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Published on: October 11, 2018
Clinical and Microbiological Features of Fulminant Haemolysis Caused by Clostridium perfringens Bacteraemia: Unknown
1Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Ohyaguchi Kamicho, Itabashiku, Tokyo 173-8610, Japan.
Abstract:
Bacteraemia brought on by Clostridium perfringens has a very low incidence but is severe and fatal in fifty per cent of cases. C. perfringens is a commensal anaerobic bacterium found in the environment and in the intestinal tracts of animals; it is known to produce six major toxins: α-toxin, β-toxin, ε-toxin, and others. C. perfringens is classified into seven types, A, B, C, D, E, F and G, according to its ability to produce α-toxin, enterotoxin, and necrotising enterotoxin. The bacterial isolates from humans include types A and F, which cause gas gangrene, hepatobiliary infection, and sepsis; massive intravascular haemolysis (MIH) occurs in 7-15% of C. perfringens bacteraemia cases, resulting in a rapid progression to death. We treated six patients with MIH at a single centre in Japan; however, unfortunately, they all passed away. From a clinical perspective, MIH patients tended to be younger and were more frequently male; however, there was no difference in the toxin type or genes of the bacterial isolates. In MIH cases, the level of θ-toxin in the culture supernatant of clinical isolates was proportional to the production of inflammatory cytokines in the peripheral blood, suggesting the occurrence of an intense cytokine storm. Severe and systemic haemolysis is considered an evolutionary maladaptation as it leads to the host's death before the bacterium obtains the benefit of iron utilisation from erythrocytes. The disease's extraordinarily quick progression and dismal prognosis necessitate a straightforward and expedient diagnosis and treatment. However, a reliable standard of diagnosis and treatment has yet to be put forward due to the lack of sufficient case analysis.
Insights
Clostridium perfringens bacteraemia, though rare, is often fatal. Massive intravascular hemolysis (MIH) in these cases, linked to theta-toxin and cytokine storms, leads to rapid death, necessitating urgent diagnosis and treatment.
Area of Science:
- Microbiology
- Infectious Diseases
- Toxicology
Background:
- Clostridium perfringens is an anaerobic bacterium with low incidence but high fatality in bloodstream infections.
- This bacterium produces toxins, classified into types A-G, causing various infections including sepsis and gas gangrene.
- Massive intravascular hemolysis (MIH) is a severe complication in 7-15% of C. perfringens bacteremia cases, leading to rapid mortality.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of patients with C. perfringens bacteremia complicated by massive intravascular hemolysis (MIH).
- To explore the potential role of theta-toxin and cytokine storms in the pathogenesis of MIH.
- To highlight the urgent need for improved diagnostic and treatment strategies for this severe condition.
Main Methods:
- Retrospective case series analysis of six patients with C. perfringens bacteremia and MIH treated at a single center.
- Analysis of clinical data, bacterial toxin types, and genetic profiles.
- Correlation of theta-toxin levels with inflammatory cytokine production in peripheral blood.
Main Results:
- All six treated MIH patients unfortunately died, indicating a dismal prognosis.
- MIH patients were generally younger and more frequently male, irrespective of bacterial toxin type or genes.
- Higher theta-toxin levels correlated with increased peripheral blood inflammatory cytokine production, suggesting a cytokine storm.
Conclusions:
- Massive intravascular hemolysis in C. perfringens bacteremia is a rapidly fatal complication.
- The pathogenesis likely involves theta-toxin-induced cytokine storm, leading to severe systemic hemolysis.
- The lack of effective treatments and diagnostic standards underscores the need for further research and clinical analysis.
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