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Massive intravascular hemolysis is an important factor in Clostridium perfringens-induced bacteremia

Ai Suzaki1,2, Shihoko Komine-Aizawa3, Hiroyuki Nishiyama4

  • 1Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi, Tokyo, 173-8610, Japan. suzaki.ai@nihon-u.ac.jp.

Internal and Emergency Medicine
|August 13, 2022
PubMed

Insights

Clostridium perfringens bacteremia with massive intravascular hemolysis (MIH) is rare and highly fatal. Early recognition of MIH symptoms is crucial for anticipating severe outcomes in patients with this infection.

Area of Science:

  • Infectious Diseases
  • Hematology
  • Critical Care Medicine

Background:

  • Clostridium perfringens bacteremia is a rare but severe infection.
  • Massive intravascular hemolysis (MIH) associated with C. perfringens bacteremia carries an extremely high mortality rate.
  • The pathophysiology of fulminant C. perfringens bacteremia with MIH remains poorly understood due to its rarity.

Purpose of the Study:

  • To elucidate the detailed pathogenesis of massive intravascular hemolysis (MIH) in Clostridium perfringens bacteremia.
  • To identify clinical and laboratory differences between patients with and without MIH.
  • To understand the outcomes and time course of fulminant C. perfringens bacteremia with MIH.

Main Methods:

  • Retrospective analysis of medical records and laboratory data from patients with C. perfringens bacteremia.
  • Comparison of clinical characteristics and outcomes between patients with MIH and those without MIH.
  • Review of data from two university hospitals spanning from 2000 to 2014.

Main Results:

  • Patients with MIH presented with more intense pain, impaired consciousness, shock, hematuria, metabolic acidosis, and gas formation.
  • Antibiotic susceptibility patterns did not significantly differ between MIH and non-MIH groups.
  • All patients with MIH died within 26 hours of admission, primarily from acute lung injury or ARDS, with a median survival of 4 hours 20 minutes.

Conclusions:

  • Massive intravascular hemolysis in C. perfringens bacteremia indicates a severe, rapidly fatal outcome.
  • Clinicians should be vigilant for MIH symptoms and prepare for critical illness.
  • Further investigation into the pathophysiology of fulminant C. perfringens bacteremia with MIH is warranted.
Keywords:
Acute respiratory distress syndrome (ARDS)BacteremiaClostridium perfringensHemolysisPerfringolysin OSepsis

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