• Takuma Tajiri, Genshu Tate, Katsutoshi Miura, Shinji Masuda, Nobuyuki Ohike, Toshiaki Kunimura, Toshiyuki Mitsuya, and Toshio Morohoshi.
• Department of Pathology, Showa University Fujigaoka Hospital. takumatajiri1003@yahoo.co.jp
• Intern. Med. 2008 Jan 1; 47 (17): 149915041499-504.

ObjectiveTo analyze a risk factor for the onset of fulminant bacterial infection.Patients And MethodsNine unexpected acute death cases were clinicopathologically analysed. All cases represented the sudden onset of shock symptom, led to acute death within a few days, and later bacteremia was identified. Pathogens were Streptococcus pneumoniae (S. pneumoniae) (5 cases), group A beta Hemolytic Streptococcus pyogenes (S. pyogenes) (3 cases), and Vibrio vulnificus (V. vulnificus) (1 case).ResultsSeven of the nine patients had underlying chronic illness. S. pneumoniae infection was associated with splenic dysfunction, and group A beta Hemolytic S. pyogenes and V. vulnificus infections were associated with alcoholic liver injury. Group A beta hemolytic S. pyogenes and V. vulnificus infections involved necrotizing fasciitis, and alcoholic liver cirrhosis was confirmed in two of the four patients.ConclusionDespite the different type of bacteria, the onset of fulminant bacterial infection depended upon depressed bacterial phagocytosis in the liver or spleen. Underlying chronic illnesses should be identified as a predisposing common risk factor. It is important to understand the relations between underlying chronic illness and the onset of fulminant infection.

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