Clostridium Perfringens Sepsis Research Articles

Fatal Clostridium Perfringens Sepsis with Spleen Rupture and Intraabdominal Massive Bleeding in a 37-Week Pregnancy

The maternal death rate remains unacceptably high worldwide, predominantly in areas of poor access to quality health services. According to the WHO, in 2017, 810 women died from preventable causes related to pregnancy and childbirth. Causes of maternal death are plenty, including previous morbidity and unexpected causes. Among the latter are infectious disease-related deaths. Herein, we describe a case of a 29-year-old woman at 37 weeks’ gestation who presented with right upper quadrant pain, which was initially considered to be pregnancy-related. However, she collapsed shortly after the hospital admission. The physical examination revealed severe hypovolemic shock due to a large amount of intraperitoneal free fluid. The patient was immediately rushed into an emergency cesarean section followed by exploratory laparotomy, which demonstrated a large intra-abdominal hemorrhage. The patient and her fetus died in the operating room. An autopsy revealed acute gangrenous cholecystitis along with abundant rod-shaped bacteria within the mucosa and vessels of the gallbladder, gas gangrene and rupture of the spleen, and signs of shock.Clostridium perfringens (CP) was isolated in the culture of a splenic sample. Although CP is a well-known and dreadful infectious etiological agent, catastrophic cases still happen. The acquaintance of this infection by the caregivers is crucial for the early diagnosis and treatment. This is a quite unique way to provide a dismal chance of survival in sepsis cases by this agent.

Type A fulminant Clostridium perfringens sepsis indicated RBC/Hb discrepancy; a case report

BackgroundClostridium perfringens can cause various infections, including food poisoning, gas gangrene, cellulitis and fasciitis. C. perfringens septicemia is rare, but is a known cause of hemolysis by damaging red blood cell, and often proves rapidly fatal in emergency department (ED) situations.Case presentationA previously healthy 76-year-old man presented to the ED 8 h after onset of acute abdominal pain and diarrhea. Laboratory examination revealed a large discrepancy between the red blood cell count of 1.91 × 106/mm3 and the hemoglobin level of 10.3 g/dL, suggesting massive intravascular hemolysis. Computed tomography revealed liver abscesses with gas. During ED treatment, the state of the patient rapidly deteriorated and he entered cardiopulmonary arrest. Blood cultures finally identified C. perfringens.ConclusionIntravascular hemolysis and red blood cell (RBC) / hemoglobin (Hb) discrepancy in the presence of infection should prompt ED physicians to consider C. perfringens septicemia and to act quickly to provide appropriate treatment.

A suspected case of Clostridium perfringens sepsis with intravascular hemolysis after transhepatic arterial chemoembolization: a case report

IntroductionSepsis due to Clostridium perfringens, one of several clostridial species, is an important cause of massive intravascular hemolysis in patients with underlying malignancies. Chronic liver diseases, immunosuppression, and presence of malignancies were risk factors for Clostridium perfringens sepsis. Therefore, Clostridium perfringens sepsis should always be considered in patients presenting with liver damage after chemo-embolic therapy for hepatocellular carcinoma. This case report focuses on findings characteristic of an intravascular hemolysis due to Clostridium perfringens after transhepatic arterial chemoembolization.Case presentationAn 83-year-old Japanese man presented to our hospital because of a third recurrence of hepatocellular carcinoma. He had nonalcoholic steatohepatitis-related cirrhosis, and underwent radiofrequency ablation and transhepatic arterial chemoembolization therapy for hepatocellular carcinoma of S4/S8 and S2. He had a medical history of pancreatic carcinoma and underwent pylorus-preserving pancreaticoduodenectomy approximately 5 years ago. Because follow-up computed tomography showed a recurrence of the hepatocellular carcinoma, he underwent transhepatic arterial chemoembolization with a hepatic arterial infusion of 20 mg epirubicin, followed by 4 mL Lipiodol (ethiodized oil). On the sixth day after the procedure, he complained of fever and hematuria with jaundice. Laboratory findings indicated hemolysis and increased inflammatory response. Although we initiated antibiotic therapy combined with surgical debridement for infection after transhepatic arterial chemoembolization, he died within 6 hours. The autopsy showed a 4-cm local necrotic hepatic tumor. The cut surface revealed a tumor with an internal spongiform appearance, which was a pseudocystic and partially necrotic lesion. In addition, a diffuse spread of Gram-positive rods in multiple organs including the heart was histologically confirmed. The culture obtained by fluid aspiration from the hepatic abscess revealed Clostridium perfringens. Although the role of Clostridium perfringens was never established during the life of this patient, based on the clinical course and the culture from the hepatic abscess at postmortem, intravascular hemolysis secondary to Clostridium perfringens sepsis was suspected.ConclusionIntravascular hemolysis secondary to Clostridium perfringens should always be considered in patients presenting with liver damage after chemo-embolic therapy for hepatocellular carcinoma. Biliary reconstruction is an especially important risk factor for infection.

Gaseous liver abscess with Clostridium perfringens sepsis in a patient with neutropaenia.

Gaseous liver abscess with Clostridium perfringens sepsis in a patient with neutropaenia.

Combined therapy with gas gangrene antitoxin and recombinant human soluble thrombomodulin for Clostridium perfringens sepsis in a rat model

Cases of Clostridium perfringens septicemia, such as liver abscess, often develop a rapidly progressive intravascular hemolysis and coagulation; the mortality rate with current standard care including antibiotics and surgery is high. Herein, we firstly investigated the effects of gas gangrene antitoxin (GGA) (antitoxin against C. perfringens) and recombinant human soluble thrombomodulin (rTM) on the hemolysis, coagulation status, inflammatory process, and mortality in α-toxin-treated rats. Male 11-week-old Sprague Dawley rats were randomly divided into five groups: control group, α-toxin group, GGA group, rTM group, and combined GGA and rTM (combination group). After α-toxin injection, mortality and platelet counts, and hemolysis were observed for 6 h. The fibrin/fibrinogen degradation products (FDP), and plasma high-mobility group box 1 (HMGB1) were also measured at 6 h. The combination group demonstrated 100% survival compared with 50% survival in the α-toxin group and demonstrated significantly improved hemolysis, platelet counts, and lactate levels compared with those in the α-toxin group (p < .01). The FDP and HMGB1 levels in the combination therapy group were significantly lower than those in the α-toxin group (p < .05). Combination therapy with GGA and rTM administration is applicable as adjunct therapy for fatal C. perfringens sepsis.

Complication of Invasive Molar Pregnancy withClostridium perfringensSepsis

Clostridium perfringens (CP) is an anaerobic, Gram-positive bacillus associated with malignant diseases and near-term pregnancies. The necrotic tissue that results from these disease processes fuels the proliferation of CP, leading to gas gangrene and subsequently sepsis. Herein, we report a case of a 41-year-old female patient with a history of invasive molar pregnancy that was further complicated with a CP infection. Although past research has shown a link between Clostridium infection and choriocarcinoma (Chern-Horng and Hsieh, 1999), no previous cases of CP infection have been associated with invasive molar pregnancy. We also report complete resolution of the CP sepsis and its associated symptoms following the hysterectomy.

Ischaemic intestinal perforation complicated by Clostridium perfringens sepsis in a diabetic patient

Ischaemic intestinal perforation complicated by Clostridium perfringens sepsis in a diabetic patient

A Case of Clostridium Perfringens Sepsis in the 29 Week Pregnant Woman with Diagnosed Fetal Omphalosel

Although not common, postpartum and post-abortion infections caused by clostridia can be severe. Clostridial uterine infections start as localized chorioamnionitis as a result of an infection from the fetus and/or placental tissues. The infection may spread to the uterine wall and endometrial tissues, and, in the most severe cases, uterine necrosis accompanied by sepsis ensues. In this paper we report the presence of Clostridium perfringens isolated from blood culture and placental specimen after the termination of a 29 gestational week pregnancy. The woman had a history of having omphaloceled fetus and premature membrane rupture. Fetal omphalocele is a congenital defect of the abdominal wall that allows some of the abdominal organs to protrude through it. In order to find the focus of infection, blood and plasental specimen of the patient were examined. Blood cultures of the patient were evaluated by the BACTEC 9120 system. The identification of the bacteria was performed conventionally and confirmed by the automatized API 20A system. Antibiotic susceptibility testing was performed by E-test according to the recommendations of Clinical Laboratory and Standards Institute (CLSI). Although Clostridium spp is rarely isolated from blood cultures, anaerobically evaluation of blood cultures in the infections of abdominal and genital sites could be life-saving, as in this report.

Clostridium Perfringens Sepsis With Massive Intravascular Haemolysis: A Rare Presentation

Massive intravascular haemolysis is a rare but well-known complication of Clostridium perfringens sepsis. Presence of fever, intravascular haemolysis, numerous spherocytes in peripheral blood smear and septic shock should raise this clinical suspicion. We describe the case of a 66-year-old male who was admitted in the Emergency Room complaining of abdominal pain, vomiting, fever and dark red urine. No relevant findings in physical examination were found. Laboratory tests revealed massive intravascular haemolysis (minimum haemoglobin of 4 g / dL). Ultrasound of the upper abdomen did not show relevant findings. Six hrs later his clinical condition suddenly deteriorated, evolving to septic shock. He was promptly admitted in the Intensive Care Unit but his condition continued to deteriorate very rapidly, with severe multiple organ failure. He died a few hrs later despite full organ support and large spectrum antibiotic therapy. Clostridium perfringens was identified in blood cultures taken before death . The post-mortem evaluation revealed a high stage of body decomposition suggesting presence of gas-producing bacteria precluding the execution of the autopsy. Though this is a very rare clinical condition, the suspicion of clostridium sepsis mandates the immediate prescription of antibiotic therapy and aggressive focus control in order to change the dismal prognosis associated with this entity. doi:10.4021/jmc583w

Clostridium perfringens sepsis and liver abscess following laparoscopic cholecystectomy.

Clostridium perfringens sepsis with intravascular haemolysis is a catastrophic process with a reported mortality of between 90 to 100%. We successfully treated a case of severe clostridial infection with a liver abscess following laparoscopic cholecystectomy, the first to our knowledge. A 59-year-old man presented one week after an uneventful laparoscopic cholecystectomy with jaundice, peritonism, sepsis and acute renal failure. He was found to have a haemolytic anaemia, unconjugated hyperbilirubinemia and blood cultures grew Clostridium perfringens. A CT revealed a large gas forming abscess in the gallbladder fossa and right lobe of liver. He was treated with directed antibiotic therapy and underwent emergency laparotomy, drainage of the abscess and peritoneal washout. He required intensive care support, parenteral nutrition and inotropic support for a limited period. CT liver angiogram post op was normal. Continued renal dysfunction necessitated protracted haemofiltration. This resolved and the patient was discharged home at 2 months.

Clostridium Perfringens Sepsis With Massive Intravascular Haemolysis: A Rare Presentation

Massive intravascular haemolysis is a rare but well-known complication of Clostridium perfringens sepsis. Presence of fever, intravascular haemolysis, numerous spherocytes in peripheral blood smear and septic shock should raise this clinical suspicion. We describe the case of a 66-year-old male who was admitted in the Emergency Room complaining of abdominal pain, vomiting, fever and dark red urine. No relevant findings in physical examination were found. Laboratory tests revealed massive intravascular haemolysis (minimum haemoglobin of 4 g/dL). Ultrasound of the upper abdomen did not show relevant findings. Six hrs later his clinical condition suddenly deteriorated, evolving to septic shock. He was promptly admitted in the Intensive Care Unit but his condition continued to deteriorate very rapidly, with severe multiple organ failure. He died a few hrs later despite full organ support and large spectrum antibiotic therapy. Clostridium perfringens was identified in blood cultures taken before death. The post-mortem evaluation revealed a high stage of body decomposition suggesting presence of gas-producing bacteria precluding the execution of the autopsy. Though this is a very rare clinical condition, the suspicion of clostridium sepsis mandates the immediate prescription of antibiotic therapy and aggressive focus control in order to change the dismal prognosis associated with this entity. J Med Cases. 2012;3(3):207-210 doi: https://doi.org/10.4021/jmc583w

Intravascular Hemolysis and Sepsis due to Clostridium Perfringens in a Patient with Pancreatic Cancer

Purpose: A 70 year old male with a history of pancreatic adenocarcinoma, a Whipple procedure and a recent diagnosis of liver metastasis presented to the emergency department with a 1 day history of weakness and fatigue. Physical examination was remarkable for a temperature of 94.5 degrees Fahrenheit, blood pressure of 94/58, pulse 117, marked jaundice and right sided abdominal pain. The patient was transferred to the intensive care unit. Baseline labs obtained 1 day prior to admission revealed a hemoglobin (Hb) of 11.1 g per dL, total bilirubin 0.5, AST 57, ALT 39, BUN 17, Cr. 1.3. Initial laboratory analysis upon admission demonstrated a Hb of 9.4 g per dL, total bilirubin of 10.5, AST 1019, ALT 237, BUN 57, Cr. 3.0. Of note, several attempts to measure lab tests failed because of complete hemolysis of the patient's blood samples. Repeat labs revealed a Hb of 5.7 g per dL. A direct antiglobulin test was negative x 2. The peripheral blood smear, which was reviewed by our hematologist, demonstrated many spherocytes, numerous ghost erythrocytes and toxic changes in the neutrophils with Döhle bodies. A computed tomography scan of the abdomen showed the interval development of a large complex heterogeneous low density mass lesion replacing almost the entire right hepatic lobe. The patient became progressively hypotensive and tachycardic and therapy for presumed sepsis was initiated with cefepime, vancomycin, amikacin and metronidazole. The patient was taken to interventional radiology for a percutaneous hepatic drainage catheter, and a total of 30-40 mL of brown/red serous fluid was removed. The anaerobic culture from the liver abscess grew out Clostridium perfringens. The patient's clinical status gradually improved and he was discharged 17 days after admission. Clostridium perfringens sepsis is an uncommon and frequently lethal disease that can occur in patients with underlying gastrointestinal, genitourinary and hematologic malignancies. This case illustrates that Clostridium perfringens sepsis should be in the differential diagnosis for any patient who has an underlying malignancy and presents with massive intravascular hemolysis, spherocytosis and septic shock.

急性胆嚢炎に合併した高度溶血を伴うClostridium perfringens 敗血症の1例

急性胆嚢炎に合併した高度溶血を伴うClostridium perfringens 敗血症の1例

Intravascular Haemolysis and Septicaemia Due to Clostridium Perfringens Liver Abscess

Intravascular haemolysis is a rare but serious complication of Clostridium perfringens sepsis. The outcome is usually fatal unless treatment is started early. We describe a case of survival after haemolysis and multiple organ failure in the setting of a ruptured liver abscess and sepsis caused by C. perfringens in an immunocompetent 58-year-old male.

Survival of Clostridium perfringens sepsis in a liver transplant recipient

Clostridium perfringens sepsis following orthotopic liver transplantation (OLT) is a rare but reported complication that historically results in mortality or emergent retransplantation (ReTx). Complications from C. perfringens emphysematous gastritis have contributed to the death of a healthy live liver donor as well. Herein, we describe the first documented survivor of C. perfringens sepsis following OLT managed without laparotomy or emergent ReTx.

Massive hemolysis associated with Clostridium perfringens sepsis

Massive hemolysis associated with Clostridium perfringens sepsis

Fulminant liver failure due to Clostridium perfringens sepsis 9 years after liver transplantation

Fulminant liver failure due to Clostridium perfringens sepsis 9 years after liver transplantation

Massive Intravascular Hemolysis: A Fatal Complication of Clostridium Perfringens Septicemia in a Patient with Acute Myeloid Leukemia

We describe a fatal case of a 74-year old man with acute myeloid leukemia complicated by massive intravascular hemolysis due to Clostridium perfringens sepsis.

Devastating Presentations of Regional Enteritis (Crohn's Disease): Two Reports of Survival Following Severe Multiple Organ Dysfunction Syndrome

Regional enteritis may present in the setting of a variety of clinical symptoms. These symptoms range from mild to severe. Here we describe two different presentations of regional enteritis (Crohn's disease): one in the setting of Clostridium perfringens sepsis and the second in association with hemolytic-uremic syndrome. Both presentations resulted in life-threatening multiple organ dysfunction syndrome. Following appropriate surgical management and intensive physiologic support, both patients recovered, despite a MODS-predicted risk of mortality of 100% and 91%, respectively. Fulminant presentations of regional enteritis of this magnitude are rare, and highlight the resolution of severe multiple organ dysfunction for each presentation.

Clostridium perfringens septicemia with massive hemolysis in a patient with Hodgkin's lymphoma

A 55-year-old woman with stage IV-B nodular sclerosing Hodgkin's lymphoma presented to the emergency department with fever and lethargy of 12 hours' duration. The patient developed massive intravascular hemolysis secondary to Clostridium perfringens sepsis and cardiac arrest unresponsive to transfusions and cardiac pulmonary resuscitation, and died within 4 hours of presentation. The differential diagnosis of massive intravascular hemolysis, as well as the pathogenesis and treatment of C perfringens-induced hemolysis, are discussed.