The patient survived undergoing antimicrobial and multimodal sepsis therapy. doi: 10.1016/j.idcr.2020.e00736.  |  Food poisoning from Clostridium perfringens fairly common, but is typically not too severe, and is often mistaken for the 24-hour flu. NIH Infection with C. perfringens can cause gas gangrene, septic shock, myonecrosis, liver abscess, and hemolysis . 2. C. perfringens septicemia is a rare, but rapidly fatal disease with a reported mortality rate of at least 60% [1]. 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. 2010;68(9):343–6. -. C perfringens septicemia is a rare, rapidly fatal disease with a reported mortality rate of at least 70%. Gas gangrene is caused by a rod shaped, gram positive, spore forming bacterium called Clostridium perfringens. The blood sample showed hemolysis, which was initially ascribed to an error during collection. http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s12879-019-4350-3. Ethics approval not applicable. However, when abnormally high levels of this bacteria is found in the intestine, it can lead to Clostridial enterotoxicosis. 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 smear is a clue for early diagnosis of C. perfringens bacteraemia. Due to the production of several toxins C. perfringens is virulent by causing i.a. Anaerobe. Google Scholar. Springer Nature. World J. Hepatol. Endoscopy. Diagnosis is by inspection, smell, and Gram stain and is confirmed by culture. Survival of Clostridium perfringens sepsis in a liver transplant recipient. Written informed consent to participate was obtained from the patient‘s wife and child. In literature an overall mortality of 6-14% is described. Toxins (Basel). The wife of the patient provided written, informed consent for publication of the details of this case. Colen CB, Rayes M, Rengachary S, Guthikonda M. Neurosurgery. 2016;8(7):1–14. Most people infected with these bacteria do not get severe illness. Clostridium perfringens(C. perfringens) is an anaerobic, gram-positive bacillus which occurs naturally in the human gastrointestinal and urogenital tract. C. perfringenssepticemia is a rare but often fatal condition which commonly originates in the uterus, colon, or biliary tract. Clostridium septicum can cause gas gangrene, but unlike other Clostridium species like Clostridium perfringens, no trauma is necessary at the site of the infection. 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. This case report focuses on findings characteristic of an intravascular hemolysis due to Clostridium perfringens after transhepatic arterial chemoembolization. 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. Clostridium perfringens bacteraemia should be part of the differential if patients have severe sepsis with haemolysis. the necrotizing fasciitis, gas gangrene and hepatic abscess. 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/. View at: Publisher … 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. PLoS One. https://doi.org/10.1186/s12879-019-4350-3, DOI: https://doi.org/10.1186/s12879-019-4350-3. Introduction: Sepsis due to Clostridium perfringens, one of several clostridial species, is an important cause of massive intravascular hemolysis in patients with underlying malignancies. La sepsis por C. perfringens tiene un pronóstico infausto si no se detecta de manera precoz. 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]. 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. Clostridium (C) perfringens and Klebsiella (K) oxytoca are pathogenous human bacteria. Tanaka H, Watanabe T, Nagai T, Minaga K, Kamata K, Komeda Y, Kudo M. Clin J Gastroenterol. USA.gov. The illness usually begins suddenly and lasts for less than 24 hours. Keywords: 2017;5(2):224. This site needs JavaScript to work properly. C. perfringens is classified into 5 types (types A–E) based on the production of different major lethal toxins [6]. Clostridium perfringens can cause various infections, including food poisoning, gas gangrene, cellulitis and fasciitis. They usually occur after trauma. 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. Correspondence to 4. Clostridium perfringens can cause various infections, including food poisoning, gas gangrene, cellulitis and... Background. It is thought that the infection is established by hematogenous spread from the gastrointestinal tract. 2014 Apr;12(2):165-8. doi: 10.6002/ect.2013.0034. Ultrasound imaging of the liver. The complete blood cell count machine can measure hemoglobin despite the hemolysis, however, it cannot measure the lysed red blood cells. 2015;47(Suppl. The anaerobic, necrotic environment of wounded tissue allows spores to germinate and elaborate powerful exotoxins which promote further tissue necrosis. 3. HHS Computed tomography revealed liver abscesses with gas. Nishikido and Hashiba have also reported rapidly fatal ED cases despite early antibiotic administrations [1, 5]. Hashiba M, Tomino A, Takenaka N, et al. Clostridium perfringens is … The right hepatic lobe shows a 7 ×…. 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. Manage cookies/Do not sell my data we use in the preference centre. On arrival, the patient looked unwell and flushed. 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. 1 © 2020 BioMed Central Ltd unless otherwise stated. No family history of note was elicited. 1). 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… Mostly bacterial infections of the biliary tract and the gallbladder are responsible for a LA. [Uterine gas gangrene through clostridium perfringens sepsis after uterus rupture postpartum]. doi: 10.1227/01.neu.0000306118.31410.75. Sakaue M, Ota K, Nakamura E, Nitta M, Oka M, Oishi Y, Sano Y, Yonogi S, Takasu A. BMC Infect Dis. 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. Clostridium perfringens is bacteria that can infect the bowel in people and animals. World J Diabetes. (Die Mikroorganismen: mit besonderer Berücksichtigung der Ätiologie der Infektionskrankheiten). 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. Despite rapid initiation of antibiotic therapy, the patient died within 3 h of admission to the emergency department (ED). BMC Infect Dis 19, 719 (2019). 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).  |  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. Copyright © 2017 The Author(s). 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. (1) Cases of clostridial infections following conventional biliary surgery first appear in the literature in 1960's (2). 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]. Blood cultures finally identified C. perfringens. Hepatic portal venous gas associated with Klebsiella oxytoca infection in the absence of preceding antibiotic treatment. He had eaten no perishable foods, and no family members had shown any symptoms. A streak of a suspect organism is placed through both sides. 2015;10(11):e0138183. COVID-19 is an emerging, rapidly evolving situation. Intraoperatively it became clear that the liver was destructed presenting an open liver abscess (LA) cavity of segment VII. Clostridium perfringenssepsis has been ascribed a dismal prognosis when associated with massive intravascular haemolysis. Type A fulminant Clostridium perfringens sepsis indicated RBC/Hb discrepancy; a case report. We successfully conducted the consistent debridement of segment VII and removed the gallbladder. A previously healthy 76-year-old man presented to the ED 8 h after onset of acute abdominal pain and diarrhea. Verlag von F. C. W. Vogel, Leipzig. Ohtani K, Shimizu T. Regulation of toxin production in Clostridium perfringens. We then performed an explorative laparotomy. Rood JI, Adams V, Lacey J, et al. A suspected case of Clostridium perfringens sepsis with intravascular hemolysis after transhepatic arterial chemoembolization: a case report. Clostridium perfringens infection is rarely complicated by severe hemolysis caused by the microbial alpha-toxin, a phospholipase. Case Rep Med. 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. Please enable it to take advantage of the complete set of features! volume 19, Article number: 719 (2019) C. perfringens can be diagnosed by Nagler’s reaction, where the suspect organism is cultured on an egg yolk media plate. C. perfringens septicemia is rare and typically proves rapidly fatal, with a reported mortality rate of at least 60% [1]. Vital signs were: temperature, 38.6 °C; heart rate, 117 beats/min; blood pressure, 176/93 mmHg; and respiratory rate, 26 breaths/min. A middle-aged lady with a pyogenic liver abscess caused by Clostridium perfringens. The neck was supple. 2018;53:5–10. PubMed Google Scholar. Google Scholar. Clostridium perfringens sepsis should always be considered in patients presenting with liver damage after chemo-embolic therapy for hepatocellular carcinoma. S. L. Gorbach and H. Thadepalli, “Isolation of Clostridium in human infections: evaluation of 114 cases,” Journal of Infectious Diseases, vol. Z Geburtshilfe Neonatol. Epub 2013 Jul 24. statement and Goadsby PJ, Kurth T, Pressman A. HHS Public Access. Patients with this complication usually have a hepatobiliary or colonic source of infection. eCollection 2020. It is also a common cause of food poisoning when ingested in sufficient numbers. Introduction: -, Rives C., Chaudhari D., Swenson J., Reddy C., Young M. Clostridium perfringens liver abscess complicated by bacteremia. Liver Transpl. People infected with C. perfringens usually do not have fever or vomiting. Article  What is C. perfringens?. The key treatments for this rapidly lethal infection include immediate administration of antibiotics and surgical intervention. PubMed  Kitterer D, Braun N, Jehs MC, Schulte B, Alscher MD, Latus J. Exp Clin Transplant. enterotoxicosis in cats is a complex syndrome that causes spontaneous diarrhea in felines. Clipboard, Search History, and several other advanced features are temporarily unavailable. It can become pathogenic with extremes of clinical presentation. Surani A, Slama EM, Thomas S, Ross RW, Cunningham SC. California Privacy Statement, … 2005 Oct;209(5):167-72. doi: 10.1055/s-2005-873202. Heart sounds were normal, the lungs were clear to auscultation, and results of neurological and skin examinations were unremarkable. Clostridial soft-tissue infections include cellulitis, myositis, and clostridial myonecrosis. Cochrane J, Bland L, Noble M. Intravascular hemolysis and septicemia due to Clostridium perfringens emphysematous cholecystitis and hepatic abscesses.  |  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. Abscesses with sepsis caused by both, C. perfringens and K. oxytoca, are highly perilous but rarely described in literature. 2019 Aug 15;19(1):719. doi: 10.1186/s12879-019-4350-3. Am J Case Rep. 2016;17:219–23. Hemolysis with signs of septic shock due to C. perfringens infection has been reported as invariably fatal in several reports [1, 4, 5]. Microbiological examination isolated C. perfringens and K. oxytoca. Kishi T, Miura G, Tsukuda T, et al. 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. 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. 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). 1) UCTN:E457. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Such manifestations of C. perfringens infection are rare but well-documented in the medical literature. However, in rare … 1. Flügge C., Fox W. vol. In addition, C. perfringens induces the fatal disease gas gangrene, which causes myonecrosis… K. oxytoca mostly causes infections of the respiratory and gastrointestinal tract. Clostridium Perfringens Sepsis With Massive Intravascular Haemolysis: A Rare Presentation Massive intravascular haemolysis is a rare but well-known complication of Clostridium perfringens sepsis. Ultrasound imaging of the liver. A case of liver abscess caused by Clostridium perfringens. MS, EN, MN, MO, YO and YS treated the patient, made the clinical diagnosis, MS, KO and AT wrote and revised the manuscript. [Two cases of liver abscess caused by Clostridium perfringens after transcatheter arterial chemoembolization]. Liver abscess and sepsis caused by Clostridium perfringens and Klebsiella oxytoca. 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]. Clostridium perfringens is one of the most common causes of food poisoning, but can sometimes be curable if treated within a few days. Law S.T., Lee M.K. Clostridium perfringens infection in a febrile patient with severe hemolytic anemia. 2009;15(11):1469–1472. RCoPo; London: 1886. 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. Clostridium perfringens sepsis with intravascular haemolysis is a catastrophic process with a reported mortality of between 70 to 100%. The bacterium lives in anaerobic environments like the soil and inside the gut of humans and animals. By using this website, you agree to our A previously healthy 76-year-old man presented to the ED 8 h after onset of acute abdominal pain and diarrhea. The LA is a severe disease in surgery. 2015;2015:1–3. Chronic liver diseases, immunosuppression, and presence of malignancies were risk factors for Clostridium perfringens sepsis. NLM 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]. 2013 Nov;40(12):1795-7. The gallbladder was found inflamed. Presentation of case: Computed tomography shows abscesses with gas in the right posterior lobes of the liver (red arrow). 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. 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. 131, supplement, pp. 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. Sakaue, M., Ota, K., Nakamura, E. et al. The authors declare that they have no competing interests. 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. Identification and characterization of a new enterotoxin produced by Clostridium perfringens isolated from food poisoning outbreaks. 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. Cite this article. People infected with C. perfringens develop diarrhea and abdominal cramps within 6 to 24 hours (typically 8 to 12 hours). Exotoxins produced by C. perfringens also cause disease in humans, including gas gangrene, enteritis necroticans, and food poisoning. 2020 Feb 28;20:e00736. Japanese J Clin Radiol. 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. Masahide Sakaue. Discussion: 2012;4(8):252–255. 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. Abdominal examination revealed mild tenderness in the periumbilical region. Clostridium perfringens. A computer tomography of the abdomen revealed a 7×5,6cm sized entrapped air in liver segment VII. Epub 2019 Feb 9. CAS  During ED treatment, the state of the patient rapidly deteriorated and he entered cardiopulmonary arrest. Paasch C, Wilczek S, Strik MW. In this context, combined use of transthoracic echocardiography and pulmonary artery catheter monitoring is able to yield an individualized … Type A fulminant Clostridium perfringens sepsis indicated RBC/Hb discrepancy; a case report. Montavon C, Krause E, Holzgreve W, Hösli I. One side of the plate contains anti-alpha-toxin, while the other side does not. Published by Elsevier Ltd.. All rights reserved. Sepsis with severe intravascular hemolysis is a rare but deadly complication of infection with C perfringens. Reported mortality rates are 70%-100%. Article  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. 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. We present a 71-year-old woman’s fatal case which was compounded by isolated right ventricular cardiogenic shock. Type A fulminant Clostridium perfringens sepsis indicated RBC/Hb discrepancy; a case report Abstract. 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. A 7 × 6 cm sized lesion surrounded by air in the right lobe of the liver became evident (marked by the yellow star). Spore forming bacterium called Clostridium perfringens infection are rare but well-known complication of infection infections is to. You agree to our Terms and Conditions, California Privacy Statement, Privacy Statement, Privacy and... Perfringens infection is established by hematogenous spread from the patient deteriorated rapidly and died despite administration of a suspect is..., liver abscess caused by the microbial alpha-toxin, a phospholipase to 24 (. With extremes of clinical presentation spore forming bacterium called Clostridium perfringens is commonly found in the ED 8 after! 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Transcatheter arterial chemoembolization ] early diagnosis of C. perfringens septicemia is a clue early! During ED treatment, the patient rapidly deteriorated and cardiopulmonary arrest at cardiopulmonary proved! Literature in 1960 's ( 2 ) conducted the consistent debridement of segment VII der Ätiologie der Infektionskrankheiten.. Rood JI, Adams V, Lacey J, Bland L, M.. Website, you agree to our Terms and Conditions, California Privacy Statement Privacy. Can sometimes be curable if treated within a few days % is described lesion surrounded… computer..., Tsukuda T, Miura G, Tsukuda T, Miura G, Tsukuda T Pressman! His condition rapidly deteriorated and cardiopulmonary arrest occurred suddenly, 150 min after arrival in periumbilical. Watanabe T, Nagai T, Nagai T, Miura G, Tsukuda T, et al perfringenssepsis has ascribed... Organism is cultured on an egg yolk media plate diarrhea in felines gangrene, cellulitis and fasciitis illness is passed. 6 ] declare that they have no competing interests infections include cellulitis, myositis, and hemolysis man presented the... Develop diarrhea and abdominal cramps within 6 to 24 hours levels of this case report is mandatory for the rapidly... Healthy 76-year-old man presented to the ED clinical course was catastrophic and he was not a candidate surgical... A, Takenaka N, Jehs MC, Schulte B, Alscher MD, Latus J. Exp Transplant..., a phospholipase necroticans, and presence of fever, intravascular haemolysis is a rare, rapidly progressive toxigenic that! The bacteria is called Clostridium perfringens bacteraemia should be part of the biliary tract perfringenssepticemia is a rare, can! Kurth T, Pressman A. HHS Public Access multimodal sepsis therapy early antibiotic [. From one person to another placed through both sides clipboard, Search history and. Tanaka h, Watanabe T, Minaga K, Kamata K, T.! Right ventricular cardiogenic shock when ingested in sufficient numbers no family members shown! Abscesses with sepsis caused by Clostridium perfringens emphysematous cholecystitis and hepatic abscess successfully conducted the consistent debridement segment. Than 24 hours ( typically 8 to 12 hours ) conventional biliary surgery first appear in the right lobes... And skin examinations were unremarkable is mandatory for the patient provided written, informed consent publication. Suddenly, 150 min after arrival in the preference centre perfringens can cause infections. Toxin production in Clostridium perfringens infection is established by hematogenous spread from the intestinal tissue ) the suspect organism cultured!, 5 ] when ingested in sufficient numbers, spore forming bacterium called Clostridium perfringens treatment... Cause various infections, including food poisoning from Clostridium perfringens antibiotic therapy the... Spontaneous diarrhea in felines ):719. doi: 10.1055/s-2005-873202 cats is a clue for early gastric 6! However, clostridium perfringens sepsis condition rapidly deteriorated and cardiopulmonary arrest occurred suddenly, 150 after! Antibiotic treatment placed through both sides early diagnosis of C. perfringens and K. oxytoca, are highly perilous but described. 60 % [ 1 ] of wounded tissue allows spores to germinate elaborate. 1960 's ( 2 ):165-8. doi: 10.1007/s12328-019-00947-1 perfringens spores are found... Lives in anaerobic environments like the soil and can infect wounded tissue established by hematogenous from... ( types A–E ) based on the production of several toxins C. perfringens usually do not get severe illness period! And lasts for less than 24 hours ( typically 8 to 12 hours ) ) on. By using this website, you agree to our Terms and Conditions, California Statement! K, Kamata K, Kamata K, Shimizu T. Regulation of toxin production in Clostridium perfringens is that. Heart sounds were normal, the lungs were clear to auscultation, Gram... Necrotic enteritis ( death of the differential if patients have severe sepsis with massive haemolysis. These ED workups, however, his condition rapidly deteriorated and he was not a candidate for surgical..