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2.
BMC Res Notes ; 9: 385, 2016 Aug 03.
Article in English | MEDLINE | ID: mdl-27488346

ABSTRACT

BACKGROUND: Gas gangrene is a necrotic infection of soft tissue associated with high mortality rates. We report a case of postoperative gas gangrene with very acute onset and rapid progression of symptoms. To our knowledge, this case is the most acute onset of postoperative gas gangrene ever reported. CASE PRESENTATION: A 65-year-old Japanese female patient developed a shock state 16 h after radical cystectomy with ileal conduit reconstruction. Two days after the operation, she was transferred to the intensive care unit because of deterioration in her respiratory and circulatory condition. Soon after moving her to the ICU, a subcutaneous hemorrhage-like skin rash appeared and extended rapidly over her left side. Blood tests performed on admission to the ICU indicated severe metabolic acidosis, liver and renal dysfunction, and signs of disseminated intravascular coagulation. Suspecting necrotizing fasciitis or gas gangrene, we performed emergency fasciotomy. Subsequently, multidisciplinary treatment, including empirical therapy using multiple antibiotics, mechanical ventilation, hyperbaric oxygen therapy, polymyxin B-immobilized fiber column direct hemoperfusion, and continuous hemodiafiltration, was commenced. Culture of the debris from a wound abscess removed by emergency fasciotomy detected the presence of Clostridium perfringens. We hypothesized that the source of infection in this case may have been the ileum used for bladder reconstruction. Although the initial treatment prevented further clinical deterioration, she developed secondary infection from the 3rd week onward, due to infection with multiple pathogenic bacteria. Despite prompt diagnosis and intensive therapy, the patient died 38 days after the operation. CONCLUSION: Although the patient did not have any specific risk factors for postsurgical infection, she developed a shock state only 16 h after surgery due to gas gangrene. Our experience highlights the fact that physicians should be aware that any patient could possibly develop gas gangrene postoperatively.


Subject(s)
Clostridium perfringens/physiology , Gas Gangrene/microbiology , Postoperative Complications/etiology , Postoperative Complications/microbiology , Acute Disease , Aged , Clostridium perfringens/isolation & purification , Disease Progression , Fatal Outcome , Female , Gas Gangrene/blood , Hospitalization , Humans , Intensive Care Units , Microbial Sensitivity Tests , Postoperative Complications/blood , Vital Signs
3.
Infect Genet Evol ; 40: 282-287, 2016 06.
Article in English | MEDLINE | ID: mdl-27012151

ABSTRACT

Clostridium perfringens type D infects ruminants and causes the enterotoxemia disease by ε-toxin. A mutated ε-toxin gene lacking toxicity was designed, synthesized, and cloned into the pT1NX vector and electroporated into Lactobacillus casei competent cells to yield LC-pT1NX-ε recombinant strain. BALB/c mice, immunized orally with this strain, highly induced mucosal, humoral, and cell-mediated immune responses and developed a protection against 200 MLD/ml of the activated ε-toxin. This study showed that the LC-pT1NX-ε could be a promising vaccine candidate against the enterotoxemia disease.


Subject(s)
Bacterial Toxins/immunology , Bacterial Vaccines/immunology , Clostridium perfringens/immunology , Gas Gangrene/prevention & control , Genetic Vectors/immunology , Lacticaseibacillus casei/immunology , Toxoids/immunology , Administration, Oral , Animals , Antibodies, Bacterial/blood , Antibodies, Bacterial/immunology , Bacterial Toxins/genetics , Bacterial Vaccines/administration & dosage , Bacterial Vaccines/genetics , Clostridium perfringens/genetics , Cytokines/blood , Cytokines/metabolism , Disease Models, Animal , Female , Gas Gangrene/blood , Gas Gangrene/immunology , Gas Gangrene/mortality , Gene Order , Genetic Vectors/administration & dosage , Genetic Vectors/genetics , Immunization , Immunoglobulin A/blood , Immunoglobulin A/immunology , Immunoglobulin G/blood , Immunoglobulin G/immunology , Lacticaseibacillus casei/genetics , Mice , Toxoids/administration & dosage
4.
FEMS Immunol Med Microbiol ; 50(1): 86-93, 2007 Jun.
Article in English | MEDLINE | ID: mdl-17428305

ABSTRACT

Clostridium perfringens is a common cause of the fatal disease gas gangrene (myonecrosis). Established gas gangrene is notable for a profound absence of neutrophils and monocytic cells (phagocytes), and it has been suggested that the bactericidal activities of these cells play an insignificant role in controlling the progression of the infection. However, large inocula of bacteria are needed to establish an infection in experimental animals, suggesting phagocytes may play a role in inhibiting the initiation of gangrene. Examination of tissue sections of mice infected with a lethal (1 x 10(9)) or sublethal (1 x 10(6)) inoculum of C. perfringens revealed that phagocyte infiltration in the first 3 h postinfection was inhibited with a lethal dose but not with a sublethal dose, indicating that exclusion of phagocytes begins very early in the infection cycle. Experiments in which mice were depleted of either circulating monocytes or neutrophils before infection with C. perfringens showed that monocytes play a role in inhibiting the onset of gas gangrene at intermediate inocula but, although neutrophils can slow the onset of the infection, they are not protective. These results suggest that treatments designed to increase monocyte infiltration and activate macrophages may lead to increased resistance to the initiation of gas gangrene.


Subject(s)
Clostridium perfringens/immunology , Gas Gangrene/immunology , Monocytes/immunology , Neutrophils/immunology , Animals , Female , Gas Gangrene/blood , Gas Gangrene/microbiology , Mice , Mice, Inbred BALB C , Phagocytes/immunology
5.
Clin Microbiol Rev ; 16(3): 451-62, 2003 Jul.
Article in English | MEDLINE | ID: mdl-12857777

ABSTRACT

Group A streptococcal necrotizing fasciitis/myonecrosis and Clostridium perfringens gas gangrene are two of the most fulminant gram-positive infections in humans. Tissue destruction associated with these infections progresses rapidly to involve an entire extremity. Multiple-organ failure is common, and morbidity and mortality remain high. Systemic activation of coagulation and dysregulation of the anticoagulation pathways contribute to the pathogenesis of many diverse disease entities of infectious etiology, and it has been our hypothesis that microvascular thrombosis contributes to reduced tissue perfusion, hypoxia, and subsequent regional tissue necrosis and organ failure in these invasive gram-positive infections. This article reviews the coagulation, anticoagulation, and fibrinolytic systems from cellular players to cytokines to novel antithrombotic therapies and discusses the mechanisms contributing to occlusive microvascular thrombosis and tissue destruction in invasive group A streptococcal and C. perfringens infections. A thorough understanding of these mechanisms may suggest novel therapeutic targets for patients with these devastating infections.


Subject(s)
Blood Coagulation Factors/analysis , Gas Gangrene/complications , Streptococcal Infections/complications , Streptococcus pyogenes , Thrombosis/etiology , Animals , Blood Coagulation , Cytokines/physiology , Endothelium, Vascular/cytology , Endothelium, Vascular/physiology , Gas Gangrene/blood , Humans , Leukocytes/physiology , Shock, Septic/therapy , Streptococcal Infections/blood
6.
Bol. Asoc. Méd. P. R ; 91(7/12): 103-105, Jul.-Dec. 1999.
Article in English | LILACS | ID: lil-411350

ABSTRACT

Massive intravascular hemolysis is a rare yet often fatal complication of clostridial sepsis. The only chance for survival is an early diagnosis and prompt initiation of treatment. We report a rapidly fatal case who developed electrocardiographic changes of acute myocardial injury. Autopsy showed gas-filled bubbles and cysts in the myocardium partially filled with sporulating bacilli with the morphology of clostridia. Gas filled bubbles were also present in the lungs, liver, kidneys and spleen. The gastric mucosa showed hemorrhagic and necrotizing changes, the probable site of entry of the infection


Subject(s)
Humans , Female , Middle Aged , Gas Gangrene/pathology , Sepsis/pathology , Anemia, Hemolytic/blood , Anemia, Hemolytic/etiology , Anemia, Hemolytic/pathology , Fatal Outcome , Gas Gangrene/blood , Gas Gangrene/complications , Sepsis/blood , Sepsis/complications
7.
Bol Asoc Med P R ; 91(7-12): 103-5, 1999.
Article in English | MEDLINE | ID: mdl-10842443

ABSTRACT

Massive intravascular hemolysis is a rare yet often fatal complication of clostridial sepsis. The only chance for survival is an early diagnosis and prompt initiation of treatment. We report a rapidly fatal case who developed electrocardiographic changes of acute myocardial injury. Autopsy showed gas-filled bubbles and cysts in the myocardium partially filled with sporulating bacilli with the morphology of clostridia. Gas filled bubbles were also present in the lungs, liver, kidneys and spleen. The gastric mucosa showed hemorrhagic and necrotizing changes, the probable site of entry of the infection.


Subject(s)
Gas Gangrene/pathology , Sepsis/pathology , Anemia, Hemolytic/blood , Anemia, Hemolytic/etiology , Anemia, Hemolytic/pathology , Fatal Outcome , Female , Gas Gangrene/blood , Gas Gangrene/complications , Humans , Middle Aged , Sepsis/blood , Sepsis/complications
10.
Ann Emerg Med ; 22(9): 1477-80, 1993 Sep.
Article in English | MEDLINE | ID: mdl-8363124

ABSTRACT

Spontaneous clostridial myonecrosis is a rare but aggressive disease usually associated with underlying immunosuppression or malignancy. We present a fatal case of clostridial myonecrosis arising in a patient with intact immune defenses.


Subject(s)
Gas Gangrene/diagnostic imaging , Muscular Diseases/diagnostic imaging , Anti-Bacterial Agents/therapeutic use , Biopsy , Diagnosis, Differential , Female , Gas Gangrene/blood , Gas Gangrene/pathology , Gas Gangrene/therapy , Humans , Hyperbaric Oxygenation , Immunocompetence , Middle Aged , Muscular Diseases/blood , Muscular Diseases/pathology , Muscular Diseases/therapy , Necrosis , Prognosis , Resuscitation , Tomography, X-Ray Computed
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