Clostridium (C) perfringens and Klebsiella (K) oxytoca are pathogenous human bacteria. 1). Clostridium perfringens is bacteria that can infect the bowel in people and animals. Cite this article. Chronic liver diseases, immunosuppression, and presence of malignancies were risk factors for Clostridium perfringens sepsis. the necrotizing fasciitis, gas gangrene and hepatic abscess. Masahide Sakaue. 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. Exotoxins produced by C. perfringens also cause disease in humans, including gas gangrene, enteritis necroticans, and food poisoning. Epub 2013 Jul 24. Reported mortality rates are 70%-100%. BMC Infect Dis 19, 719 (2019). Google Scholar. In light of this imaging result, he was treated empirically for suspected septicemia from liver abscesses with 1 g of meropenem after blood cultures were obtained. SY identified type of Clostridium perfringens using Multiplex polymerase chain reaction. When diagnosing an LA caused by C. perfringens an immediate surgical debridement and antimicrobial treatment is mandatory for the patient's survival. Colen CB, Rayes M, Rengachary S, Guthikonda M. Neurosurgery. Intravascular hemolysis and RBC/Hb discrepancy in the presence of infection should prompt ED physicians to consider C. perfringens septicemia and to act quickly to treat the infection. Presentation of case: Attempts at cardiopulmonary resuscitation proved unsuccessful and the patient died.  |  Clostridium perfringens bacteraemia should be part of the differential if patients have severe sepsis with haemolysis. The LA is a severe disease in surgery. California Privacy Statement, 1. 2015;2015:1–3. Gas gangrene is caused by a rod shaped, gram positive, spore forming bacterium called Clostridium perfringens. Ohtani K, Shimizu T. Regulation of toxin production in Clostridium perfringens. Terms and Conditions, Patients with this complication usually have a hepatobiliary or colonic source of infection. Clostridium perfringens sepsis should always be considered in patients presenting with liver damage after chemo-embolic therapy for hepatocellular carcinoma. Copyright © 2017 The Author(s). The illness that results from a toxin produced by the bacteria is called Clostridium perfringens enteritis. Clostridial soft-tissue infections include cellulitis, myositis, and clostridial myonecrosis. 3. … Computed tomography performed 45 min after arrival in the ED revealed abscesses with gas in the right posterior lobes of the liver (Fig. Presence of fever, intravascular haemolysis, numerous spherocytes in peripheral blood smear and septic shock should raise this clinical suspicion. Due to the production of several toxins C. perfringens is virulent by causing i.a. Computed tomography revealed liver abscesses with gas. Clostridium perfringens; Gas gangrene; Klebsiella oxytoca; Liver abscess; Sepsis. RCoPo; London: 1886. Most people infected with these bacteria do not get severe illness. K. oxytoca mostly causes infections of the respiratory and gastrointestinal tract. BMC Infectious Diseases The authors declare that they have no competing interests. Intraoperatively it became clear that the liver was destructed presenting an open liver abscess (LA) cavity of segment VII. Despite rapid initiation of antibiotic therapy, the patient died within 3 h of admission to the emergency department (ED). Clostridium perfringens is currently known to … Clostridium perfringens infection in a febrile patient with severe hemolytic anemia. A previously healthy 76-year-old man presented to the ED 8 h after onset of acute abdominal pain and diarrhea. Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 596-8686, Japan, Masahide Sakaue, Koshi Ota, Eriko Nakamura, Masahiko Nitta, Masahiro Oka, Yasuo Oishi, Yohei Sano & Akira Takasu, Osaka Institute of Public Health, Osaka, Japan, You can also search for this author in The wife of the patient provided written, informed consent for publication of the details of this case. Ultrasound imaging of the liver. The incubation period for Clostridium perfringens infections is 6 to 24 hours. He was treated with fluid replacement of 1000 mL. If food that contains spores is not eaten soon after it is cooked, the spores develop into active clostridia bacteria, which then multiply in the food. Ultrasound imaging of the liver. In literature an overall mortality of 6-14% is described. Springer Nature. Tanaka H, Watanabe T, Nagai T, Minaga K, Kamata K, Komeda Y, Kudo M. Clin J Gastroenterol. 2011;56(3):378–82. Kitterer D, Braun N, Jehs MC, Schulte B, Alscher MD, Latus J. Exp Clin Transplant. Case Rep Med. He had eaten no perishable foods, and no family members had shown any symptoms. Abstract. Computed tomography shows abscesses with gas in the right posterior lobes of the liver (red arrow). A streak of a suspect organism is placed through both sides. The anaerobic, necrotic environment of wounded tissue allows spores to germinate and elaborate powerful exotoxins which promote further tissue necrosis. Such manifestations of C. perfringens infection are rare but well-documented in the medical literature. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. However, in the past 50 years, with refinements in anaerobic bacteriologic techniques and more routine anaerobic culturing [4], it has become apparent that the anaerobic, gram-p… 4. Clostridium perfringens is one of the most common causes of food poisoning, but can sometimes be curable if treated within a few days. 2013 Nov;40(12):1795-7. Epub 2019 Feb 9. Abdominal examination revealed mild tenderness in the periumbilical region. The key treatments for this rapidly lethal infection include immediate administration of antibiotics and surgical intervention. USA.gov. During the first half of the 20th century, clostridial infections, usually with Clostridium perfringens, were associated with extremely serious soft-tissue and muscle infections, such as gas gangrene, which often occurred in patients who had fecally contaminated farm wounds, war wounds, intra-abdominal sepsis, or septic abortion [1–3]. Mostly bacterial infections of the biliary tract and the gallbladder are responsible for a LA. 2016;35(14):1252–60. Written informed consent to participate was obtained from the patient‘s wife and child. The gallbladder was found inflamed. https://doi.org/10.1186/s12879-019-4350-3, DOI: https://doi.org/10.1186/s12879-019-4350-3. Cochrane J, Bland L, Noble M. Intravascular hemolysis and septicemia due to Clostridium perfringens emphysematous cholecystitis and hepatic abscesses. Hashiba M, Tomino A, Takenaka N, et al. The blood sample showed hemolysis, which was initially ascribed to an error during collection. View at: Publisher … 1 A 7 × 6 cm sized lesion surrounded…, Computer tomography of the abdomen. Conclusion: Multiplex polymerase chain reaction only identified expression of the α toxin gene, and the pathogen isolated from the present patient was shown to be C. perfringens type A (Table 1). It can become pathogenic with extremes of clinical presentation. This may cause RBC/Hb discrepancy. 2019 Aug 15;19(1):719. doi: 10.1186/s12879-019-4350-3. (1) Cases of clostridial infections following conventional biliary surgery first appear in the literature in 1960's (2). Blood cultures finally identified C. perfringens. Toxins (Basel). by Vittoria Lipari and Andréanne Breton-Carbonneau Introduction Clostridium perfringens is the 3rd most common form of food poisoning, causing 1 million cases of food poisoning per year. PubMed Google Scholar. -, Rives C., Chaudhari D., Swenson J., Reddy C., Young M. Clostridium perfringens liver abscess complicated by bacteremia. HHS Type A fulminant Clostridium perfringens sepsis indicated RBC/Hb discrepancy; a case report Abstract. However, in rare … Clostridium perfringens is commonly found in the surrounding environment and is isolated from the intestinal tract of humans. It can occasionally lead to lethal inflammation and necrotic enteritis (death of the intestinal tissue). On arrival, the patient looked unwell and flushed. PubMed  1 Its expeditious lethality is due to a combination 7-minute doubling time of the organism and its production of a multitude of virulent toxins. The disease was called “Darmbrand” (meaning “fire bowels”) in Germany and “Pig bel” in Papua New Guinea. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Sepsis with severe intravascular hemolysis is a rare but deadly complication of infection with C perfringens. Cookies policy. Food poisoning from Clostridium perfringens fairly common, but is typically not too severe, and is often mistaken for the 24-hour flu. Japanese J Clin Radiol. C. perfringens septicemia is a rare, but rapidly fatal disease with a reported mortality rate of at least 60% [1]. van Bunderen CC, Bomers MK, Wesdorp E, Peerbooms P, Veenstra J. Clostridium perfringens septicaemia with massive intravascular haemolysis: a case report and review of the literature. During ED treatment, the state of the patient rapidly deteriorated and he entered cardiopulmonary arrest. Oshima S, Takaishi K, Tani N, Hirano M, Ikeda K, Makari Y, Hoshi M, Doi T, Kobori Y, Kurokawa E, Tamura S. Gan To Kagaku Ryoho. The complete blood cell count machine can measure hemoglobin despite the hemolysis, however, it cannot measure the lysed red blood cells. Other data were as follows: white blood cell count, 20,900/mm3 with 85.6% neutrophils; C-reactive protein, 4.70 mg/dL; procalcitonin, 28.82 ng/mL; platelet count, 545,000/μL; blood urea nitrogen, 27 mg/dL; creatinine, 2.42 mg/dL; serum aspartate aminotransferase, 874 IU/ L; serum alanine aminotransferase, 299 IU/L; and lactate dehydrogenase, 7605 IU/L; Na, 124 mEq/L; Cl, 92 mEq/L; K, 5.8 mEq/L. Clostridium perfringens(C. perfringens) is an anaerobic, gram-positive bacillus which occurs naturally in the human gastrointestinal and urogenital tract. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Nishikido and Hashiba have also reported rapidly fatal ED cases despite early antibiotic administrations [1, 5]. 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. By using this website, you agree to our A suspected case of Clostridium perfringens sepsis with intravascular hemolysis after transhepatic arterial chemoembolization: a case report. Discussion: Surani A, Slama EM, Thomas S, Ross RW, Cunningham SC. References 2015;47(Suppl. C. perfringens type A produces an α-toxin that induces hemolysis by destroying red blood cells, resulting in a failure to supply oxygen to tissues [2, 3]. Arterial blood gas analysis revealed metabolic acidosis and compensatory respiratory alkalosis (pH, 7.486; partial pressure of arterial carbon dioxide, 16.1 mmHg; partial pressure of arterial oxygen, 66.1 mmHg; lactate, 86.4 mg/dL; base excess, − 9.2 mmol/L). Correspondence to Peripheral oxygen saturation was 95% on room air. They usually occur after trauma. Clostridium perfringens can cause various infections, including food poisoning, gas gangrene, cellulitis and... Background. -, Irikura D., Monma C., Suzuki Y., Nakama A., Kai A., Fukui-Miyazaki A., Horiguchi Y., Yoshinari T., Sugita-Konishi Y., Kamata Y. The right hepatic lobe shows a 7 ×…. MS, EN, MN, MO, YO and YS treated the patient, made the clinical diagnosis, MS, KO and AT wrote and revised the manuscript. Hepatic portal venous gas associated with Klebsiella oxytoca infection in the absence of preceding antibiotic treatment. 2009;15(11):1469–1472. What is C. perfringens?. 1. -. No family history of note was elicited. We are presenting the case of a male patient at the age of 64, who suffered from nausea and progressive pain in the right upper abdomen. Uojima H, Onoue M, Hidaka H, Wada N, Tanaka Y, Inoue T, Kubota K, Nakazawa T, Shibuya A, Koizumi W. J Med Case Rep. 2019 Apr 27;13(1):125. doi: 10.1186/s13256-019-2023-x. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Hemolysis with signs of septic shock due to C. perfringens infection has been reported as invariably fatal in several reports [1, 4, 5]. Necrotizing enteritis (enteritis necroticans, NEC) is a life-threatening infection caused by Clostridium perfringens type C and type A and characterized by ischemic necrosis of the jejunum and gas in the tissue plane. Sakaue, M., Ota, K., Nakamura, E. et al. A 7 × 6 cm sized lesion surrounded by air in the right lobe of the liver became evident (marked by the yellow star). COVID-19 is an emerging, rapidly evolving situation. Blood smear is a clue for early diagnosis of C. perfringens bacteraemia. C. perfringens septicemia is rare and typically proves rapidly fatal, with a reported mortality rate of at least 60% [1]. 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