Clostridium Perfringens Septicemia Research Articles

Severe Intravascular Hemolysis from Clostridium perfringens Septicemia in a Neonate with Necrotizing Enterocolitis in China: A Case Report

Clostridium perfringens (C. perfringens) is a gram-positive anaerobic bacillus. As an opportunistic pathogen, C. perfringens can colonize the intestine of infants, but highly pathogenic forms are uncommon in newborns. Sporadic cases of neonatal infection have been reported worldwide, but no case has yet been reported in Chinese neonates. We herein report the first Chinese neonate who developed severe intravascular hemolysis and necrotizing enterocolitis following C. perfringens septicemia. A 7-day-old full-term female newborn was admitted to our hospital with necrotizing enterocolitis. The patient developed severe intravascular hemolysis on the day of admission and underwent continuous renal replacement therapy for hyperkalemia and severe acute kidney injury. Despite optimal treatment, this baby died at 20 hours after admission. Clinical metagenomic next-generation sequencing for pathogen detection showed a positive result for C. perfringens. Literature on C. perfringens-associated sepsis in neonates was reviewed to offer a reference for clinical practice. Our case demonstrates that neonatologists should consider a diagnosis of C. perfringens infection in a newborn when symptoms of severe intestinal infection and intravascular hemolysis are present, so that early treatment can be initiated.

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.

Pyogenic Liver Abscesses and Multi-Organ Failure Secondary to Clostridium perfringens Septicemia

Pyogenic Liver Abscesses and Multi-Organ Failure Secondary to Clostridium perfringens Septicemia

Massive Intravascular Hemolysis From Clostridium perfringens Septicemia

We describe the case of a patient with hemolysis-associated Clostridium perfringens septicemia and review all similar cases published in the literature since 1990, with specific focus on the relationship between treatment strategy and survival. We searched PubMed for all published cases of C. perfringens-associated hemolysis, using the medical subject terms “clostridia,” “clostridial sepsis,” and/or “hemolysis.” All case reports, case series, review articles, and other relevant references published in the English literature since 1990 were included in this study. There were no exclusion criteria. Each case was examined with respect to presenting features of illness, antibiotic regimen, time-to-antibiotic therapy, additional interventions, complications, and patient survival. These variables were entered into a data set and then systematically analyzed with the aid of a statistician, using serial t tests and chi-square analyses. Since 1990, 50 patients of C. perfringens septicemia with hemolysis have been reported. Median age was 61 years (range 31-84), and 58% were male. Mortality was 74%, with a median time to death of 9.7 hours (range 0-96 hours). Of the patients, 35 (70%) were treated medically, while 15 (30%) received antibiotics and surgery. Surgical intervention was associated with significantly improved survival (risk ratio [RR] 0.23, 95% confidence interval [CI] 0.10, 0.53) as was the use of a combination of penicillin and clindamycin (RR of death 0.46, 95% CI 0.25, 0.83). Four patients utilizing hyperbaric oxygen therapy (HBOT) have been reported, and all patients survived. In cases of clostridial sepsis with hemolysis, strong predictors of survival include early initiation of appropriate antibiotics as well as surgical removal of infected foci. The HBOT may also be associated with survival. The disease often progresses rapidly to death, so rapid recognition is critical for the patient survival.

Fulminant Hepatic Failure and Gas Gangrene Secondary to Clostridium Perfringens Septicemia

Purpose:Clostridium perfringens is an exotoxin producing bacteria, and can be found in the intestinal tract of humans. Their invasive nature as pathogens can be attributed to physical trauma or surgical procedures, with resulting evidence of myonecrosis. We present a unique case of fulminant liver failure with gas gangrene, pneumobilia, myonecrosis, and splenorenal shunt phlebitis in an Asian female, without recent history of physical trauma or surgery. An 81-year-old female with history of Diabetes Mellitus presented with acute complaints of fever and altered mental status. Exam was significant for an erythematous rash on the right knee, without evidence of trauma. Labs were significant for leukocytosis, elevated LFTs (AST/ALT >2600 IU/L), and coagulopathy. CT scan of the abdomen revealed two necrotic masses in the right hepatic lobe, pneumobilia, and splenorenal shunt septic phlebitis. Additionally, multiple areas of intramuscular air were noted within the gluteus maximums muscles. The patient was started on broad spectrum antibiotics but expired within 12 hours. Blood cultures revealed C. perfringens after 24 hours of incubation. C. perfringens, is a gram-positive, rod-shaped, anaerobic, spore forming bacterium. These environmental bacteria enter the muscle tissue via a wound, resulting in tissue necrosis and systemic spread. Gas gangrene found in the liver with fulminant hepatic failure is exceedingly rare, especially in constellation with pneumobilia, myonecrosis, and splenorenal shunt septic phlebitis. Management consists of medical therapy with penicillin and clindamycin. Aggressive surgical debridement and excision of affected tissue is vital to increasing the likelihood of survival. A few rare cases of spontaneous gas gangrene have been described in the literature attributed to C. perfringens. None have shown the manifestations of fulminant hepatic failure with gas gangrene along with pneumobilia, splenorenal shunt phlebitis, and myonecrosis without preceding surgery or physical trauma. The exact incidence of this infectious process remains unknown because it is rapidly progressing and is often unrecognized in the emergency setting. Hematogenous seeding of muscles with bacteria from a gastrointestinal tract port of entry should be entertained. Early detection and diagnosis, together with proper supportive treatment, can improve patient outcomes.Figure: [1008]

大腸穿孔で発症し，急激な転帰をたどったClostridium perfringens感染症の一剖検例

大腸穿孔で発症し，急激な転帰をたどったClostridium perfringens感染症の一剖検例

Fatal massive hemolysis as the first manifestation of Clostridium perfringens septicemia in a patient with non-systematic or local predisposing disorder

We report a case of fulminant massive hemolysis due to Clostridium perfringens septicemia in an elderly patient with non-systematic or local predisposing disorder. The patient presented with atypical symptoms but the progress of the disease was extremely rapid and he died almost 3 h after his hospital admission. A focal infection or a possible portal of bacterial access was not found.

A Case of Clostridium perfringens Septicemia with Fatal Hemolytic Complication

Massive intravascular hemolysis secondary to Clostridium perfringens septicemia is rare but often fatal. We report a case of a fatal clostridial hemolytic complication in a 71-year-old woman with probable refractory anemia. The patient was admitted to the emergency room due to a comatose mental state and a high fever. Laboratory analysis showed massive hemolysis. She died from severe anemia two hours after admission. The next day, blood cultures grew gram positive cocci and boxcarshaped gram positive rods, which were identified as coagulase-negative staphylococci and C. perfringens, respectively.

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.

An autopsy case of the hepatocellular carcinoma associated with multiple myeloma which developed fatal massive hemolysis due to the Clostridium perfringens septicemia following TAE

An autopsy case of the hepatocellular carcinoma associated with multiple myeloma which developed fatal massive hemolysis due to the Clostridium perfringens septicemia following TAE

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.

Fatal Intravascular Hemolysis in a Patient with Clostridium perfringens Septicemia

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Investigation of the pathogenesis of massive hemolysis in a case ofClostridium perfringens septicemia

Massive hemolysis is a rare, usually fatal complication of Clostridium perfringens septicemia. Of all toxins produced by the bacterium, phospholipase C (PLC) is believed to be the most likely cause of hemolysis. An influence of neuraminidase has often been suspected. In the present study, a case of C. perfringens septicemia with acute massive intravascular hemolysis is described. It led to death within 4 h of admission to the hospital. While the course of events was comparable to previously reported cases, we succeeded in gaining deeper insight into the pathogenesis by monitoring serum anti-T titer and quantifying serum PLC activity during the course of the disease. We excluded an effect of neuraminidase by a negative direct antiglobulin test, a negative anti-T lectin test, and a steady serum anti-T titer of 1 in 32. Serum PLC activity, on the other hand, showed a nearly fivefold increase (6.0 to 27.3 U/l), which is consistent with the hypothesized dominant role of this enzyme.

Clostridium perfringens Septicemia with Massive Hemolysis

Massive hemolysis with acute renal failure occurred in a previously healthy 69-year-old patient as a complication of Clostridium perfringens septicemia secondary to gall bladder empyema. To our knowledge, this is one of the few patients with C. perfringens septicemia and massive intravascular hemolysis who survived the episode and regained a normal renal function.

Clostridium perfringens Septicemia in Acute Lymphocytic Leukemia

Clostridial septicemia is a rapidly progressive and often fatal infection that is being recognized with increased frequency in relationship to neoplastic disease.1Since children with acute leukemia are unusually susceptible to infection with uncommon or opportunistic pathogens, the presence of fever with signs and symptoms of gastrointestinal (GI) abnormalities in these children should signal prompt consideration of this infection. This report on a child with acute lymphocytic leukemia illustrates the rapidly fatal progression of septicemia withClostridium perfringens. Report of a Case.—This 5-year-old boy had been diagnosed as having acute lymphocytic leukemia two years ago. Two weeks prior to admission, he was found to be in hematologic relapse. He was treated with oral prednisone daily and received intravenous vincristine sulfate and daunorubicin hydrochloride once, and there was some hematologic improvement. Three days prior to admission, persistent epistaxis developed and the next day a low-grade fever was noted. There

Intraleukocytic Spore Formation and Leukocytic Vacuolization during Clostridium perfringens Septicemia

The case of a patient with fulminant Clostridium perfringens septicemia and intravascular hemolysis is presented. The organisms in the blood stream were in sufficient quantity to be detected on a peripheral blood smear, and some were found to be within leukocytes. In vivo spore formation by C. perfringens is thought to be uncommon; however, in this patient probable spore formation by this organism was observed within peripheral blood leukocytes. The peripheral polymorphonuclear leukocytes from this patient were also markedly vacuolated.

Clostridium perfringens septicemia with detection of phospbolipase C activity in the serum

Clostridium perfringens septicemia with massive hemolysis is described in an elderly woman with refractory anemia. This case is highly unusual in that (1) the diagnosis was made during life by discovery of the organisms on a routine peripheral blood film, and that (2) phospholipase C activity was detected in the serum.

Barium Enema Septicemia

A patient with acute leukemia and depressed bone marrow following chemotherapy developed a Clostridium perfringens septicemia immediately following a barium enema examination. Autopsy showed ulcerated colonic mucosa with phagocytized bacteria within the colonic wall. There was no leukemic involvement of the colon nor was there any intestinal perforation. Comparison of the antemortem and postmortem bacteriological findings as well as the temporal relationship leads us to incriminate the barium enema as the prime causative factor in this patient's fatal septicemia.

Barium enema septicemia. Occurrence in a patient with leukemia.

A patient with acute leukemia and depressed bone marrow following chemotherapy developed a Clostridium perfringens septicemia immediately following a barium enema examination. Autopsy showed ulcerated colonic mucosa with phagocytized bacteria within the colonic wall. There was no leukemic involvement of the colon nor was there any intestinal perforation. Comparison of the antemortem and postmortem bacteriological findings as well as the temporal relationship leads us to incriminate the barium enema as the prime causative factor in this patient's fatal septicemia.

Clostridium perfringenssepticemia as a postoperative complication of the newborn infant: Report of a case

Clostridium perfringenssepticemia as a postoperative complication of the newborn infant: Report of a case