Toxinotype A Clostridium perfringens causing septicaemia with intravascular haemolysis: two cases and review of the literature

Woittiez, Nicky J C; Prehn, Joffrey van; Immerseel, Filip Van; Goossens, Evy; Bauer, Martijn P.; Ramspek, Chava; Slangen, Rob M.E.; Purmer, Ilse M.; Ludikhuize, Jeroen

doi:10.1016/j.ijid.2021.12.331

Cited by 8 publications

(7 citation statements)

References 11 publications

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“… 5 However, to date, only toxinotype A has been associated with human cases of hemolysis. 10 These toxins are usually disease-specific. For example, α-toxin is involved in human clostridial myonecrosis or gas gangrene, 11 CPE causes food poisoning in humans, 12 and β-toxin, ε-toxin, and Clostridium perfringens necrotic enteritis B-like toxin primarily mediate infection in animals.…”

Section: Discussionmentioning

confidence: 99%

Clostridium perfringens Liver Abscess Disguised as Biliary Disease: A Report of Two Cases and a Review of the Literature

Peng¹,

Zhai²,

Li³

et al. 2023

IDR

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Liver abscesses caused by Clostridium perfringens are rare but rapidly fatal. In only a few days, patients progress from liver abscess to sepsis, intravascular hemolysis, multiple organ failure, and even death. These abscesses often occur in patients after trauma or surgery or in those with immunodeficiency. Because patients only show non-specific symptoms such as fever and abdominal pain in the early stage, they can easily be misdiagnosed and miss the therapeutic window, resulting in a poor prognosis. The diagnosis of Clostridium perfringens liver abscess mainly depends on computed tomography (CT), needle aspiration, and/or blood culture. After diagnosis, treatments such as antibiotic therapy, surgical abscess drainage, blood transfusion as needed, and correction of metabolic disturbances must be immediately administered to prevent severe complications. Here, we present two cases of liver abscess due to Clostridium perfringens infection. Both patients initially presented only with fever, abdominal pain, and jaundice, symptoms that were easily confused with cholangitis caused by cholelithiasis. The patients then progressed rapidly and, despite receiving antimicrobial and multimodal sepsis treatment, both eventually died of multiple organ dysfunction syndrome. Clinicians should be on high alert for Clostridium perfringens liver abscesses disguised as biliary disease. Early diagnosis and treatment with the appropriate antibiotics and surgery are fundamental for the survival of the affected patients.

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Section: Discussionmentioning

confidence: 99%

Clostridium perfringens Liver Abscess Disguised as Biliary Disease: A Report of Two Cases and a Review of the Literature

Peng¹,

Zhai²,

Li³

et al. 2023

IDR

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“…Only approximately 0.12-0.16% of blood culture-positive samples in clinical laboratories show Clostridium spp., with C. perfringens found in 22-42% of them [12][13][14]. Clinically relevant is the fact that 7-15% of patients with C. perfringens bacteraemia suffer massive intravascular haemolysis (MIH) [6,15], which is characterised by the severe and systemic destruction of red blood cells. MIH is brought on by many pathogeneses [16], including immune-mediated and microangiopathic illnesses, malaria, and babesiosis [17,18].…”

Section: Clostridium Perfringensmentioning

confidence: 99%

“…Nevertheless, because most of these cases are found in single case reports, there has been little research on causative organisms. In six cases, multiplex PCR was applied for typing toxins produced by the causative organism, all of which were type A bacteria that produce only CPA [6,21,[23][24][25]. Type A C. perfringens bacteria, on the other hand, are common and have been linked to hepatobiliary infections, gas gangrene, and sepsis in humans.…”

Section: Pathogenic Factorsmentioning

confidence: 99%

“…However, the prognosis for C. perfringens bacteraemia with MIH is extremely poor, with a median time from admission to death of only 10 hours, despite intensive care [2,3,5]. Even when apparently susceptible antimicrobial agents are used, mortality rates range from 70 to 100% [2][3][4][5][6], and there has been no decrease in mortality over the past 30 years. So far, antimicrobials have been used to treat cases of other Clostridium pathogens, including C. difficile infection (CDI), while C. tetani and C. botulinum infections are already effectively treated with antitoxins.…”

Section: State-of-the-art Treatment and Prognosismentioning

confidence: 99%

“…However, when it does occur, the fatality rate can exceed 52 per cent, making it one of the most severe types of bacteraemia [1]. C. perfringens infection is more lethal when massive intravascular haemolysis (MIH) develops, with fatality rates ranging from 70 to 100 per cent [2][3][4][5][6]. At Nihon University Hospital in Tokyo, we observed six cases of C. perfringens-related MIH.…”

Section: Introductionmentioning

confidence: 99%

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Clinical and Microbiological Features of Fulminant Haemolysis Caused by Clostridium perfringens Bacteraemia: Unknown Pathogenesis

Suzaki

Hayakawa

2023

Microorganisms

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Bacteraemia brought on by Clostridium perfringens has a very low incidence but is severe and fatal in fifty per cent of cases. C. perfringens is a commensal anaerobic bacterium found in the environment and in the intestinal tracts of animals; it is known to produce six major toxins: α-toxin, β-toxin, ε-toxin, and others. C. perfringens is classified into seven types, A, B, C, D, E, F and G, according to its ability to produce α-toxin, enterotoxin, and necrotising enterotoxin. The bacterial isolates from humans include types A and F, which cause gas gangrene, hepatobiliary infection, and sepsis; massive intravascular haemolysis (MIH) occurs in 7–15% of C. perfringens bacteraemia cases, resulting in a rapid progression to death. We treated six patients with MIH at a single centre in Japan; however, unfortunately, they all passed away. From a clinical perspective, MIH patients tended to be younger and were more frequently male; however, there was no difference in the toxin type or genes of the bacterial isolates. In MIH cases, the level of θ-toxin in the culture supernatant of clinical isolates was proportional to the production of inflammatory cytokines in the peripheral blood, suggesting the occurrence of an intense cytokine storm. Severe and systemic haemolysis is considered an evolutionary maladaptation as it leads to the host’s death before the bacterium obtains the benefit of iron utilisation from erythrocytes. The disease’s extraordinarily quick progression and dismal prognosis necessitate a straightforward and expedient diagnosis and treatment. However, a reliable standard of diagnosis and treatment has yet to be put forward due to the lack of sufficient case analysis.

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Acute fulminant intravascular hemolysis induced by Clostridium perfringens in a symptomatic multiple myeloma patient under immuno-chemotherapy

et al. 2022

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Toxinotype A Clostridium perfringens causing septicaemia with intravascular haemolysis: two cases and review of the literature

Cited by 8 publications

References 11 publications

Clostridium perfringens Liver Abscess Disguised as Biliary Disease: A Report of Two Cases and a Review of the Literature

Clostridium perfringens Liver Abscess Disguised as Biliary Disease: A Report of Two Cases and a Review of the Literature

Clinical and Microbiological Features of Fulminant Haemolysis Caused by Clostridium perfringens Bacteraemia: Unknown Pathogenesis

Acute fulminant intravascular hemolysis induced by Clostridium perfringens in a symptomatic multiple myeloma patient under immuno-chemotherapy

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