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Suzaki A, Hayakawa S. Clinical and Microbiological Features of Fulminant Haemolysis Caused by Clostridium perfringens Bacteraemia: Unknown Pathogenesis. Microorganisms 2023; 11:microorganisms11040824. [PMID: 37110247 PMCID: PMC10143116 DOI: 10.3390/microorganisms11040824] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
Bacteraemia brought on by Clostridium perfringens has a very low incidence but is severe and fatal in fifty per cent of cases. C. perfringens is a commensal anaerobic bacterium found in the environment and in the intestinal tracts of animals; it is known to produce six major toxins: α-toxin, β-toxin, ε-toxin, and others. C. perfringens is classified into seven types, A, B, C, D, E, F and G, according to its ability to produce α-toxin, enterotoxin, and necrotising enterotoxin. The bacterial isolates from humans include types A and F, which cause gas gangrene, hepatobiliary infection, and sepsis; massive intravascular haemolysis (MIH) occurs in 7-15% of C. perfringens bacteraemia cases, resulting in a rapid progression to death. We treated six patients with MIH at a single centre in Japan; however, unfortunately, they all passed away. From a clinical perspective, MIH patients tended to be younger and were more frequently male; however, there was no difference in the toxin type or genes of the bacterial isolates. In MIH cases, the level of θ-toxin in the culture supernatant of clinical isolates was proportional to the production of inflammatory cytokines in the peripheral blood, suggesting the occurrence of an intense cytokine storm. Severe and systemic haemolysis is considered an evolutionary maladaptation as it leads to the host's death before the bacterium obtains the benefit of iron utilisation from erythrocytes. The disease's extraordinarily quick progression and dismal prognosis necessitate a straightforward and expedient diagnosis and treatment. However, a reliable standard of diagnosis and treatment has yet to be put forward due to the lack of sufficient case analysis.
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Affiliation(s)
- Ai Suzaki
- Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Ohyaguchi Kamicho, Itabashiku, Tokyo 173-8610, Japan
| | - Satoshi Hayakawa
- Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Ohyaguchi Kamicho, Itabashiku, Tokyo 173-8610, Japan
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Khan MZ, Li F, Huang X, Nouman M, Bibi R, Fan X, Zhou H, Shan Z, Wang L, Jiang Y, Cui W, Qiao X, Li Y, Wang X, Tang L. Oral Immunization of Chickens with Probiotic Lactobacillus crispatus Constitutively Expressing the α-β2-ε-β1 Toxoids to Induce Protective Immunity. Vaccines (Basel) 2022; 10:vaccines10050698. [PMID: 35632454 PMCID: PMC9147743 DOI: 10.3390/vaccines10050698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 02/04/2023] Open
Abstract
Clostridium perfringens (C. perfringens) is a bacterium that commonly causes zoonotic disease. The pathogenicity of C. perfringens is a result of the combined action of α, β, and ε exotoxins. In this study, Lactobacillus crispatus (pPG-T7g10/L. crispatus) expressing the main toxoids of C. perfringens, α, ε, β1, and β2, with EGFP-labeling, was constructed, and the protective effect was estimated in chickens. The α-β2-ε-β1 toxoid was constitutively expressed for confirmation by laser confocal microscopy and western blotting, and its immunogenicity was analyzed by enzyme-linked immunosorbent assay (ELISA) and immunohistochemical assays. After booster immunization, the probiotic vaccine group showed significantly higher levels (p < 0.05) of specific secretory IgA (sIgA) and IgY antibodies in the serum and intestinal mucus. Furthermore, the levels of cytokines, including interferon (IFN)-γ, interleukin (lL)-2, IL-4, IL-10, IL-12, and IL-17, and the proliferation of spleen lymphocytes in chickens orally immunized with pPG-E-α-β2-ε-β1/L. crispatus increased significantly. Histopathological observations showed that the intestinal pathological changes in chickens immunized with pPG-E-α-β2ε-β1/L. crispatus were significantly alleviated. These data reveal that the probiotic vaccine could stimulate mucosal, cellular, and humoral immunity and provide an active defense against the toxins of C. perfringens, suggesting a promising candidate for oral vaccines against C. perfringens.
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Affiliation(s)
- Mohammad Zeb Khan
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China; (M.Z.K.); (F.L.); (X.H.); (X.F.); (H.Z.); (Z.S.); (L.W.); (Y.J.); (W.C.); (X.Q.); (Y.L.)
| | - Fengsai Li
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China; (M.Z.K.); (F.L.); (X.H.); (X.F.); (H.Z.); (Z.S.); (L.W.); (Y.J.); (W.C.); (X.Q.); (Y.L.)
| | - Xuewei Huang
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China; (M.Z.K.); (F.L.); (X.H.); (X.F.); (H.Z.); (Z.S.); (L.W.); (Y.J.); (W.C.); (X.Q.); (Y.L.)
| | | | - Roshna Bibi
- Department of Boyany, University of Swat, Mingora 19200, Pakistan;
| | - Xiaolong Fan
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China; (M.Z.K.); (F.L.); (X.H.); (X.F.); (H.Z.); (Z.S.); (L.W.); (Y.J.); (W.C.); (X.Q.); (Y.L.)
| | - Han Zhou
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China; (M.Z.K.); (F.L.); (X.H.); (X.F.); (H.Z.); (Z.S.); (L.W.); (Y.J.); (W.C.); (X.Q.); (Y.L.)
- Heilongjiang Key Laboratory for Animal Disease Control and Pharmaceutical Development, Harbin 150030, China
| | - Zhifu Shan
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China; (M.Z.K.); (F.L.); (X.H.); (X.F.); (H.Z.); (Z.S.); (L.W.); (Y.J.); (W.C.); (X.Q.); (Y.L.)
- Heilongjiang Key Laboratory for Animal Disease Control and Pharmaceutical Development, Harbin 150030, China
| | - Li Wang
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China; (M.Z.K.); (F.L.); (X.H.); (X.F.); (H.Z.); (Z.S.); (L.W.); (Y.J.); (W.C.); (X.Q.); (Y.L.)
- Heilongjiang Key Laboratory for Animal Disease Control and Pharmaceutical Development, Harbin 150030, China
| | - Yanping Jiang
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China; (M.Z.K.); (F.L.); (X.H.); (X.F.); (H.Z.); (Z.S.); (L.W.); (Y.J.); (W.C.); (X.Q.); (Y.L.)
- Heilongjiang Key Laboratory for Animal Disease Control and Pharmaceutical Development, Harbin 150030, China
| | - Wen Cui
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China; (M.Z.K.); (F.L.); (X.H.); (X.F.); (H.Z.); (Z.S.); (L.W.); (Y.J.); (W.C.); (X.Q.); (Y.L.)
- Heilongjiang Key Laboratory for Animal Disease Control and Pharmaceutical Development, Harbin 150030, China
| | - Xinyuan Qiao
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China; (M.Z.K.); (F.L.); (X.H.); (X.F.); (H.Z.); (Z.S.); (L.W.); (Y.J.); (W.C.); (X.Q.); (Y.L.)
- Heilongjiang Key Laboratory for Animal Disease Control and Pharmaceutical Development, Harbin 150030, China
| | - Yijing Li
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China; (M.Z.K.); (F.L.); (X.H.); (X.F.); (H.Z.); (Z.S.); (L.W.); (Y.J.); (W.C.); (X.Q.); (Y.L.)
- Heilongjiang Key Laboratory for Animal Disease Control and Pharmaceutical Development, Harbin 150030, China
| | - Xiaona Wang
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China; (M.Z.K.); (F.L.); (X.H.); (X.F.); (H.Z.); (Z.S.); (L.W.); (Y.J.); (W.C.); (X.Q.); (Y.L.)
- Heilongjiang Key Laboratory for Animal Disease Control and Pharmaceutical Development, Harbin 150030, China
- Correspondence: (X.W.); (L.T.); Tel.: +86-451-55190824 (L.T.); Fax: +86-451-55190363 (L.T.)
| | - Lijie Tang
- College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China; (M.Z.K.); (F.L.); (X.H.); (X.F.); (H.Z.); (Z.S.); (L.W.); (Y.J.); (W.C.); (X.Q.); (Y.L.)
- Heilongjiang Key Laboratory for Animal Disease Control and Pharmaceutical Development, Harbin 150030, China
- Correspondence: (X.W.); (L.T.); Tel.: +86-451-55190824 (L.T.); Fax: +86-451-55190363 (L.T.)
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Gafumbegete E, van der Weide BJ, Misgeld S, Schmidt H, Elsharkawy AE. Fatal Clostridium perfringens sepsis with spleen rupture and intraabdominal massive bleeding in a 37-week pregnancy. IDCases 2021; 26:e01355. [PMID: 34900590 PMCID: PMC8640441 DOI: 10.1016/j.idcr.2021.e01355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/27/2021] [Accepted: 11/28/2021] [Indexed: 11/27/2022] Open
Abstract
The maternal death rate remains unacceptably high worldwide, predominantly in areas of poor access to quality health services. According to the WHO, in 2017, 810 women died from preventable causes related to pregnancy and childbirth. Causes of maternal death are plenty, including previous morbidity and unexpected causes. Among the latter are infectious disease-related deaths. Herein, we describe a case of a 29-year-old woman at 37 weeks’ gestation who presented with right upper quadrant pain, which was initially considered to be pregnancy-related. However, she collapsed shortly after the hospital admission. The physical examination revealed severe hypovolemic shock due to a large amount of intraperitoneal free fluid. The patient was immediately rushed into an emergency cesarean section followed by exploratory laparotomy, which demonstrated a large intra-abdominal hemorrhage. The patient and her fetus died in the operating room. An autopsy revealed acute gangrenous cholecystitis along with abundant rod-shaped bacteria within the mucosa and vessels of the gallbladder, gas gangrene and rupture of the spleen, and signs of shock. Clostridium perfringens (CP) was isolated in the culture of a splenic sample. Although CP is a well-known and dreadful infectious etiological agent, catastrophic cases still happen. The acquaintance of this infection by the caregivers is crucial for the early diagnosis and treatment. This is a quite unique way to provide a dismal chance of survival in sepsis cases by this agent.
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Affiliation(s)
| | | | | | - Henning Schmidt
- General surgery department, Hümmling Hospital Sögel, Sögel, Germany
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