Fulminant Massive Gas Gangrene Caused by Clostridium perfringens

Kuroda, S.; Okada, Yoshiie; Mita, Masaki; Okamoto, Y; Kato, Hirotaka; Ueyama, Shigemitsu; Fujii, Ikuzo; Morita, Sumiharu; Yoshida, Yasuaki

doi:10.2169/internalmedicine.44.499

Cited by 29 publications

(28 citation statements)

References 12 publications

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“…Gas gangrene, or myonecrosis, is considered one of the most fulminate infections caused by a Gram-positive organism in humans and animals (8,9). Infection starts from the site of a recent surgical wound or trauma, where C. perfringens type A strains must first attach to the disrupted epidermal epithelium and proliferate while at the same time producing toxins that necrotize the tissue (8,(14)(15)(16). Tissue destruction associated with C. perfringens infection progresses rapidly to involve an entire extremity (8,14,(17)(18)(19).…”

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The CpAL Quorum Sensing System Regulates Production of Hemolysins CPA and PFO To Build Clostridium perfringens Biofilms

2015

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Mexico bClostridium perfringens strains produce severe diseases, including myonecrosis and enteritis necroticans, in humans and animals. Diseases are mediated by the production of potent toxins that often damage the site of infection, e.g., skin epithelium during myonecrosis. In planktonic cultures, the regulation of important toxins, such as CPA, CPB, and PFO, is controlled by the C. perfringens Agr-like (CpAL) quorum sensing (QS) system. Strains also encode a functional LuxS/AI-2 system. Although C. perfringens strains form biofilm-like structures, the regulation of biofilm formation is poorly understood. Therefore, our studies investigated the role of CpAL and LuxS/AI-2 QS systems and of QS-regulated factors in controlling the formation of biofilms. We first demonstrate that biofilm production by reference strains differs depending on the culture medium. Increased biomass correlated with the presence of extracellular DNA in the supernatant, which was released by lysis of a fraction of the biofilm population and planktonic cells. Whereas ⌬agrB mutant strains were not able to produce biofilms, a ⌬luxS mutant produced wild-type levels. The transcript levels of CpAL-regulated cpa and pfoA genes, but not cpb, were upregulated in biofilms compared to planktonic cultures. Accordingly, ⌬cpa and ⌬pfoA mutants, in type A (S13) or type C (CN3685) backgrounds, were unable to produce biofilms, whereas CN3685⌬cpb made wild-type levels. Biofilm formation was restored in complemented ⌬cpa/cpa and ⌬pfoA/ pfoA strains. Confocal microscopy studies further detected CPA partially colocalizing with eDNA on the biofilm structure. Thus, CpAL regulates biofilm formation in C. perfringens by increasing levels of certain toxins required to build biofilms.

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“…Tissue destruction associated with C. perfringens infection progresses rapidly to involve an entire extremity (8,14,(17)(18)(19). Amputation remains the single best life-saving treatment, although mortality still remains high (8,9,15,16).…”

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The CpAL Quorum Sensing System Regulates Production of Hemolysins CPA and PFO To Build Clostridium perfringens Biofilms

2015

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“…Six Clostridium species cause gas gangrene in humans [10], with C. perfringens being the most common [6]. C. perfringens has five types, A-E, distinguished by their individual toxin [6]. There are at least 12 separate toxins produced by this bacterium, and the alpha-type toxin is the most common cause of human gas gangrene [6].…”

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confidence: 99%

“…C. perfringens has five types, A-E, distinguished by their individual toxin [6]. There are at least 12 separate toxins produced by this bacterium, and the alpha-type toxin is the most common cause of human gas gangrene [6]. Factors increasing the risk of clostridial infection include increasing age, diabetes, liver cirrhosis, arterial insufficiency, and disease or treatment causing immunosuppression [5].…”

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confidence: 99%

Clostridium Perfringens Infection Following Carpal Tunnel Release

Sanger

2012

Hand (New York, N,Y.)

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“…CP may cause septicemia without any apparent wound through bacterial translocation [5][6][7][8] . Patients typically have an underlying condition such as diabetes, malignancy, liver cirrhosis, or an immunosuppressive state [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] . In some reports, CP septicemia occurred after an invasive procedure in the hepatobiliary tract [24][25][26] or gastrointestinal tract or following gynecological treatment [27,28] or line insertion [29] .…”

Section: Introductionmentioning

confidence: 99%

Gas-forming liver abscess associated with rapid hemolysis in a diabetic patient

Kurasawa¹,

Nishikido²,

Koike³

et al. 2014

WJD

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We experienced a case of liver abscess due to Clostridium perfringens (CP ) complicated with massive hemolysis and rapid death in an adequately controlled type 2 diabetic patient. The patient died 6 h after his first visit to the hospital. CP was later detected in a blood culture. We searched for case reports of CP septicemia and found 124 cases. Fifty patients survived, and 74 died. Of the 30 patients with liver abscess, only 3 cases survived following treatment with emergency surgical drainage. For the early detection of CP infection, detection of Gram-positive rods in the blood or drainage fluid is important. Spherocytes and ghost cells indicate intravascular hemolysis. The prognosis is very poor once massive hemolysis occurs. The major causative organisms of gas-forming liver abscess in diabetic patients are Klebsiella pneumoniae (K. pneumoniae ) and Escherichia coli (E. coli ). Although CP is relatively rare, the survival rate is very poor compared with those of K. pneumoniae and E. coli . Therefore, for every case that presents with a gas-forming liver abscess, the possibility of CP should be considered, and immediate aspiration of the abscess and Gram staining are important.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Liver abscess; Gas-forming; Clostridium perfringens ; Hemolysis; Diabetes Core tip: Gas-forming liver abscess caused by Clostridium perfringens can result in massive hemolysis and death within several hours. For survival, urgent surgical intervention and antibiotic administration are necessary.Kurasawa M, Nishikido T, Koike J, Tominaga S, Tamemoto H. Gas-forming liver abscess associated with rapid hemolysis in a diabetic patient. World J Diabetes 2014; 5(2): 224-229 Available from:

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Fulminant Massive Gas Gangrene Caused by Clostridium perfringens

Cited by 29 publications

References 12 publications

The CpAL Quorum Sensing System Regulates Production of Hemolysins CPA and PFO To Build Clostridium perfringens Biofilms

The CpAL Quorum Sensing System Regulates Production of Hemolysins CPA and PFO To Build Clostridium perfringens Biofilms

Clostridium Perfringens Infection Following Carpal Tunnel Release

Gas-forming liver abscess associated with rapid hemolysis in a diabetic patient

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