Clostridium Perfringens Infection in a Febrile Patient with Severe Hemolytic Anemia.
Clostridium Perfringens Infection in a Febrile Patient with Severe Hemolytic Anemia.
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DOI：
10.12659/ajcr.895721
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发表时间：
2016-04-06
期刊：
影响因子：
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通讯作者：
Takeyama N
中科院分区：
文献类型：
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作者：
Hashiba M;Tomino A;Takenaka N;Hattori T;Kano H;Tsuda M;Takeyama N
病人：男性，82岁最终诊断：产气荚膜梭菌感染症状：贫血·发热·休克用药：-临床程序：抗菌药物化疗专业：感染性疾病罕见疾病产气荚膜梭菌（C。产气荚膜杆菌）可引起各种感染，包括气性坏疽、捻发音蜂窝织炎和筋膜炎。而C.产气荚膜杆菌败血症是不常见的，它通常是迅速致命的，因为这种细菌的α毒素通过破坏红细胞膜而诱导大量的血管内溶血。我们报告一位男性糖尿病患者，因丙型肝炎病毒引起的致命性肝脓疡合并大量血管内溶血及感染性休克。产气荚膜杆菌外周血涂片显示中心苍白消失，有大量球形红细胞。多重PCR仅检测到cpa基因的表达，表明该病原菌为C. A型产气荚膜杆菌C.如果发热患者患有严重溶血性贫血，MCV非常低，血液样本溶血，Coombs试验阴性，则应考虑产气荚膜杆菌感染。特征性的外周血涂片检查有助于快速诊断。
Patient: Male, 82 Final Diagnosis: Clostridium perfringens infection Symptoms: Anemia • fever • shock Medication: — Clinical Procedure: Antimicrobial chemotherapy Specialty: Infectious Diseases Rare disease Clostridium perfringens (C. perfringens) can cause various infections, including gas gangrene, crepitant cellulitis, and fasciitis. While C. perfringens sepsis is uncommon, it is often rapidly fatal because the alpha toxin of this bacterium induces massive intravascular hemolysis by disrupting red blood cell membranes. We present the case of a male patient with diabetes who developed a fatal liver abscess with massive intravascular hemolysis and septic shock caused by toxigenic C. perfringens. The peripheral blood smear showed loss of central pallor, with numerous spherocytes. Multiplex PCR only detected expression of the cpa gene, indicating that the pathogen was C. perfringens type A. C. perfringens infection should be considered in a febrile patient who has severe hemolytic anemia with a very low MCV, hemolyzed blood sample, and negative Coombs test. The characteristic peripheral blood smear findings may facilitate rapid diagnosis.