On April 2nd, the National Hospital for Tropical Diseases announced that it had just received and treated patient D. T. N. (52 years old, from Bac Ninh) in critical condition due to septic shock.
Previously, the patient had stable health. Recently, she developed symptoms of headache, dizziness and neck and shoulder pain, so she went to a private clinic to get injections to support the treatment of bones and joints, with a frequency of 1 injection/day for 5-6 days.
After stopping injection for 2 days, the patient began to have a fever, fatigue and a swelling area appeared at the injection site in the back of his left hand. The injury then progressed very quickly. In just 24 hours, the damaged skin area formed a black necrotic blister, about 5x6cm in size. The patient had a continuous high fever, exhaustion and was transferred to emergency care in a state of multiple organ failure.
When admitted to the Emergency Department, Central Tropical Diseases Hospital, the patient was in a state of severe fatigue, requiring maintenance of vasopressor drugs at a relatively high dose, about 0.7 mcg/kg/minute, showing that the shock condition was still very severe. On the back of the left hand, a black necrotic blister wound was recorded, swelling, inflammation and severe pain around.
Notably, in just 48 hours, the inflammation from the necrotic area spread rapidly, swelling all over the hand and spreading to the forearm. Doctors determined that this was a sign of rapidly progressing infection, with a risk of spreading if not controlled promptly.
Test results showed that the patient had experienced multiple organ failure, affecting the lungs, liver, kidneys and cardiovascular system.
MSc. Dr. Nguyen Duc Minh, Department of Emergency Medicine, said that microbiological test results have identified the causative agent as Serratia marcescens bacteria. This is a Gram-negative opportunistic bacteria, often existing in environments such as water and soil, capable of causing sepsis, very severe cell inflammatory disease if entering the blood.
After 2 days of intensive resuscitation with broad-spectrum antibiotics, fluid replenishment and vasopressors, the patient had initial response, and the dose of vasopressor was gradually reduced.
Analyzing the source of infection, Dr. Nguyen Duc Minh said that although symptoms appear at the injection site, there is not enough basis to confirm that the direct cause is the injection. According to the doctor, the injection site creates a small skin lesion, unintentionally becoming an "open door" for bacteria to enter. During daily life, if this skin area comes into contact with dirty water, dust or raw food, Serratia marcescens bacteria can follow and enter the body and cause disease.
After 2 weeks of intensive treatment at the Emergency Department, the patient's multiple organ failure condition has stabilized. Currently, the patient has been transferred to the Department of Plastic Surgery and Interdisciplinary Surgery to continue dissection and treatment of the necrotic damage area.
