Perianal gas-producing infection of non-clostridial origin

Brightmore, T. G. J.

doi:10.1002/bjs.1800590211

Cited by 23 publications

(9 citation statements)

References 21 publications

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“…Gas-forming clostridial infection was most frequently encountered following amputation for peripheral vascular disease, as was found by other authors (Parker, 1969;Brightmore, 1972). Although some cases followed trauma, this was not the commonest factor, as found by Roding et al (1972) and Jackson and Waddell (1973).…”

Section: Clinical Featuresmentioning

confidence: 56%

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Gas gangrene and related infection: Classification, clinical features and aetiology, management and mortality. A report of 88 cases

Darke

King

Slack

1977

British Journal of Surgery

107

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The clinical features of gas gangrene and related infection seen in 88 patients over a 10-year period are described. It is suggested that clostridial infection could be simply classified as either 'gas-forming' or 'non-gas-forming'. The gas-forming group represents the more severe form of infection. Non-clostridial gas gangrene may present in a variety of forms. The anaerobic streptococcus was the organism most frequently responsible, but these cases were indistinguishable from clostridial infection on clinical grounds. The treatment of gas gangrene in this series of patients is reported. Emphasis is laid on the importance of adequate prophylaxis with penicillin in patients at risk. The value of antibiotics in established infection remains equivocal. The evidence supporting the value of hyperbaric oxygen therapy is assessed and an attempt made to quantify the response to this treatment. Benefit was apparent in only a proportion of patients. A favourable response indicated clostridial infection and guaranteed immediate survival. Extensive debridement or amputation is unnecessary in this group. No response following hyperbaric oxygen therapy indicated widespread mixed clostridial and non-clostridial infection, or infection due to organisms other than clostridia. Urgent and extensive debridement and amputation remain the predominant measures in this group.

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Section: Clinical Featuresmentioning

confidence: 56%

“…Recognizable among this group were examples of necrotizing fasciitis and progressive dermal gangrene, which has recently been comprehensively described and reviewed by Ledingham and Tehrani (1975). Two of the patients in this series have been reported previously (Brightmore, 1972).…”

Section: Classijca Tion Clostridial Infectionmentioning

confidence: 87%

Gas gangrene and related infection: Classification, clinical features and aetiology, management and mortality. A report of 88 cases

Darke

King

Slack

1977

British Journal of Surgery

107

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“…Non-clostridial gas forming infections may be due to aerobic or anaerobic bacteria [16]. They occur in many sites, commonly within the abdomen, but also in other sites including the perirenal space [17], perianally [18], the eye [19] and the urinary tract [20]. Diabetics appear to be more susceptible to such infections [21,22], which are usually due to the aerobe E. coli, although anaerobic streptococci acting alone may cause a similar condition in nondiabetics.…”

Section: Discussionmentioning

confidence: 99%

Non-clostridial gas gangrene in the diabetic lower limb

1977

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Three cases of non-clostridial gas gangrene in diabetic lower limbs are reported. This rare condition occurs only in diabetes with peripheral neuropathy and is invariably fatal unless treated surgically. The clinical picture is deceptive with a slow, but insidiously progressive course, and the late appearance of skin necrosis. Antibacterial therapy is ineffective in preventing death. A serious delay may be fostered by inconclusive bacteriological investigations. Urgent radical amputation is required to save the patient's life.

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“…If untreated, the disease is 100% lethal, and it is 5 ~ 30% lethal with prompt diagnosis and appropriate treatment [ 2 , 3 ]. However, considering the possibility of non-clostridial infections in gas-producing perianal abscess [ 4 ], the importance of pathogenic organism identification cannot be overemphasized, as the treatment of non-clostridial infections often differs from that of clostridial infections which they may closely resemble. Radical surgery may not be warranted, penicillin may not be the antibiotic of choice, and hyperbaric oxygen is of equivocal value [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Coinfection of Clostridium perfringens and Escherichia coli in gas-producing perianal abscess diagnosed by 16S rDNA sequencing: a case report

Sun

Bai

et al. 2021

Gut Pathog

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Background Gas-producing perianal abscess raises the possibility of clostridial infection, with Clostridium perfringens being the most common causative agent, which is highly lethal if untreated timely. As the treatment of clostridial infections often differs from that of non-clostridial infections, which they may closely resemble, the importance of accurate pathogenic organism identification cannot be overemphasized. The 16S rDNA of bacteria is highly conserved within a species and among species of the same genus but demonstrates substantial variation between different species, thus making it a suitable genomic candidate for bacterial detection and identification. Case presentation Here, we report the case of a 53-year-old patient who was admitted to the hospital for a gas-producing perianal abscess. The patient was managed with ceftizoxime and ornidazole and then received debridement and drainage at the lesion on the second day after admission. The bacterial cultures of the patient isolates from the debridement showed a coinfection of Escherichia coli and Enterococcus faecium. Although perianal redness and swelling subsided obviously after the surgery, the patient was febrile to 38.3℃ with his left upper thigh red and swollen, aggravated with tenderness and crepitus. Considering insufficient debridement and the risk of incorrect identification of pathogens, a second debridement and drainage were performed 4 days after the primary operation, and 16S rDNA sequencing of the isolates implicated Clostridium perfringens infection. Given the discrepancies in diagnostic results and the treatment outcomes, Enterococcus faecium was identified as sample contamination, and a diagnosis of coinfection of Clostridium perfringens and Escherichia coli in gas-producing perianal abscess was confirmed. The patient was then successfully treated with meropenem and vancomycin and was discharged at 27 days of admission. Conclusions This case represents the first report of coinfection of both clostridial and non-clostridial organisms in gas-producing perianal abscess and the first case reporting the use of 16S rDNA sequencing in the diagnosis of perianal abscess. Timely pathogen identification is critical for treating gas-producing perianal abscess and an antibiotic regimen covering both aerobic and anaerobic organisms is recommended before true pathogens are identified.

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Perianal gas-producing infection of non-clostridial origin

Cited by 23 publications

References 21 publications

Gas gangrene and related infection: Classification, clinical features and aetiology, management and mortality. A report of 88 cases

Gas gangrene and related infection: Classification, clinical features and aetiology, management and mortality. A report of 88 cases

Non-clostridial gas gangrene in the diabetic lower limb

Coinfection of Clostridium perfringens and Escherichia coli in gas-producing perianal abscess diagnosed by 16S rDNA sequencing: a case report

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