Clostridium perfringens and Escherichia coli Bacteremia in a Patient with Acute Obstructive Suppurative Cholangitis: A Case Report and Review of the Literature

Abstract

Patient: Male, 74-year-old Final Diagnosis: Acute obstructive suppurative cholangitis Symptoms: Nausea and vomiting and chills Medication: — Clinical Procedure: — Specialty: Infectious Diseases Objective: Rare disease Background: Clostridium perfringens (CP), one of several clostridial species gram-positive bacteria, is a major cause of animal necrosis enteritis and traumatic gangrene. In some reports, CP can cause acute emphysematous cholecystitis in patients with biliary tract infections. However, C. perfringens combined with other aerobic bacteria (eg, E. coli ) in bloodstream co-infection is extremely rare and often fatal. Herein, we present a case of co-infection to underscore this unusual situation so that clinicians can adequately evaluate and treat patients in time. Case Report: A 74-year-old man presented to the Emergency Department half a day after the onset of acute abdominal pain accompanied by nausea, vomiting, and chills. The patient was admitted, following development of jaundice, chills, high fever, confusion, and shock. Computed tomography (CT) revealed that the patient had cholangiectasis with acute obstructive suppurative cholangitis (AOSC). We subsequently performed percutaneous transhepatic gallbladder drainage surgery combined with antibiotics, including ceftriaxone, levofloxacin, and metronidazole. C. perfringens and Escherichia coli infections were identified by in vitro blood culture. Fortunately, the patient responded favorably to treatment in our hospital and was cured within 1 week. Conclusions: We report a rare case of C. perfringens and E. coli bloodstream co-infection in a patient with AOSC. We suggest that anaerobic and aerobic co-infection should be considered in future clinical diagnoses. Effective antibiotic treatment combined with surgical drainage is crucial if mixed infection occurs.

Pathophysiological consequences and treatment strategy of obstructive jaundice

“…Elevated biliary pressure pushes bacteria into the bile ducts, hepatic veins, and perihepatic lymphatics, which results in bacteremia[ 17 , 18 ]. Increased pressure in the bile ducts during acute cholangitis frequently renders the ducts more permeable to bacteria and toxins, leading to severe infection and sepsis[ 19 ]. In addition, bile reflux leads to inflammatory infiltration of polymorphonuclear neutrophilic leukocytes into the portal sinus and increases fibrin deposition.…”

Binary Enterotoxin Producing Clostridium perfringens Isolated in Blood Cultures: Case Report and Review of the Literature

“…In humans, this bacterium is responsible for necrotizing gangrene, bacteremia in cancer patients or in patients with gastrointestinal tract infection, antibiotic-associated diarrhea, and infection after chemoembolization. Gas gangrene is the most frequent manifestation of C. perfringens infection and is one of the fatal manifestations that present after trauma or gastrointestinal surgeries [ 2 , 3 , 4 , 5 , 6 , 7 ].…”