Fulminant sepsis with massive intravascular haemolysis, probably caused by Clostridium perfringens
Keywords:
Clostridium, Fulminant sepsis, Intravascular haemolysisAbstract
Clostridium perfringens sepsis is a serious infection, less common nowadays and often associated with malignant diseases of
the gastrointestinal tract and haematological system. Massive
intravascular haemolysis is a rare and unique complication of
this infection. A few cases have been reported in previously
healthy people. The usually fatal course of this infection means
that prompt diagnosis and early institution of therapy is essential,
when faced with this clinical entity. The Authors report the clinical
case of a previously healthy woman with a fulminant evolution.
The micro-organism was not definitively identified, but intracellular
Gram positive bacilli, with a characteristic box car appearance,
were observed in peripheral blood neutrophils, a finding almost
pathognomonic of C. perfringens infection in this context. The
Authors present a review of the literature on the topic
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References
Lorber B. Gas gangrene and other Clostridium-associated diseases. In Mandell GL, Bennett JE , Dolin R Eds. Principles and Practice of Infectious Diseases 6th Ed. Churchill Livingstone. 2005 ;244: 2828.
Pritchard JA, Whalley PJ. Abortion complicated by Costridium perfringens infection. Am J Obstet Gynecol 1971; 111: 484-492.
Myers G, Ngoi SS, Cennerazzo W, Harris L, DeCrosse JJ. Clostridial septicemia in an urban hospital. Surg Gynecol Obstet 1992; 174: 291-296.
George WL. Gas gangrene. In Hoeprich PD, Jordan MC Eds. Infectious Diseases , 4th Ed. Lippincott Company 1989;170:1419-1423.
Becker RC, Giuliani M, Savage RA, Weick JK. Massive hemolysis in Clostridium perfringens infection. J Surg Oncol 1987; 35: 13-18.
Kaiser CW, Milgrom ML, Lynch JA. Distant nontraumatic clostridial myonecrosis and malignancy. Cancer 1986; 57: 885-889.
Caya JG, Farmer SG, Ritch PS, Wollenberg NJ, Tieu TM, Oechler HW. Clostridial septicemia complicating the course of leukemia. Cancer 1986; 57: 2045-2048.
Bodey GP, Rodriguez S, Fainstein V, Elting LS. Clostridial bacteremia in cancer patients. A 12- year experience. Cancer 1991; 67: 1928-1942.
Pun KC, Wehner JH. Abdominal pain and massive intravascular hemolysis in a 47-year-old man. Chest 1996; 110: 1353-1355.
Beutler E. Hemolytic anemia resulting from infections with microorganisms. In Lichtman MA, Beutler E, Seligsohn U Eds. Williams Hematology 7th Ed. McGraw-Hill Medical 2006;51:723-727.
Lee GR. Acquired hemolytic anemias resulting from direct effects of infectious, chemical, or physical agents. In Lee GR, Foerster J, Lukens J et al Eds. Wintrobe’s Cilnical Hematology 10th Ed. Lippincott Williams & Wilkins 1999;48:1289-1304.
Jones TK, Sullivan DA, Smilack JD. A 66-year-old woman with fever and hemolysis. Mayo Clin Proc 1996; 71: 1007-1010.
Chaplin H. Abdominal pain, total intravascular hemolysis, and death in a 53-yearold woman. Am J Med 1990; 88: 667-674.
Tsai IK, Yen MY, Ho IC, Yu KW, Liu CY, Cheng DL. Clostridium perfringens septicemia with massive hemolysis. Scand J Infect Dis 1989; 21: 467-471.
Rogstad B, Ritland S, Lunde S, Hagen AG. Clostridium perfringens septicemia with massive hemolysis. Infection 1993; 21: 54-56.
Alvarez A, Rives S, Nomdedeu B, Pereira A. Massive hemolysis in Clostridium perfringens infection ( Letter ). Hematologica 1999; 84: 571-573.
Elliot DL, Goldberg L, Shilt SC, Girard DE. Emphysematous cholecystitis following cardiopulmonary resuscitation. Arch Intern Med 1984; 144: 635-636.
Bennett JM, Healey PJM. Spherocytic hemolytic anemia and acute cholecystitis caused by Clostridium whelchii. N Engl J Med 1963; 268: 1070-1072.
Batge B, Filejski W, Kurowski V, Klutter H, Djonlagic H. Clostridial sepsis with massive intravascular hemolysis: rapid diagnosis and successful treatment. Intensive Care Med 1992; 18: 488-490.
Zeggwagh AA, Abouqal R, Zekraoui A, Kerkeb O. Quatre sepsis sévères à Clostridium perfringens. La Presse Médicale 1993; 22 (35): 1791.
Bush G, Clements R, Philips M, Kent R. Clostridium perfringens sepsis with intravascular hemolysis following laparoscopic cholecystectomy: a newly reported complication. Am Surg 1996; 62: 326-327.
Meyerhoff A, Renzi RM, Wehbe T, Opal SM. Fatal clostridial sepsis in a previously healthy woman ( Letter ). Clin Infect Dis 1995; 20: 1066-1067.
Gutiérrez A, Florencio R, Ezpeleta C, Cisterna R, Martinez M. Fatal intravascular hemolysis in a patient with Clostridium perfringens septicemia ( Letter ). Clin Infect Dis 1995; 20: 1064-1065.
Singer AJ, Migdal PM, Oken JP, Chale SN, Moll UM. Clostidium perfringens septicemia with massive hemolysis in a patient with Hodgkin’s Lymphoma. Am J Emerg Med 1997; 15: 152-154.
Alvarez-Elcoro S, Sifuentes-Osorio J. Clostridium perfringens bacteremia in prosthetic valve endocarditis: diagnosis by peripheral blood smear. Arch Intern Med 1984; 144: 849-850.
Rechner PM, Agger WA, Mruz K, Cogbill TH. Clinical features of Clostridial bacteremia: a review from a rural area. Cin Infect Dis 2001; 33: 349-353.
Jimenez M, Sanz C, Alvarez A, Pereira A. Massive intravascular haemolysis in a patient with Clostridium perfringens sepsis ( Letter ). Vox Sanguinis 2002; 82: 214.
Seges RA, Kenny A, Bird GWG, Wingham J, Baals H, Stauffer UG. Pediatric surgical patients with severe anaerobic infection: report of 16 T-antigen positive cases and possible hazards of blood transfusion. J Pediatr Surg 1981; 16: 905-910.
Hubl W, Mostbeck B, Hartleb H, Pointner H, Kofler K, Bayer PM. Investigation of the pathogenesis of massive hemolysis in a case of Clostridium perfringens septicemia. Ann Hematol 1993; 67: 145-147
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