Severe Sepsis due toClostridium perfringensBacteremia of Urinary Origin: A Case Report and Systematic Review

Abstract

Clostridium perfringens bacteremia is an uncommon yet serious clinical syndrome that typically arises from a gastrointestinal source. However, clinicians should consider nongastrointestinal sources as well. We present a rare case of C. perfringens bacteremia of urinary origin that required surgical intervention for definitive treatment. A 61-year-old male presented with acute nausea and vomiting, altered mental status, and chronic diarrhea. His physical exam revealed right costovertebral tenderness and his laboratory work-up revealed acute renal failure. Percutaneous blood cultures grew C. perfringens. Cross-sectional imaging revealed a right-sided ureteral stone with hydronephrosis, which required nephrostomy placement. On placement of the nephrostomy tube, purulent drainage was identified and Gram stain of the drainage revealed Gram-variable rods. A urinary source of C. perfringens was clinically supported. Although it is not a common presentation, nongastrointestinal sources such as a urinary source should be considered in C. perfringens bacteremia because failure to recognize a nongastrointestinal source can delay appropriate treatment, which may include surgical intervention.

Clostridium perfringens sepsis in three patients with acute leukemia and review of the literature

“…With the exception of the antibacterial regimen, patients were infected during agranulocytosis, suggesting that applying G-CSF early could manage agranulocytosis and improve prognosis for patients with C. perfringens infection [ 16 ]. In addition, treating the infected area with hyperbaric oxygen therapy and surgery has also been shown to be effective [ 17 ]. Patients with leukemia are also susceptible to infection via a central venous catheter.…”

Black Urine and Methemoglobinemia in the Setting of Sepsis Due to Clostridium Perfringens

“…17 Other important interventions consist of early administration of antibiotics (a regimen of penicillin/clindamycin is recommended), prior to onset of the massive hemolysis, defined as hemoglobin <8 g/dL or hematocrit <24%, and surgical intervention with drainage of any identifiable source (liver abscess, cholecystitis or any abscess or gas in tissues that suggest gasforming anaerobic infection) has been shown to improve survival and prolong time to death. 18,19…”

Septic Shock Due to Clostridium perfringens

“…Emergency surgery may be needed for diagnosis, source control, removal of necrotic tissue, and reducing bacterial toxin burden. The mortality rate can range from 27 to 58% if treated promptly and correctly [10].…”

“…Clostridium perfringens is an anaerobic Gram-positive bacterium that can be found in the gastrointestinal tract, female genital tract, and on the skin. Infection with C. perfringens can cause gas gangrene, septic shock, myonecrosis, liver abscess, and hemolysis [1, 2]. Clostridial toxic shock syndrome is a life-threatening, rapidly progressive toxigenic illness that can be caused by infection of Clostridium perfringens [3].…”