Early diagnosis and application of hemopurification combined with antibiotic therapy and surgical debridement for successful treatment of a child with Vibrio vulnificus necrotizing fasciitis and septic shock: a case report

Abstract

Background

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.

Methods

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.

Results

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 × 10⁹/L), neutrophilia %(65%), thrombocytopenia (56 × 10⁹/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.

Conclusion

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.