups substantially reduced the proportion and it did not approach 85% again until the daily number of cases exceeded 125. This 2.5-fold improvement in capacity contributed crucially to suppression of the outbreak.InterpretationThe number of recently confirmed infections is an indicator of the load on the contact-tracing system, the consequence of which can be assessed by the probability of confirmation delay. Measures to monitor and improve contact-tracing efficiency, alongside social distancing interventions, can enable outbreaks to be controlled without lockdown.FundingCity University of Hong Kong and Health and Medical Research Fund.

Project description:ObjectivesThe Laboratory Risk Indicator for Necrotizing Fasciitis score was developed as a clinical decision tool for distinguishing necrotizing fasciitis from other soft tissue infections. We prospectively evaluated the performance of the Laboratory Risk Indicator for Necrotizing Fasciitis score for the diagnosis of patients with necrotizing fasciitis in the extremities.MethodsWe conducted a prospective and observational cohort study of emergency department patients with necrotizing fasciitis or severe cellulitis in the extremities between April 2015 and December 2016. The Laboratory Risk Indicator for Necrotizing Fasciitis score was calculated for every enrolled patient. The sensitivity, specificity, positive predictive value, and negative predictive value of cut-off scores of 6 and 8 were evaluated. The accuracy of the Laboratory Risk Indicator for Necrotizing Fasciitis score was expressed as the area under the receiver operating characteristic curve.ResultsA total of 106 patients with necrotizing fasciitis and 825 patients with cellulitis were included. With an Laboratory Risk Indicator for Necrotizing Fasciitis cut-off score ≥6, the sensitivity was 43% (95% confidence interval 34% to 53%), specificity was 83% (95% confidence interval 80% to 86%), positive predictive value was 25% (95% confidence interval 20% to 30%), and negative predictive value was 92% (95% confidence interval 91% to 93%); with an Laboratory Risk Indicator for Necrotizing Fasciitis cut-off score ≥8, the sensitivity was 27% (95% confidence interval 19% to 37%), specificity was 93% (95% confidence interval 91% to 94%), positive predictive value was 33% (95% confidence interval 25% to 42%), and negative predictive value was 91% (95% confidence interval 90% to 92%). The area under the receiver operating characteristic curve for accuracy of the Laboratory Risk Indicator for Necrotizing Fasciitis score was 0.696 (95% CI 0.640 to 0.751).ConclusionThe Laboratory Risk Indicator for Necrotizing Fasciitis score may not be an accurate tool for necrotizing fasciitis risk stratification and differentiation between severe cellulitis and necrotizing fasciitis in the emergency department setting based on our study.

Dataset Information

Necrotizing fasciitis induced by Vibrio vulnificus in patients without marine contact in Hong Kong.

Publications

Necrotizing fasciitis induced by <i>Vibrio vulnificus</i> in patients without marine contact in Hong Kong.

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