Sudden death caused by Clostridium perfringens sepsis presenting as massive intravascular hemolysis

Chinen, Katsuya

doi:10.4322/acr.2020.185

Cited by 10 publications

(11 citation statements)

References 52 publications

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“…CPA also induces hemolysis alone (Kiu and Hall, 2018;Liu et al, 2020); however, CPA production and the hemolysis rate were not correlated. CPA, which hydrolyzes sphingomyelin and lecithin, can lyse erythrocyte, platelet, and endothelial cell membranes (Uzal et al, 2014;Kiu and Hall, 2018;Chinen, 2020). Serum CPA activity was detected in two case reports of C. perfringens septicemia with MIH (Moore et al, 1976;Hübl et al, 1993).…”

Section: Discussionmentioning

confidence: 99%

“…Serum CPA activity was detected in two case reports of C. perfringens septicemia with MIH (Moore et al, 1976;Hübl et al, 1993). Therefore, CPA has been considered the most important pathogenic factor for MIH in C. perfringens sepsis (Hübl et al, 1993;Chinen, 2020). However, when patient sera with detected CPA activity were used, no hemolytic effect was observed in vitro after culture at 37°C for 24 h (Moore et al, 1976).…”

Section: Discussionmentioning

confidence: 99%

“…The bacterial strains used were 11 clinical blood-derived isolates of C. perfringens stored at Nihon University Hospital. Of the 11 strains, five were from group H, whose sera appeared exceptionally bright red with marked hemoglobinemia on arrival at the hospital (Chinen, 2020), and six were from group NH. The clinical backgrounds of the isolates used in this study are provided in Table 1.…”

Section: Bacterial Strainsmentioning

confidence: 99%

“…In humans, C. perfringens resides in the gastrointestinal tract and genital organs and is well-known as a causative agent of mass food poisoning (Kiu and Hall, 2018), gas gangrene (Awad et al, 2001;Uzal et al, 2014), liver abscess, and sepsis (Hübl et al, 1993;van Bunderen et al, 2010;Chinen, 2020). Food poisoning develops when CPE is produced by this microorganism (Kiu and Hall, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…In addition, complementation with the pore-forming θ-toxin (perfringolysin O, PFO) aggravates muscle necrosis; thus, the pathogenesis of gas gangrene is currently believed to be caused by the synergistic effect of both toxins (Awad et al, 2001;Uzal et al, 2014). The incidence rate of C. perfringens sepsis is lower than that of food poisoning or gas gangrene, but its prognosis is very poor, especially when massive intravascular hemolysis (MIH) occurs (Chinen, 2020). Clostridium perfringens sepsis with MIH remains an extremely serious disease, with a fatality rate of 74-80% (van Bunderen et al, 2010;Simon et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

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Pathogenic Characterization of Clostridium perfringens Strains Isolated From Patients With Massive Intravascular Hemolysis

et al. 2021

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Sepsis caused by Clostridium perfringens infection is rare but often fatal. The most serious complication leading to poor prognosis is massive intravascular hemolysis (MIH). However, the molecular mechanism underlying this fulminant form of hemolysis is unclear. In the present study, we employed 11 clinical strains isolated from patients with C. perfringens septicemia and subdivided these isolates into groups H and NH: septicemia with (n = 5) or without (n = 6) MIH, respectively. To elucidate the major pathogenic factors of MIH, biological features were compared between these groups. The isolates of two groups did not differ in growth rate, virulence-related gene expression, or phospholipase C (CPA) production. Erythrocyte hemolysis was predominantly observed in culture supernatants of the strains in group H, and the human erythrocyte hemolysis rate was significantly correlated with perfringolysin O (PFO) production. Correlations were also found among PFO production, human peripheral blood mononuclear cell (PBMC) cytotoxicity, and production of interleukin-6 (IL-6) and interleukin-8 (IL-8) by human PBMCs. Analysis of proinflammatory cytokines showed that PFO induced tumor necrosis factor-α (TNF-α), IL-5, IL-6, and IL-8 production more strongly than did CPA. PFO exerted potent cytotoxic and proinflammatory cytokine induction effects on human blood cells. PFO may be a major virulence factor of sepsis with MIH, and potent proinflammatory cytokine production induced by PFO may influence the rapid progression of this fatal disease caused by C. perfringens.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Bacterial Strainsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pathogenic Characterization of Clostridium perfringens Strains Isolated From Patients With Massive Intravascular Hemolysis

et al. 2021

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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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Fatal Clostridium perfringens sepsis with spleen rupture and intraabdominal massive bleeding in a 37-week pregnancy

Gafumbegete¹,

Weide²,

Misgeld³

et al. 2021

IDCases

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The maternal death rate remains unacceptably high worldwide, predominantly in areas of poor access to quality health services. According to the WHO, in 2017, 810 women died from preventable causes related to pregnancy and childbirth. Causes of maternal death are plenty, including previous morbidity and unexpected causes. Among the latter are infectious disease-related deaths. Herein, we describe a case of a 29-year-old woman at 37 weeks’ gestation who presented with right upper quadrant pain, which was initially considered to be pregnancy-related. However, she collapsed shortly after the hospital admission. The physical examination revealed severe hypovolemic shock due to a large amount of intraperitoneal free fluid. The patient was immediately rushed into an emergency cesarean section followed by exploratory laparotomy, which demonstrated a large intra-abdominal hemorrhage. The patient and her fetus died in the operating room. An autopsy revealed acute gangrenous cholecystitis along with abundant rod-shaped bacteria within the mucosa and vessels of the gallbladder, gas gangrene and rupture of the spleen, and signs of shock. Clostridium perfringens (CP) was isolated in the culture of a splenic sample. Although CP is a well-known and dreadful infectious etiological agent, catastrophic cases still happen. The acquaintance of this infection by the caregivers is crucial for the early diagnosis and treatment. This is a quite unique way to provide a dismal chance of survival in sepsis cases by this agent.

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Sudden death caused by Clostridium perfringens sepsis presenting as massive intravascular hemolysis

Abstract: How to cite: Chinen K. Sudden death caused by Clostridium perfringens sepsis presenting as massive intravascular hemolysis.

Cited by 10 publications

References 52 publications

Pathogenic Characterization of Clostridium perfringens Strains Isolated From Patients With Massive Intravascular Hemolysis

Pathogenic Characterization of Clostridium perfringens Strains Isolated From Patients With Massive Intravascular Hemolysis

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

Fatal Clostridium perfringens sepsis with spleen rupture and intraabdominal massive bleeding in a 37-week pregnancy

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