Necrotizing Fasciitis and Toxic Shock Syndrome from Clostridium septicum following a Term Cesarean Delivery

Fatal Clostridium septicum gas gangrene complicating ECMO: case report and review of literature

Clostridium septicum gas gangrene is a severe and deadly infection caused by an anaerobic, spore-forming, Gram-positive bacillus. As previously described, two entities are observed: traumatic and spontaneous (or non-traumatic) forms. In this report, we aim to describe the case of a fulminant and ultimately fatal C. septicum myonecrosis occurring in a patient who was first admitted for refractory cardiac arrest and placed on veino-arterial extracorporeal membrane oxygenation (ECMO). Building upon prior studies that have documented cases of spontaneous gas gangrene caused by C. septicum, we provide an updated compilation, focusing on microbiological characteristics of C. septicum, along with the diagnostic and therapeutic challenges associated with spontaneous gas gangrene. Additionally, the specific clinical situation of our case illustrates the seriousness of this infectious complication that combined both spontaneous and traumatic gas gangrene risk factors. We thus, discuss the antibiotic coverage prior to the initiation of ECMO procedure.

Toxic Shock Syndrome after Surgery: Case Presentation and Systematic Review of the Literature

Toxic shock syndrome (TSS) is an underrecognized but highly fatal cause of septic shock in postoperative patients. Although it may present with no overt source of infection, its course is devastating and rapidly progressive. Surgeon awareness is needed to recognize and treat this condition appropriately. In this paper, we aim to describe a case of postoperative TSS, present a systematic review of the literature, and provide an overview of the disease for the surgeon.

METHODS

A systematic review of the literature between 1978 and 2018 was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the keywords "toxic shock syndrome" and "surgery." Variables of interest were collected in each report.

RESULTS

A total of 298 reports were screened, and 67 reports describing 96 individual patients met inclusion criteria. Six reports described a streptococcal cause, although the vast majority attributed TSS to Staphylococcus aureus (SA). The mortality in our review was 9.4%, although 24% of patients suffered some manner of permanent complication. TSS presented at a median of 4 days postoperatively, with most cases occurring within 10 days.

CONCLUSIONS

Surgeons must maintain a high index of suspicion for postoperative TSS. Our review demonstrates that TSS should not be excluded despite young patient age, patient health, or relative simplicity of a procedure. Symptoms such as fever, rash, pain out of proportion to examination, and diarrhea or emesis should raise concern for TSS and prompt exploration and cultures even of benign-appearing postoperative wounds.

Fulminating Postcaesarean Necrotising Fasciitis: A Rare and Lethal Condition Successfully Managed in a Resource-Disadvantaged Setting in Sub-Saharan Africa

Necrotising fasciitis is a rare but potentially lethal condition in obstetrics which usually presents with fulminant tissue destruction and a resultant high mortality. We report a 19-year-old Sub-Saharan female diagnosed with a rapidly erosive necrotising fasciitis on day 5 after caesarean section in a resource-limited setting. Timely diagnosis, aggressive antibiotic therapy, and prompt surgical intervention via an extensive abdominal wall debridement were pivotal to her survival.