Early clinical manifestations of vibrio necrotising fasciitis

Abstract

We present five patients with vibrio necrotising fasciitis, a lethal and disabling disease. Two of these patients had a history of exposure to either warm seawater or raw/live seafood, three had underlying chronic liver disease, and four presented with hypotension and fever. There were three deaths and four patients required intensive care unit stays. Among the two survivors, one had high morbidity. Only one patient met the criteria of Laboratory Risk Indicator for Necrotising Fasciitis score > 6. A clinician should suspect possible vibrio necrotising fasciitis if the following are present: contact with fresh seafood/warm seawater, a known history of chronic liver disease and pain that is out of proportion to cutaneous signs. All patients must be managed via intensive care in high dependency units. We recommend a two-step surgical protocol for patient management involving an initial local debridement, followed by a second-stage radical debridement and skin grafting.

Keywords: LRINEC score; outcome; treatment; vibrio necrotising fasciitis.

Fig. 1

Patient 1. Multiplanar MR image of the left thigh shows extensive subcutaneous stranding and oedema with enhancement. STIR/T2 high signal suggests fluid within the deep/intermuscular fascial planes, predominantly along the anterior and medial compartments of the left thigh. The image also shows mild, patchy, deep/intermuscular fascial enhancement.

Fig. 2

Patient 3. Photograph shows necrotic fascia and copious amounts of ‘dishwater’ fluid and pus in the left leg.