Clostridium Perfringens Infection in a Febrile Patient with Severe Hemolytic Anemia

Abstract

Patient: Male, 82Final Diagnosis: Clostridium perfringens infectionSymptoms: Anemia • fever • shockMedication: —Clinical Procedure: Antimicrobial chemotherapySpecialty: Infectious DiseasesObjective:Rare diseaseBackground:Clostridium perfringens (C. perfringens) can cause various infections, including gas gangrene, crepitant cellulitis, and fasciitis. While C. perfringens sepsis is uncommon, it is often rapidly fatal because the alpha toxin of this bacterium induces massive intravascular hemolysis by disrupting red blood cell membranes.Case Report:We present the case of a male patient with diabetes who developed a fatal liver abscess with massive intravascular hemolysis and septic shock caused by toxigenic C. perfringens. The peripheral blood smear showed loss of central pallor, with numerous spherocytes. Multiplex PCR only detected expression of the cpa gene, indicating that the pathogen was C. perfringens type A.Conclusions:C. perfringens infection should be considered in a febrile patient who has severe hemolytic anemia with a very low MCV, hemolyzed blood sample, and negative Coombs test. The characteristic peripheral blood smear findings may facilitate rapid diagnosis.

Type A fulminant Clostridium perfringens sepsis indicated RBC/Hb discrepancy; a case report

“…C. perfringens is classified into 5 types (types A–E) based on the production of different major lethal toxins [6]. All types of C. perfringens produce α toxin [3], which has been reported to hydrolyze phospholipids in red blood cell membranes, leading to massive hemolysis and severe tissue hypoxia due to the failure of oxygen transport functions [2, 5]. This may cause RBC/Hb discrepancy.…”

“…C. perfringens type A produces an α-toxin that induces hemolysis by destroying red blood cells, resulting in a failure to supply oxygen to tissues [2, 3]. Hemolysis with signs of septic shock due to C. perfringens infection has been reported as invariably fatal in several reports [1, 4, 5]. We report herein a case of fulminant C. perfringens septicemia with massive acute hemolysis and liver abscess.…”

Spontaneous Non-Traumatic <i>Clostridium perfringens</i> Sepsis

“…Recently, a French group was the first to report the case of a patient with septic shock due to peritonitis caused by C. perfringens; the case was complicated by massive hemolysis secondary to the secretion of alpha-toxin and theta-toxin by the bacterium (29). Alpha-toxin is a phospholipase C lecithinase that degrades phospholipids in the erythrocyte membrane, leading to subsequent accelerated destruction (14,30). Phospholipase C lecithinase may also cause platelet destruction, leading to thrombocytopenia.…”

“…In these cases, alpha-toxin secreted by C. perfringens is considered to be the main toxin, which is responsible for intravascular hemolysis, disseminated intravascular coagulopathy (DIC) (12,13), and multiple organ failure. Although the number of reported cases with spontaneous C. perfringens sepsis is increasing (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27), appropriate treatment strategies have not been established.…”

Hemolisi masibo barreiatua eta Clostridium perfringens

“…Leukozito eta plaketak hausteaz gain, toxina honek eritrozitoen mintzaren osotasuna kaltetu eta haien hemolisia eragiten du(1,2,3,4,5).…”