NECROTIZING FASCIITIS CAUSED BY VIBRIO-VULNIFICUS DIFFERS FROM THAT CAUSED BY STREPTOCOCCAL INFECTION

We reviewed the clinical record of all patients admitted to Saga Medic al School Hospital during the most recent 10 years and found that 17 ( 0.03%) were diagnosed as having necrotizing fasciitis. Bacteriological examination demonstrated that Vibrio vulnificus was the pathogen resp onsible in five patients (29%). The disease caused by Ir. vulnificus o ccurred in the warmer half of the year. All of the patients had underl ying chronic liver dysfunction, and three of them had previously consu med raw seafood. In these patients, the predominant skin lesions were oedema and subcutaneous bleeding, such as ecchymosis and purpura, whil e superficial necrosis was not recognized. Three patients died of syst emic complications. By contrast, all of the five patients with necroti zing fasciitis caused by Streptococcus pyogenes had the disorder in wi nter, and only one of them had chronic liver dysfunction. In skin lesi ons, subcutaneous bleeding was pare but necrosis was seen often. Despi te the high incidence of systemic complications, no patients with stre ptococcal necrotizing fasciitis died. These findings suggest that the clinical features of necrotizing fasciitis caused by V. vulnificus are different from those of necrotizing fasciitis caused by classical pat hogens, and that the two should be differentiated as early as possible to improve the prognosis.