Vibrio infection associated with finning injury of the hand.

Background: Penetrating injury by fish fins is common and often overlooked. Vibrio spp. are known worldwide for their virulence, quickly causing soft-tissue infection and lethal septicaemia. Vibrio infection following finning injury is rare, but can result in devastating complications in susceptible individuals.

Aim: To elucidate the clinical significance of such injury.

Method: Between July 2003 and September 2005, nine cases of Vibrio infection caused by finning injury to the hand were retrospectively reviewed. Clinical data, including skin presentations, treatment course and outcomes, were collected and reviewed.

Results: In our group of nine patients, seven had concurrent hepatoma, diabetes mellitus, cirrhosis, chronic renal insufficiency or the effects of long-term steroid use; three had wound infections manifested by cellulitis or tenosynovitis and six had life-threatening necrotising soft-tissue infections. Vibrio spp. were identified from the wound (n=4), blood (n=1), and both (n=4). Symptoms appeared within a few hours to 3 days after injury, with 50% of patients developing symptoms within 24h; three patients were hypotensive upon admission; one patient received antibiotic therapy only and eight required emergency fasciotomy. All patients survived and none required amputation. The mean hospital stay was 23.2 days.

Conclusions: Vibrio infections after finning injury can produce bacteraemic necrotising soft tissue-infections, especially in individuals with a systemic illness. Health education should include a recommendation to wear protective gloves while handling fish. Early antibiotic and surgical treatment can avoid potentially life-threatening complications.