Clinical Usefulness of Real-Time Polymerase Chain Reaction for the Diagnosis of Vibrio vulnificus Infection Using Skin and Soft Tissues

Jun-Young Lee Department of Orthopedic Surgery, College of Medicine, Chosun University, Gwangju, South Korea

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Seok Won Kim Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Republic of Korea

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Dong-Min Kim Division of Infectious Disease, Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, South Korea

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Na Ra Yun Division of Infectious Disease, Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, South Korea

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Choon-Mee Kim Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea

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Sang-Hong Lee Department of Orthopedic Surgery, College of Medicine, Chosun University, Gwangju, South Korea

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Vibrio vulnificus is a halophilic gram-negative bacillus isolated in seawater, fish, and shellfish. Infection by V. vulnificus is the most severe food-borne infection reported in the United States of America. Here, we aimed to examine the clinical usefulness of polymerase chain reaction (PCR) using tissue specimens other than blood samples as a diagnostic tool for V. vulnificus infection. A retrospective study was conducted with patients who underwent real-time PCR of toxR in both blood and skin tissues, including serum, bullae, swab, and operation room specimens, between 2006 and 2009. The median V. vulnificus DNA load of 14 patients in real-time PCR analysis of serum at the time of admission was 638.5 copies/mL blood, which was within the interquartile range (IQR: 37–3,225). In contrast, the median value by real-time PCR using the first tissue specimen at the time of admission was 16,650 copies/mL tissue fluid (IQR: 4,419–832,500). This difference was statistically significant (P = 0.022). DNA copy numbers in tissues were less affected by short-term antibiotic administration than that in blood samples, and antibiotic administration increased the DNA copy number in some patients. We found, for the first time, that DNA copy numbers in tissues of patients infected by V. vulnificus were higher than those in blood samples. Additionally, skin lesions were more useful than blood samples as specimens for PCR analysis in patients administered antibiotics for V. vulnificus infection before admission.

Author Notes

Address correspondence to Dong-Min Kim, Department of Internal Medicine, College of Medicine, Chosun University, 588 Seosuk-dong, Dong-gu, Gwangju 501-717, Republic of Korea. E-mail: drongkim@chosun.ac.kr
These authors contributed equally to this work.

Financial support: This work was supported by a grant from the Clinical Medicine Research Institute of the Chosun University Hospital (2015).

Authors' addresses: Jun-Young Lee, Sang-Hong Lee, Department of Orthopaedic Surgery, College of Medicine, Chosun University, Dong-Gu, Gwangju, Republic of Korea, E-mail: leejy88@chosun.ac.kr, shalee@chosun.ac.kr. Seok-Won Kim, Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea, E-mail: chosunns@chosun.ac.kr. Dong-Min Kim, and Na-Ra Yun, Department of Internal Medicine, College of Medicine, Chosun University, Dong-Gu, Gwangju, Republic of Korea, E-mail: drongkim@chosun.ac.kr, shine@chosun.ac.kr. Choon-Mee Kim, Premedical Science, College of Medicine, Chosun University, Gwangju, South Korea, E-mail: choonmee@chosun.ac.kr.

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