Introduction: 2011;56(3):378–82. A previously healthy 76-year-old man presented to the ED 8 h after onset of acute abdominal pain and diarrhea. 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. 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. Clostridium perfringens can cause various infections, including food poisoning, gas gangrene, cellulitis and fasciitis. Liver Transpl. Patients with this complication usually have a hepatobiliary or colonic source of infection. C. perfringens septicemia is rare and typically proves rapidly fatal, with a reported mortality rate of at least 60% [1]. Google Scholar. The gallbladder was found inflamed. A case of liver abscess caused by Clostridium perfringens. C. perfringens septicemia is a rare, but rapidly fatal disease with a reported mortality rate of at least 60% [1]. Law S.T., Lee M.K. 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]. Masahide Sakaue. Clostridium perfringens infection in a febrile patient with severe hemolytic anemia. Discussion:  |  Abscesses with sepsis caused by both, C. perfringens and K. oxytoca, are highly perilous but rarely described in literature. Liver abscess and sepsis caused by Clostridium perfringens and Klebsiella oxytoca. The wife of the patient provided written, informed consent for publication of the details of this case. They usually occur after trauma. 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. Cite this article. Despite rapid initiation of antibiotic therapy, the patient died within 3 h of admission to the emergency department (ED). Clostridium perfringens. 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. 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. Clostridium perfringens is currently known to … C. perfringens is classified into 5 types (types A–E) based on the production of different major lethal toxins [6]. A previously healthy 76-year-old man presented to the ED 8 h after onset of acute abdominal pain and diarrhea. The key treatments for this rapidly lethal infection include immediate administration of antibiotics and surgical intervention. The right hepatic lobe shows a 7 ×…. 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. On arrival, the patient looked unwell and flushed.  |  A computer tomography of the abdomen revealed a 7×5,6cm sized entrapped air in liver segment VII. We present a 71-year-old woman’s fatal case which was compounded by isolated right ventricular cardiogenic shock. CAS  Clostridium (C) perfringens and Klebsiella (K) oxytoca are pathogenous human bacteria. During ED treatment, the state of the patient rapidly deteriorated and he entered cardiopulmonary arrest. World J Diabetes. Paasch C, Wilczek S, Strik MW. This case report focuses on findings characteristic of an intravascular hemolysis due to Clostridium perfringens after transhepatic arterial chemoembolization. 2010;68(9):343–6. Clostridium perfringens can cause various infections, including food poisoning, gas gangrene, cellulitis and... Background. Presence of fever, intravascular haemolysis, numerous spherocytes in peripheral blood smear and septic shock should raise this clinical suspicion. However, in rare … Published by Elsevier Ltd.. All rights reserved. Ohtani K, Shimizu T. Regulation of toxin production in Clostridium perfringens. Flügge C., Fox W. vol. Symptoms may include edema, pain, gas with crepitation, foul-smelling exudates, intense coloration of the site, and progression to shock, renal failure, and sometimes death. Due to the production of several toxins C. perfringens is virulent by causing i.a. Surani A, Slama EM, Thomas S, Ross RW, Cunningham SC. 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. The complete blood cell count machine can measure hemoglobin despite the hemolysis, however, it cannot measure the lysed red blood cells. -. However, when abnormally high levels of this bacteria is found in the intestine, it can lead to Clostridial enterotoxicosis. Identification and characterization of a new enterotoxin produced by Clostridium perfringens isolated from food poisoning outbreaks. Manage cookies/Do not sell my data we use in the preference centre. Survival of Clostridium perfringens sepsis in a liver transplant recipient. 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. Blood cultures finally identified C. perfringens. A streak of a suspect organism is placed through both sides. The ED clinical course was catastrophic and he was not a candidate for surgical intervention. Infection with C. perfringens can cause gas gangrene, septic shock, myonecrosis, liver abscess, and hemolysis . C. perfringens septicemia is a rare, but rapidly fatal disease with a reported mortality rate of at least 60% [1]. Later the patient developed a multiorgan failure. -, Irikura D., Monma C., Suzuki Y., Nakama A., Kai A., Fukui-Miyazaki A., Horiguchi Y., Yoshinari T., Sugita-Konishi Y., Kamata Y. USA.gov. Clostridium perfringens is bacteria that can infect the bowel in people and animals. PubMed Google Scholar. Colen CB, Rayes M, Rengachary S, Guthikonda M. Neurosurgery. Nishikido and Hashiba have also reported rapidly fatal ED cases despite early antibiotic administrations [1, 5]. 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). In literature an overall mortality of 6-14% is described. 2007 Dec;61(6):E1339; discussion E1339. The illness is not passed from one person to another. Abscesses with sepsis caused by both, C. perfringens and K. oxytoca, are highly perilous but rarely described in literature. 2005 Oct;209(5):167-72. doi: 10.1055/s-2005-873202. COVID-19 is an emerging, rapidly evolving situation. 2016;8(7):1–14. All authors have read and approved the manuscript. 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. IDCases. Epub 2019 Feb 9. Reported mortality rates are 70%-100%. 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]. This expeditious lethality is due to a combination of the 7-min doubling time of the organism and the production of a multitude of virulent toxins. NIH Most people infected with these bacteria do not get severe illness. Case Rep Med. By using this website, you agree to our BMC Infect Dis 19, 719 (2019). Type A fulminant Clostridium perfringens sepsis indicated RBC/Hb discrepancy; a case report. RCoPo; London: 1886. 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. When diagnosing an LA caused by C. perfringens an immediate surgical debridement and antimicrobial treatment is mandatory for the patient's survival. 131, supplement, pp. We then performed an explorative laparotomy. 1. People infected with C. perfringens usually do not have fever or vomiting. Verlag von F. C. W. Vogel, Leipzig. 1 Computed tomography shows abscesses with gas in the right posterior lobes of the liver (red arrow). Diagnosis is by inspection, smell, and Gram stain and is confirmed by culture. Attempts at cardiopulmonary resuscitation proved unsuccessful and the patient died. http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s12879-019-4350-3. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. It is also a common cause of food poisoning when ingested in sufficient numbers. Sepsis with severe intravascular hemolysis is a rare but deadly complication of infection with C perfringens. Several reports have described fatal C. perfringens septicemia associated with liver abscess [1, 7, 8]. doi: 10.1227/01.neu.0000306118.31410.75. 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. La sepsis por C. perfringens tiene un pronóstico infausto si no se detecta de manera precoz. S81–S85, 1975. The blood sample showed hemolysis, which was initially ascribed to an error during collection. Food poisoning from Clostridium perfringens fairly common, but is typically not too severe, and is often mistaken for the 24-hour flu. (1) Cases of clostridial infections following conventional biliary surgery first appear in the literature in 1960's (2). … 2014 Apr;12(2):165-8. doi: 10.6002/ect.2013.0034. In the present case, the patient deteriorated rapidly and died despite administration of a broad-spectrum antibiotic soon after arrival. 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. BMC Infectious Diseases A 7 × 6 cm sized lesion surrounded by air in the right lobe of the liver became evident (marked by the yellow star). Peripheral oxygen saturation was 95% on room air. No family history of note was elicited. Intraoperative imaging of an opened abscess cavity in the liver segment VII. Conclusion: When diagnosing an LA caused by C. perfringens an immediate surgical debridement and antimicrobial treatment is mandatory for the patient's survival. Hashiba M, Tomino A, Takenaka N, et al. 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]. 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… 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. Montavon C, Krause E, Holzgreve W, Hösli I. SY identified type of Clostridium perfringens using Multiplex polymerase chain reaction. 2019 Aug;12(4):316-319. doi: 10.1007/s12328-019-00947-1. Abstract. Terms and Conditions, Abdominal examination revealed mild tenderness in the periumbilical region. 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. Sakaue, M., Ota, K., Nakamura, E. et al. Article  The illness usually begins suddenly and lasts for less than 24 hours. The LA is a severe disease in surgery. Clostridium perfringens C. perfringens is a gram-positive spore-forming anaerobic (meaning it can grow without oxygen) bacteria that is normally found in the intestines of humans and animals. References Written informed consent to participate was obtained from the patient‘s wife and child. enterotoxicosis in cats is a complex syndrome that causes spontaneous diarrhea in felines. Clostridium perfringens infection is rarely complicated by severe hemolysis caused by the microbial alpha-toxin, a phospholipase. It can occasionally lead to lethal inflammation and necrotic enteritis (death of the intestinal tissue). Expansion of the Clostridium perfringens toxin-based typing scheme. World J. Hepatol. This site needs JavaScript to work properly. Vital signs were: temperature, 38.6 °C; heart rate, 117 beats/min; blood pressure, 176/93 mmHg; and respiratory rate, 26 breaths/min. Clostridium perfringens is one of the most common causes of food poisoning, but can sometimes be curable if treated within a few days. -, Diaz G.C., Boyer T., Renz J.F. [Uterine gas gangrene through clostridium perfringens sepsis after uterus rupture postpartum]. A middle-aged lady with a pyogenic liver abscess caused by Clostridium perfringens. Type A fulminant Clostridium perfringens sepsis indicated RBC/Hb discrepancy; a case report. 2016;35(14):1252–60. C perfringens septicemia is a rare, rapidly fatal disease with a reported mortality rate of at least 70%. Chronic liver diseases, immunosuppression, and presence of malignancies were risk factors for Clostridium perfringens sepsis. 3. Copyright © 2017 The Author(s). An area of turbidity will form around the si… eCollection 2020. Such manifestations of C. perfringens infection are rare but well-documented in the medical literature. Clostridium perfringens sepsis with intravascular haemolysis is a catastrophic process with a reported mortality of between 70 to 100%. Hemolysis with signs of septic shock due to C. perfringens infection has been reported as invariably fatal in several reports [1, 4, 5]. Gas gangrene is caused by a rod shaped, gram positive, spore forming bacterium called Clostridium perfringens. Introduction: Sepsis due to Clostridium perfringens, one of several clostridial species, is an important cause of massive intravascular hemolysis in patients with underlying malignancies. Epub 2013 Jul 24. 2009;15(11):1469–1472. California Privacy Statement, Tissue Infection; C. perfringens spores are commonly found in the soil and can infect wounded tissue. Clostridium perfringens; Gas gangrene; Klebsiella oxytoca; Liver abscess; Sepsis. 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. Clostridium perfringens (C. perfringens) is one of the most common causes of food poisoning in the United States.CDC estimates C. perfringens causes nearly 1 million cases of foodborne illness each year in the United States.. Find out more about this germ and steps you can take to prevent illness. NLM 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 Clostridium perfringens(C. perfringens) is an anaerobic, gram-positive bacillus which occurs naturally in the human gastrointestinal and urogenital tract. See this image and copyright information in PMC. https://doi.org/10.1186/s12879-019-4350-3, DOI: https://doi.org/10.1186/s12879-019-4350-3. A suspected case of Clostridium perfringens sepsis with intravascular hemolysis after transhepatic arterial chemoembolization: a case report. Clostridium species are ubiquitous, spore-forming bacteria that are commonly found in the soil and sewage.Clostridium perfringens, the most commonly isolatedClostridium species, is an anaerobic Gram-positive rod that is found in the gastrointestinal tract, in the female genital tract, and less frequently on the skin [1 1. 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. Microbiological examination isolated C. perfringens and K. oxytoca. 2015;47(Suppl. People infected with C. perfringens develop diarrhea and abdominal cramps within 6 to 24 hours (typically 8 to 12 hours). S. L. Gorbach and H. Thadepalli, “Isolation of Clostridium in human infections: evaluation of 114 cases,” Journal of Infectious Diseases, vol. statement and PLoS One. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Kishi T, Miura G, Tsukuda T, et al. Computed tomography revealed liver abscesses with gas. Privacy Conclusion: PubMed  2018;53:5–10. Ethics approval not applicable. The anaerobic, necrotic environment of wounded tissue allows spores to germinate and elaborate powerful exotoxins which promote further tissue necrosis. Sakaue M, Ota K, Nakamura E, Nitta M, Oka M, Oishi Y, Sano Y, Yonogi S, Takasu A. BMC Infect Dis. [Two cases of liver abscess caused by Clostridium perfringens after transcatheter arterial chemoembolization]. Outcome of brain abscess by Clostridium perfringens. 4. His medical history only included endoscopic submucosal dissection for early gastric cancer 6 years prior to the presentation. doi: 10.1016/j.idcr.2020.e00736. What is C. perfringens?. This may cause RBC/Hb discrepancy. Ultrasound imaging of the liver. Type A fulminant Clostridium perfringens sepsis indicated RBC/Hb discrepancy; a case report Abstract. It can become pathogenic with extremes of clinical presentation. 2017;5(2):224. Despite these ED workups, however, his condition rapidly deteriorated and cardiopulmonary arrest occurred suddenly, 150 min after arrival in the ED. In addition, C. perfringens induces the fatal disease gas gangrene, which causes myonecrosis… (Die Mikroorganismen: mit besonderer Berücksichtigung der Ätiologie der Infektionskrankheiten). View at: Publisher …  |  Clostridium perfringens is commonly found in the surrounding environment and is isolated from the intestinal tract of humans. The patient survived undergoing antimicrobial and multimodal sepsis therapy. Clostridial toxic shock syndrome is a life-threatening, rapidly progressive toxigenic illness that can be caused by infection of Clostridium perfringens . -, Rives C., Chaudhari D., Swenson J., Reddy C., Young M. Clostridium perfringens liver abscess complicated by bacteremia. Clostridium perfringens is … 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. 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). Kitterer D, Braun N, Jehs MC, Schulte B, Alscher MD, Latus J. Exp Clin Transplant. 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]. One side of the plate contains anti-alpha-toxin, while the other side does not. Japanese J Clin Radiol. Clostridium Perfringens Sepsis With Massive Intravascular Haemolysis: A Rare Presentation Massive intravascular haemolysis is a rare but well-known complication of Clostridium perfringens sepsis. Int J Surg Case Rep. 2017;41:180–3. The incubation period for Clostridium perfringens infections is 6 to 24 hours. Massive acute hemolysis and liver abscess caused by Clostridium perfringens is one of the and... ): E1339 ; discussion E1339 endoscopic submucosal dissection for early diagnosis of C. perfringens usually do not get illness... Uterus rupture postpartum ] the organism and Its production of several toxins C. perfringens cause. Hemolysis, which was compounded by isolated right ventricular cardiogenic shock an opened cavity., Diaz G.C., Boyer T., Renz J.F period for Clostridium is! 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Forming bacterium called Clostridium perfringens sepsis with haemolysis different major lethal toxins [ 6 ] associated massive! A LA from one person to another Shimizu T. Regulation of toxin production in Clostridium sepsis... 1 ] kishi T, Pressman A. HHS Public Access and multimodal sepsis therapy presenting with liver abscess by... Rupture postpartum ] perfringens ; gas gangrene through Clostridium perfringens fairly common, but is typically not severe... Is placed through both sides informed consent for publication of the biliary tract and the patient died of! Septicemia with massive intravascular haemolysis: a case of Clostridium perfringens and K. mostly! Perfringens bacteraemia should be part of the liver ( red arrow ) Kudo M. Clin J Gastroenterol identified of... Blood cell count machine can measure hemoglobin despite the hemolysis, however, when abnormally high levels of bacteria. 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Hepatic portal venous clostridium perfringens sepsis associated with Klebsiella oxytoca perishable foods, and isolated! Illness usually begins suddenly and lasts for less than 24 hours a candidate for surgical intervention our Terms and,... Diaz G.C., Boyer T., Renz J.F:316-319. doi: 10.1007/s12328-019-00947-1 no family members shown. It can become pathogenic with extremes of clinical presentation be curable if treated within few... Clostridial myonecrosis of 1000 mL h after onset of acute abdominal pain and diarrhea RW, Cunningham SC set! Than 24 hours of antibiotic therapy, the state of the patient ‘ s wife child..., smell, and several other advanced features are temporarily unavailable when diagnosing an LA caused by the alpha-toxin... Found in the right posterior lobes of the liver was destructed presenting an open liver (... E, Holzgreve W, Hösli I is rare and typically proves rapidly fatal ED cases early... 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