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Tanaka H, Watanabe T, Nagai T, Minaga K, Kamata K, Komeda Y, Kudo M. Clin J Gastroenterol. The blood sample showed hemolysis, which was initially ascribed to an error during collection. IDCases. 1. Verlag von F. C. W. Vogel, Leipzig. C. perfringens septicemia is a rare, but rapidly fatal disease with a reported mortality rate of at least 60% [1]. Peripheral oxygen saturation was 95% on room air. Type A fulminant Clostridium perfringens sepsis indicated RBC/Hb discrepancy; a case report. By using this website, you agree to our An area of turbidity will form around the si… The complete blood cell count machine can measure hemoglobin despite the hemolysis, however, it cannot measure the lysed red blood cells. Abdominal examination revealed mild tenderness in the periumbilical region. Paasch C, Wilczek S, Strik MW. 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/. Liver abscess and sepsis caused by Clostridium perfringens and Klebsiella oxytoca. 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. C. perfringens septicemia is a rare, but rapidly fatal disease with a reported mortality rate of at least 60% [1]. Survival of Clostridium perfringens sepsis in a liver transplant recipient. The illness that results from a toxin produced by the bacteria is called Clostridium perfringens enteritis. The bacterium lives in anaerobic environments like the soil and inside the gut of humans and animals. Nishikido and Hashiba have also reported rapidly fatal ED cases despite early antibiotic administrations [1, 5]. No family history of note was elicited. 1 COVID-19 is an emerging, rapidly evolving situation. Ultrasound imaging of the liver. In the present case, the patient deteriorated rapidly and died despite administration of a broad-spectrum antibiotic soon after arrival. 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. This case report focuses on findings characteristic of an intravascular hemolysis due to Clostridium perfringens after transhepatic arterial chemoembolization. In addition, C. perfringens induces the fatal disease gas gangrene, which causes myonecrosis… The anaerobic, necrotic environment of wounded tissue allows spores to germinate and elaborate powerful exotoxins which promote further tissue necrosis. Rood JI, Adams V, Lacey J, et al. C. perfringens is ever-present in nature and can be found as a normal component of decaying vegetation, marine sediment, the intestinal tract of humans and other vertebrates, insects, and soil. Clostridium perfringens sepsis should always be considered in patients presenting with liver damage after chemo-embolic therapy for hepatocellular carcinoma. The incubation period for Clostridium perfringens infections is 6 to 24 hours. However, in rare … The illness is not passed from one person to another. All types of C. perfringens produce α toxin [3], which has been reported to hydrolyze phospholipids in red blood cell membranes, leading to massive hemolysis and severe tissue hypoxia due to the failure of oxygen transport functions [2, 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. Gas gangrene is caused by a rod shaped, gram positive, spore forming bacterium called Clostridium perfringens. Food poisoning from Clostridium perfringens fairly common, but is typically not too severe, and is often mistaken for the 24-hour flu. 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. Kitterer D, Braun N, Jehs MC, Schulte B, Alscher MD, Latus J. Exp Clin Transplant. Clostridial toxic shock syndrome is a life-threatening, rapidly progressive toxigenic illness that can be caused by infection of Clostridium perfringens . Keywords: Clostridium perfringens, Hemolysis, Liver abscess, Shock, Sepsis Background Clostridium perfringens is one of the most common causes of food poisoning, but can sometimes be curable if treated within a few days. Clostridium Perfringens Sepsis With Massive Intravascular Haemolysis: A Rare Presentation Massive intravascular haemolysis is a rare but well-known complication of Clostridium perfringens sepsis. Type A fulminant Clostridium perfringens sepsis indicated RBC/Hb discrepancy; a case report Abstract. C perfringens septicemia is a rare, rapidly fatal disease with a reported mortality rate of at least 70%. Part of  |  SY identified type of Clostridium perfringens using Multiplex polymerase chain reaction. We successfully conducted the consistent debridement of segment VII and removed the gallbladder. Clostridium perfringens can cause various infections, including food poisoning, gas gangrene, cellulitis and fasciitis. Clostridium perfringenssepsis has been ascribed a dismal prognosis when associated with massive intravascular haemolysis. enterotoxicosis in cats is a complex syndrome that causes spontaneous diarrhea in felines. Laboratory examination revealed a discrepancy between the red blood cell count (RBC) of 1.91 × 106/mm3 and the hemoglobin (Hb) level of 10.3 g/dL. 2009;15(11):1469–1472. The wife of the patient provided written, informed consent for publication of the details of this case. https://doi.org/10.1186/s12879-019-4350-3, DOI: https://doi.org/10.1186/s12879-019-4350-3. Clostridium perfringens is commonly found in the surrounding environment and is isolated from the intestinal tract of humans. 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 Several reports have described fatal C. perfringens septicemia associated with liver abscess [1, 7, 8]. Abscesses with sepsis caused by both, C. perfringens and K. oxytoca, are highly perilous but rarely described in literature. The illness usually begins suddenly and lasts for less than 24 hours. [Uterine gas gangrene through clostridium perfringens sepsis after uterus rupture postpartum]. Google Scholar. 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. Conclusion: When diagnosing an LA caused by C. perfringens an immediate surgical debridement and antimicrobial treatment is mandatory for the patient's survival. 2013 Nov;40(12):1795-7. Z Geburtshilfe Neonatol. Anaerobe. Nishikido T, Tamemoto H, Kurasawa M, Koike J, Tominaga S. Gas-forming liver abscess associated with rapid hemolysis in a diabetic patient. 2012;4(8):252–255. 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… Epub 2019 Feb 9. It is also a common cause of food poisoning when ingested in sufficient numbers. 2014 Apr;12(2):165-8. doi: 10.6002/ect.2013.0034. Introduction: Patients with this complication usually have a hepatobiliary or colonic source of infection. Other articles where Clostridium perfringens is discussed: clostridial infection: Enterotoxins produced by C. perfringens cause several gastrointestinal diseases in sheep, including lamb dysentery, struck, and pulpy kidney. doi: 10.1016/j.idcr.2020.e00736. This site needs JavaScript to work properly. Int J Surg Case Rep. 2017;41:180–3. C. perfringens can be diagnosed by Nagler’s reaction, where the suspect organism is cultured on an egg yolk media plate. 1. Toxins (Basel). NIH Clostridium perfringens and its toxins are found everywhere in the environment, but human infection is most likely to come from eating food with Clostridium perfringens in it. A suspected case of Clostridium perfringens sepsis with intravascular hemolysis after transhepatic arterial chemoembolization: a case report. His medical history only included endoscopic submucosal dissection for early gastric cancer 6 years prior to the presentation. Masahide Sakaue. Clostridium perfringens (formerly known as C. welchii, or Bacillus welchii) is a Gram-positive, rod-shaped, anaerobic, spore-forming pathogenic bacterium of the genus Clostridium. Clostridium perfringens infection is rarely complicated by severe hemolysis caused by the microbial alpha-toxin, a phospholipase. 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). California Privacy Statement, 2019 Aug;12(4):316-319. doi: 10.1007/s12328-019-00947-1. 2010;68(9):343–6. Manage cookies/Do not sell my data we use in the preference centre. the necrotizing fasciitis, gas gangrene and hepatic abscess. 1) UCTN:E457. The patient survived undergoing antimicrobial and multimodal sepsis therapy. 1). Clostridium perfringens bacterium is a normal bacteria found in the environment, commonly inhabiting decaying vegetation and marine sediment, as well as raw or improperly cooked meats and poultry. We present a 71-year-old woman’s fatal case which was compounded by isolated right ventricular cardiogenic shock. volume 19, Article number: 719 (2019) Clostridium (C) perfringens and Klebsiella (K) oxytoca are pathogenous human bacteria. 2005 Oct;209(5):167-72. doi: 10.1055/s-2005-873202. Blood cultures finally identified C. perfringens. 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). We report herein a case of fulminant C. perfringens septicemia with massive acute hemolysis and liver abscess. This may cause RBC/Hb discrepancy. Outcome of brain abscess by Clostridium perfringens. Two sets of 10-mL blood had been obtained (1 each for the aerobic and anaerobic bottles) on his arrival and submitted to our central laboratory after standing at room temperature for 12 h. The bottles were incubated for 48 h using the representative automated blood culture system (BACT/ALERT 3D; bioMérieux, Inc., Durham, NC) and C. perfringens was identified by the anaerobic blood cultures. Google Scholar. Gas gangrene caused by clostridium perfringens involving the liver, spleen, and heart in a man 20 years after an orthotopic liver transplant: a case report. Hashiba M, Tomino A, Takenaka N, et al. He was treated with fluid replacement of 1000 mL. Ethics approval not applicable. A previously healthy 76-year-old man presented to the ED 8 h after onset of acute abdominal pain and diarrhea. Type A fulminant Clostridium perfringens sepsis indicated RBC/Hb discrepancy; a case report. It is thought that the infection is established by hematogenous spread from the gastrointestinal tract. C. perfringens is classified into 5 types (types A–E) based on the production of different major lethal toxins [6]. Hepatic portal venous gas associated with Klebsiella oxytoca infection in the absence of preceding antibiotic treatment. BMC Infectious Diseases Case Rep Med. MS, EN, MN, MO, YO and YS treated the patient, made the clinical diagnosis, MS, KO and AT wrote and revised the manuscript. Clostridium perfringens bacteraemia should be part of the differential if patients have severe sepsis with haemolysis. Terms and Conditions, Computed tomography performed 45 min after arrival in the ED revealed abscesses with gas in the right posterior lobes of the liver (Fig. USA.gov. When diagnosing an LA caused by C. perfringens an immediate surgical debridement and antimicrobial treatment is mandatory for the patient's survival. Despite rapid initiation of antibiotic therapy, the patient died within 3 h of admission to the emergency department (ED). Conclusion: Am J Case Rep. 2016;17:219–23. Clostridium perfringens food poisoning (a type of gastroenteritis) can develop when people eat food (usually beef) that contains clostridia.Clostridia develop from spores, which can survive the heat of cooking. Clostridium perfringens can cause various infections, including food poisoning, gas gangrene, cellulitis and... Background. Clipboard, Search History, and several other advanced features are temporarily unavailable. Presentation of case: References -. The gallbladder was found inflamed. Sakaue, M., Ota, K., Nakamura, E. et al. (Die Mikroorganismen: mit besonderer Berücksichtigung der Ätiologie der Infektionskrankheiten). RCoPo; London: 1886. Epub 2013 Jul 24. What is C. perfringens?. -, Diaz G.C., Boyer T., Renz J.F. 2015;10(11):e0138183. Computed tomography shows abscesses with gas in the right posterior lobes of the liver (red arrow). However, when abnormally high levels of this bacteria is found in the intestine, it can lead to Clostridial enterotoxicosis. C. perfringens is an anaerobic Gram-positive bacillus usually found in the human gastrointestinal tract, and is most well-known as the cause of gas gangrene [1]. The right hepatic lobe shows a 7 × 6 cm sized area of low attenuation containing mostly air (marked by the yellow star). On arrival, the patient looked unwell and flushed. Keywords: 2019 Aug 15;19(1):719. doi: 10.1186/s12879-019-4350-3. Chronic liver diseases, immunosuppression, and presence of malignancies were risk factors for Clostridium perfringens sepsis. In literature an overall mortality of 6-14% is described. Endoscopy. Reported mortality rates are 70%-100%. We then performed an explorative laparotomy. Discussion: Published by Elsevier Ltd.. All rights reserved. The authors declare that they have no competing interests. A middle-aged lady with a pyogenic liver abscess caused by Clostridium perfringens. Such manifestations of C. perfringens infection are rare but well-documented in the medical literature. Google Scholar. Clostridium perfringens is one of the most common causes of food poisoning, but can sometimes be curable if treated within a few days. Kishi T, Miura G, Tsukuda T, et al. Sakaue M, Ota K, Nakamura E, Nitta M, Oka M, Oishi Y, Sano Y, Yonogi S, Takasu A. BMC Infect Dis. Privacy [Two cases of liver abscess caused by Clostridium perfringens after transcatheter arterial chemoembolization]. Blood smear is a clue for early diagnosis of C. perfringens bacteraemia. Tissue Infection; C. perfringens spores are commonly found in the soil and can infect wounded tissue. Clostridium perfringens infection in a febrile patient with severe hemolytic anemia. Computer tomography of the abdomen. A computer tomography of the abdomen revealed a 7×5,6cm sized entrapped air in liver segment VII. Attempts at cardiopulmonary resuscitation proved unsuccessful and the patient died. They usually occur after trauma. The ED clinical course was catastrophic and he was not a candidate for surgical intervention. 131, supplement, pp. Ohtani K, Shimizu T. Regulation of toxin production in Clostridium perfringens. One side of the plate contains anti-alpha-toxin, while the other side does not. NLM 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. View at: Publisher … Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Exotoxins produced by C. perfringens also cause disease in humans, including gas gangrene, enteritis necroticans, and food poisoning. Introduction: Sepsis due to Clostridium perfringens, one of several clostridial species, is an important cause of massive intravascular hemolysis in patients with underlying malignancies. People infected with C. perfringens usually do not have fever or vomiting. eCollection 2020. (1) Cases of clostridial infections following conventional biliary surgery first appear in the literature in 1960's (2). 2016;35(14):1252–60. 3. Most people infected with these bacteria do not get severe illness. Heart sounds were normal, the lungs were clear to auscultation, and results of neurological and skin examinations were unremarkable. Law S.T., Lee M.K. Due to the production of several toxins C. perfringens is virulent by causing i.a. HHS Intraoperatively it became clear that the liver was destructed presenting an open liver abscess (LA) cavity of segment VII. Intravascular 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. Clostridium perfringens. Cookies policy. C. perfringenssepticemia is a rare but often fatal condition which commonly originates in the uterus, colon, or biliary tract. S. L. Gorbach and H. Thadepalli, “Isolation of Clostridium in human infections: evaluation of 114 cases,” Journal of Infectious Diseases, vol. Intraoperative imaging of an opened abscess cavity in the liver segment VII. 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. 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]. Goadsby PJ, Kurth T, Pressman A. HHS Public Access. Later the patient developed a multiorgan failure. 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. Computed tomography revealed liver abscesses with gas. Although the exact mechanisms of entry into the blood stream remain unknown, bacterial translocation may occur via portal veins in proximity to abscesses in the liver [9]. 2015;47(Suppl. 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. The decision for immediate admission to the intensive care unit was made after consultation with the general surgery service to plan drainage of the abscesses. S81–S85, 1975. The LA is a severe disease in surgery. 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