Hien sustained a foot injury during a beach trip, suspected to be caused by an underwater organism. Approximately 12 hours later, the injured area became swollen and painful, and he developed a fever and severe fatigue.

Doctor of First-Degree Specialization Nguyen Hoang Anh Duy, from the Department of Internal Medicine, Tam Anh General Hospital, Ho Chi Minh City, stated that Hien had two small wounds, each about 2 mm, on the inner side of his right big toe, oozing cloudy fluid. His right foot was swollen, hot, red, and painful. The infection quickly spread from his toe up to his right knee. The patient had a fever of 38,7 degrees C, chills, and felt exhausted.

Ultrasound results indicated edema and fluid accumulation in the soft tissues of the foot. Laboratory tests showed signs of infection, while the inflamed area continued to spread. The patient received treatment in the Intensive Care Unit (ICU). In the initial days, he experienced continuous high fever, with redness and swelling spreading from his foot to his calf, up to his thigh and groin area. His C-reactive protein (CRP) level, an indicator of inflammation in the body, rose to over 400 mg/L, 80 times higher than normal.

The small wound on the patient's foot after a beach trip. *Photo: Tam Anh General Hospital*

The medical team administered multiple types of broad-spectrum antibiotics and took blood and wound fluid samples to identify the cause. Subsequent pus culture results confirmed *streptococcus pyogenes* as the causative agent.

According to Doctor Duy, *streptococcus pyogenes* is a bacterium commonly found on the skin or in the environment, capable of causing skin infections, soft tissue infections, and various other types of infections. When the bacteria enter through a scratch or small skin lesion, they can rapidly spread into the subcutaneous tissues, leading to swelling, warmth, redness, and pain. In some cases, the bacteria also release toxins that trigger a strong inflammatory response in the body, resulting in high fever, widespread infection, and a risk of sepsis if not treated promptly.

Doctor Duy explaining the condition to the patient. *Photo: Tam Anh General Hospital*

Doctor Duy explained that these results indicated the infection did not originate from a specific marine animal bacterium. It was more likely that the bacteria entered through the damaged skin, subsequently causing soft tissue inflammation and a systemic infection.

During treatment, Hien was diagnosed with type 2 diabetes. According to Doctor Duy, individuals with diabetes are more susceptible to infections because prolonged high blood sugar impairs immunity and damages small blood vessels, leading to poor blood and oxygen supply to tissues, which delays wound healing. "Even a minor skin injury can become a gateway for bacteria to enter and cause severe infection," Doctor Duy stated.

After three days of intensive treatment, the patient's fever subsided, swelling and pain gradually decreased, the affected area shrank, and there was no longer any pus discharge. Two weeks later, the patient was discharged.

Doctors advise individuals with skin wounds from contact with unfamiliar organisms or during daily work and activities to monitor them closely. If a wound exhibits widespread redness and swelling, increased pain, discharge, or is accompanied by fever, the patient should seek early medical attention. Those with diabetes and other man tinh conditions should undergo regular health check-ups and adhere to treatment plans to manage underlying diseases, reduce infection risk, and promote faster wound healing.

Nhat Thanh

*Patient's name has been changed