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Sumigama A, Goto Y, Ohno Y, Ohata H, Okuno M, Onogi A, Watanabe N, Tanaka T, Kanoh H. A case of gas gangrene caused by Clostridium septicum with undiagnosed advanced colon cancer. J Dermatol 2024. [PMID: 38433365 DOI: 10.1111/1346-8138.17167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/30/2023] [Accepted: 02/09/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Anna Sumigama
- Department of Dermatology, Gifu Municipal Hospital, Gifu, Japan
| | - Yusuke Goto
- Department of Dermatology, Gifu Municipal Hospital, Gifu, Japan
| | - Yoshiyuki Ohno
- Department of Orthopedic Surgery, Gifu Municipal Hospital, Gifu, Japan
| | - Hiroto Ohata
- Department of Anesthesiology, Gifu Municipal Hospital, Gifu, Japan
| | - Mitsuru Okuno
- Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan
| | - Akane Onogi
- Department of Pathology, Gifu Municipal Hospital, Gifu, Japan
| | - Naoki Watanabe
- Department of Pathology, Gifu Municipal Hospital, Gifu, Japan
| | - Takuji Tanaka
- Department of Pathology, Gifu Municipal Hospital, Gifu, Japan
| | - Hiroyuki Kanoh
- Department of Dermatology, Gifu Municipal Hospital, Gifu, Japan
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Li HY, Wang ZX, Wang JC, Zhang XD. Clostridium perfringens gas gangrene caused by closed abdominal injury: A case report and review of the literature. World J Clin Cases 2023; 11:852-858. [PMID: 36818624 PMCID: PMC9928709 DOI: 10.12998/wjcc.v11.i4.852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/28/2022] [Accepted: 01/09/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Abdominal Clostridium perfringens (C. perfringens) gas gangrene is a rare infection that has been described in the literature as most frequently occurring in postoperative patients with open trauma. Intra-abdominal gas gangrene caused by C. perfringens infection after closed abdominal injury is extremely rare, difficult to diagnose, and progresses rapidly with high mortality risk. Here, we report a case of C. perfringens infection caused by closed abdominal injury.
CASE SUMMARY A 54-year-old male suffered multiple intestinal tears and necrosis after sustaining an injury caused by falling from a high height. These injuries and the subsequent necrosis resulted in intra-abdominal C. perfringens infection. In the first operation, we removed the necrotic intestinal segment, kept the abdomen open and covered the intestine with a Bogota bag. A vacuum sealing drainage system was used to cover the outer layer of the Bogota bag, and the drainage was flushed under negative pressure. The patient was transferred to the intensive care unit for supportive care and empirical antibiotic treatment. The antibiotics were not changed until the results of bacterial culture and drug susceptibility testing were obtained. Two consecutive operations were then performed due to secondary intestinal necrosis. After three definitive operations, the patient successfully survived the perioperative period. Unfortunately, he died of complications related to Guillain-Barre syndrome 75 d after the first surgery. This paper presents this case of intra-abdominal gas gangrene infection and analyzes the diagnosis and treatment based on a review of current literature.
CONCLUSION When the intestines rupture leading to contamination of the abdominal cavity by intestinal contents, C. perfringens bacteria normally present in the intestinal tract may proliferate in large numbers and lead to intra-abdominal infection. Prompt surgical intervention, adequate drainage, appropriate antibiotic therapy, and intensive supportive care comprise the most effective treatment strategy. If the abdominal cavity is heavily contaminated, an open abdominal approach may be a beneficial treatment.
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Affiliation(s)
- He-Yun Li
- Department of Intensive Care Unit, Shaanxi Nuclear Industry 215 Hospital, Xianyang 712000, Shaanxi Province, China
| | - Zhi-Xiang Wang
- Department of General Surgery, Shaanxi Nuclear Industry 215 Hospital, Xianyang 712000, Shaanxi Province, China
| | - Jian-Chun Wang
- Department of Healthcare-associate Infection Management, Shaanxi Nuclear Industry 215 Hospital, Xianyang 712000, Shaanxi Province, China
| | - Xiao-Di Zhang
- Department of General Surgery, Shaanxi Nuclear Industry 215 Hospital, Xianyang 712000, Shaanxi Province, China
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Gas Where It Shouldn't Be! Imaging Spectrum of Emphysematous Infections in the Abdomen and Pelvis. AJR Am J Roentgenol 2021; 216:812-823. [DOI: 10.2214/ajr.20.23545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Hussain C, Ball MK, McGwire BS. Multidrug-Resistant Bovine Salmonellosis Predisposing for Severe Human Clostridial Myonecrosis. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:268-273. [PMID: 30820022 PMCID: PMC6410603 DOI: 10.12659/ajcr.913472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The overuse of antibiotics in animals promotes the development of multidrug-resistance predisposing for severe polymicrobial human infections. CASE REPORT We describe a case of spontaneous clostridial myonecrosis due to ulcerative colonic infection with multidrug-resistant Salmonella enterica subsp. enterica, serotype 4,[5],12: i: -. Serotyping of the colonic Salmonella isolate in the index case and the bovine farm outbreak isolates from where the patient worked indicated they were both serotype I 4,[5],12: i: -, which is linked with a multitude of large reported disease outbreaks. Further analysis revealed that they are highly genetically related and antibiotic susceptibility testing indicated that they are phenotypically identical. CONCLUSIONS Enteritis due to human acquisition of multidrug-resistant Salmonella from cattle led to the invasion and dissemination of Clostridium septicum resulting in devastating myonecrotic disease. This highlights the ramifications of co-existence and evolution of pathogenic bacteria in animals and humans and lends support to reducing the use of antibiotics in animals.
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Affiliation(s)
- Cory Hussain
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Matthew K Ball
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Bradford S McGwire
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Srivastava I, Aldape MJ, Bryant AE, Stevens DL. Spontaneous C. septicum gas gangrene: A literature review. Anaerobe 2017; 48:165-171. [PMID: 28780428 DOI: 10.1016/j.anaerobe.2017.07.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/28/2017] [Accepted: 07/31/2017] [Indexed: 10/19/2022]
Abstract
As the infectious disease paradigm undergoes a subtle shift, unusual infections associated with malignancy and immunosuppression are being increasingly reported. Spontaneous or non-traumatic Clostridium septicum infection is one such unusual infection which has gained prominence. This article aims to understand the pathophysiology, clinical manifestations and current trends in diagnosing and treating this rare but deadly infection. To understand the multifactorial causation of this infection a review of published cases of spontaneous C. septicum gas gangrene was performed and a total of 94 such cases were identified. Several factors were analyzed for each case: age, infection location and underlying illness, presenting signs and symptoms, neutropenia, gross pathology of the colon, antibiotic use, surgical intervention, and survival. A known or occult malignancy was present in 71% patients and an overall mortality of 67% was observed.
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Sudharsanan S, Vijayakumar C, Manish K, Elamurugan TP, Manwar AS. Anal Canal Gas Gangrene in Aplastic Anaemia: Rare yet Lethal Entity - A Caveat. Cureus 2017; 9:e1469. [PMID: 28936381 PMCID: PMC5597065 DOI: 10.7759/cureus.1469] [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: 06/15/2017] [Accepted: 06/28/2017] [Indexed: 11/05/2022] Open
Abstract
Gas gangrene is one of the most serious infections of traumatic and surgical wounds. The importance lies in the fact that, if not managed at the right time, the condition is fatal. Though perianal cellulitis and gangrene are commonly reported in immunocompromised patients, we report the case of a patient with gas gangrene involving only the anal canal extending to the rectum, a rare presentation to be reported in literature. An 18-year-old lady, a patient of aplastic anaemia - immunodeficiency, developed gas gangrene of the anal canal possibly due to faecal contamination of anal fissures. The patient was managed with surgical debridement and intravenous antibiotics. The clinical manifestations of gas gangrene are due to the liberation of toxins by Clostridium perfringens. The infection spreads rapidly and results in necrosis and devitalisation of tissues, unless intervened surgically. The clinical manifestations are more rapid and a high index of suspicion is needed for the diagnosis.
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Affiliation(s)
- Sundaramurthi Sudharsanan
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Chellappa Vijayakumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Kumar Manish
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - T P Elamurugan
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Ali S Manwar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Engen RM, Killien EY, Davis JL, Symons JM, Hartmann SM. C septicum Complicating Hemolytic Uremic Syndrome: Survival Without Surgical Intervention. Pediatrics 2017; 139:peds.2016-1362. [PMID: 28183731 PMCID: PMC5330394 DOI: 10.1542/peds.2016-1362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 12/13/2022] Open
Abstract
Clostridium septicum is an anaerobic bacterium that causes rapidly progressive myonecrosis, bacteremia, and central nervous system infection. It has been reported as a complication of Escherichia coli hemolytic uremic syndrome (HUS) in 8 children worldwide; 5 children died, and the 3 reported survivors had surgically treated disease. We present 3 cases of C septicum complicating HUS in children, including the first 2 reported cases of survival without surgical intervention. All patients presented with classic cases of HUS with initial clinical improvement followed by deterioration. Patient 1 had rising fever, tachycardia, and severe abdominal pain 24 hours after admission. She developed large multifocal intraparenchymal cerebral hemorrhages and died 12 hours later. Autopsy revealed C septicum intestinal necrosis, myonecrosis, and encephalitis. Patient 2 had new fever, increasing leukocytosis, and severe abdominal pain on hospital day 4. She was diagnosed with C septicum bacteremia and treated with metronidazole, meropenem, and clindamycin. Patient 3 had new fever and increasing leukocytosis on hospital day 3; blood cultures grew C septicum, and she was treated with penicillin. Patients 2 and 3 improved rapidly and did not require surgery. C septicum is a potential co-infection with E coli It thrives in the anaerobic environment of E coli-damaged intestinal mucosa and translocates to cause systemic infection. Fever, tachycardia, a rising white blood cell count, and abdominal pain out of proportion to examination are key findings for which physicians should be vigilant. Timely evaluation by anaerobic blood culture and early initiation of antibiotics are necessary to prevent fatalities.
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Affiliation(s)
| | | | - Jessica L. Davis
- Pathology, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, Washington; and,Departments of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, California
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Spontaneous Clostridium perfringens myonecrosis: Case report, radiologic findings, and literature review. Radiol Case Rep 2015; 8:806. [PMID: 27330636 PMCID: PMC4900111 DOI: 10.2484/rcr.v8i3.806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The utility of computed tomography (CT) has not been studied in the initial evaluation of a patient with suspected spontaneous Clostridial myonecrosis. Here, we present a patient with acute lymphoblastic leukemia (ALL) and neutropenia who developed spontaneous Clostridium perfringens myonecrosis after induction chemotherapy. Although suspected, the patient’s symptoms and physical exam findings were not specific for Clostridial myonecrosis. CT confirmed the diagnosis and helped direct surgical intervention.
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Wu YE, Baras A, Cornish T, Riedel S, Burton EC. Fatal Spontaneous Clostridium septicum Gas Gangrene: A Possible Association With Iatrogenic Gastric Acid Suppression. Arch Pathol Lab Med 2014; 138:837-41. [DOI: 10.5858/arpa.2013-0104-cr] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The long-term use of proton pump inhibitors has been linked to an increased risk for the development of gastric polyps, hip fractures, pneumonia, and Clostridium difficile colitis. There is evidence that chronic acid suppression from long-term use of proton pump inhibitors poses some risk for the development of C difficile–associated diarrhea by decreasing the elimination of pathogenic microbes before reaching the lower gastrointestinal tract. Here we present a case of a 51-year-old woman with a recent history of abdominal pain and fever who presented to the emergency department with rapidly progressive spontaneous necrotizing fasciitis and gas gangrene and died within hours of presentation. Postmortem examination confirmed spreading tissue gas gangrene and myonecrosis. In addition, multiple intestinal ulcers containing Clostridium septicum were present at autopsy. This case illustrates a possible association between proton pump inhibitor therapy and fatal C septicum infection.
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Affiliation(s)
- Yiru E. Wu
- From Johns Hopkins School of Medicine, Baltimore, Maryland (Ms Wu); and the Department of Pathology (Drs Baras, Cornish, Riedel, and Burton), Johns Hopkins Medicine, Baltimore, Maryland
| | - Alexander Baras
- From Johns Hopkins School of Medicine, Baltimore, Maryland (Ms Wu); and the Department of Pathology (Drs Baras, Cornish, Riedel, and Burton), Johns Hopkins Medicine, Baltimore, Maryland
| | - Toby Cornish
- From Johns Hopkins School of Medicine, Baltimore, Maryland (Ms Wu); and the Department of Pathology (Drs Baras, Cornish, Riedel, and Burton), Johns Hopkins Medicine, Baltimore, Maryland
| | - Stefan Riedel
- From Johns Hopkins School of Medicine, Baltimore, Maryland (Ms Wu); and the Department of Pathology (Drs Baras, Cornish, Riedel, and Burton), Johns Hopkins Medicine, Baltimore, Maryland
| | - Elizabeth C. Burton
- From Johns Hopkins School of Medicine, Baltimore, Maryland (Ms Wu); and the Department of Pathology (Drs Baras, Cornish, Riedel, and Burton), Johns Hopkins Medicine, Baltimore, Maryland
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Garg D, Garg N, Gupta M. Gas gangrene in the abdominal wall: a physician's nightmare. Clin Res Hepatol Gastroenterol 2013; 37:549-50. [PMID: 23684577 DOI: 10.1016/j.clinre.2013.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 02/19/2013] [Accepted: 02/28/2013] [Indexed: 02/04/2023]
Affiliation(s)
- Deepak Garg
- Santosh University Medical College and Hospital, 1, Ambedkar Road, 201001 Ghaziabad, India.
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Rossignol DA. Hyperbaric oxygen treatment for inflammatory bowel disease: a systematic review and analysis. Med Gas Res 2012; 2:6. [PMID: 22417628 PMCID: PMC3328239 DOI: 10.1186/2045-9912-2-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Accepted: 03/15/2012] [Indexed: 01/14/2023] Open
Abstract
Background Traditionally, hyperbaric oxygen treatment (HBOT) has been used to treat a limited repertoire of disease, including decompression sickness and healing of problem wounds. However, some investigators have used HBOT to treat inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. Methods Comprehensive searches were conducted in 8 scientific databases through 2011 to identify publications using HBOT in IBD. Human studies and animal models were collated separately. Results Thirteen studies of HBOT in Crohn's disease and 6 studies in ulcerative colitis were identified. In all studies, participants had severe disease refractory to standard medical treatments, including corticosteroids, immunomodulators and anti-inflammatory medications. In patients with Crohn's disease, 31/40 (78%) had clinical improvements with HBOT, while all 39 patients with ulcerative colitis improved. One study in Crohn's disease reported a significant decrease in proinflammatory cytokines (IL-1, IL-6 and TNF-alpha) and one study in ulcerative colitis reported a decrease in IL-6 with HBOT. Adverse events were minimal. Twelve publications reported using HBOT in animal models of experimentally-induced IBD, including several studies reporting decreased markers of inflammation or immune dysregulation, including TNF-alpha (3 studies), IL-1beta (2 studies), neopterin (1 study) and myeloperoxidase activity (5 studies). HBOT also decreased oxidative stress markers including malondialdehyde (3 studies) and plasma carbonyl content (2 studies), except for one study that reported increased plasma carbonyl content. Several studies reported HBOT lowered nitric oxide (3 studies) and nitric oxide synthase (3 studies) and one study reported a decrease in prostaglandin E2 levels. Four animal studies reported decreased edema or colonic tissue weight with HBOT, and 8 studies reported microscopic improvements on histopathological examination. Although most publications reported improvements with HBOT, some studies suffered from limitations, including possible publication and referral biases, the lack of a control group, the retrospective nature and a small number of participants. Conclusions HBOT lowered markers of inflammation and oxidative stress and ameliorated IBD in both human and animal studies. Most treated patients were refractory to standard medical treatments. Additional studies are warranted to investigate the effects of HBOT on biomarkers of oxidative stress and inflammation as well as clinical outcomes in individuals with IBD.
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Affiliation(s)
- Daniel A Rossignol
- Rossignol Medical Center, 3800 West Eau Gallie Blvd,, Melbourne, FL 32934, USA.
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