Clostridium perfringens septicaemia with massive intravascular haemolysis: a case report and review of the literature.
Clostridium perfringens septicaemia with massive intravascular haemolysis: a case report and review of the literature.
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发表时间：
2010-09
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通讯作者：
C. C. Bunderen-C.;M. Bomers;E. Wesdorp;PaulG. H. Peerbooms;J. Veenstra
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作者：
C. C. Bunderen-C.;M. Bomers;E. Wesdorp;PaulG. H. Peerbooms;J. Veenstra
我们描述的情况下，74岁的男子胆管炎，并发产气荚膜梭菌败血症和大量血管内溶血。产气荚膜梭菌败血症是一种罕见但众所周知的引起大量血管内溶血的原因。本文回顾了自1990年以来发表的40例类似病例。大多数病例涉及免疫功能低下患者，伴有潜在的血液系统疾病（22.5%），胰腺癌或胃癌（12.5%），and÷or糖尿病（30.0%）。侵入性手术后感染主要集中在肝胆（45.0%）、肠道或妇科。80%的病例没有存活下来；入院和死亡之间的平均时间只有8小时。如果尝试切除感染病灶（即肝脓肿引流、胆囊切除术、子宫切除术或ERCP），这被证明是一个强有力的生存预后指标。然而，在许多病例中，患者在做出诊断之前已经休克或死亡。对于急诊科出现发热和溶血的重症患者，应始终考虑产气荚膜梭菌败血症，因为早期抗生素治疗和在可能的情况下切除感染病灶可以使患者免于致命的结局。
We describe the case of a 74-year-old man with cholangitis, complicated by Clostridium perfringens septicaemia and massive intravascular haemolysis. Clostridium perfringens septicaemia is a rare but well-known cause of massive intravascular haemolysis. Here we review 40 similar cases published since 1990. Most cases involve immunocompromised patients with underlying haematological disorder (22.5%), pancreatic or gastric cancer (12.5%) and÷or diabetes (30.0%). Focus of infection is mostly hepatobiliary (45.0%), intestinal or gynaecological after invasive procedure. Eighty percent of reviewed cases did not survive; the median time between admission and death was only eight hours. If an attempt was made to remove the focus of infection (i.e. by drainage of liver abscess, cholecystectomy, hysterectomy or ERCP), this proved to be a strong prognostic indicator of survival. However, in many of the cases the patient had already gone into shock or died before a diagnosis could be made. In severely ill patients with fever and haemolysis on the emergency department Clostridium perfringens septicaemia should always be considered, since early antibiotic treatment and if possible removal of the focus of infection can rescue patients from an otherwise fatal outcome.