The role of Clostridium septicum in paraneoplastic sepsis.

CONTEXT: Clostridium septicum infections are rare but often associated with serious if not fatal outcomes. Clostridium septicum infection does not appear to be associated with a single specific defect in cellular or humoral immunity. It has been associated with multiple medical problems, including but not limited to leukemia, malignancy of the bowel, other solid tumors, cyclic neutropenia with enterocolitis, diabetes mellitus, and severe arteriosclerosis. Most cases of C septicum are associated with malignancy, and mortality approaches 100% if care is not rendered within 12 to 24 hours. OBJECTIVES: To evaluate outcomes of patients with C septicum bacteremia, whether treated medically or surgically or both, and to note associated conditions. DESIGN: Retrospective evaluation of patients found to have C septicum bacteremia in the past 6 years. SETTING: Two teaching hospitals, Brooke Army Medical Center (250 beds) and Wilford Hall Medical Center (292 beds), were the source of our patients. PATIENTS: All patients found to have C septicum bacteremia during hospitalization or postmortem examination were included in the study. There were no exclusion criteria. MAIN OUTCOME MEASURE: Mortality associated with C septicum infection. RESULTS: In our case series, mortality was 33%, which is slightly lower than reported in prior studies (43%-70%). CONCLUSION: Presumptive identification based on Gram stain, awareness of C septicum infection as a paraneoplastic syndrome, and prompt, clear communication between laboratory personnel and clinicians are necessary for early diagnosis of C septicum infection. Early institution of antibiotic therapy improves prognosis.

The incidence of unexpected antibodies in blood products collected at a military donor center.

The objective of the study was to determine the frequency of unexpected antibodies in a population of Air Force personnel thought to be representative of the population involved in combat situations. Recipients of blood transfusions in combat situations may not be screened for the presence of unexpected (non-A, non-B) antibodies. The records of the Wilford Hall Medical Center/59th Medical Defense Wing Donor Center and Transfusion Medicine Laboratory were reviewed for the calendar years 1995 and 1996 to determine the frequency of unexpected antibodies in this center's donor population, the vast majority of whom are Air Force basic trainees. The frequency of unexpected antibodies in the basic trainee donor population was 4/10,000. Clinically significant antibodies were present in 2/10,000. Because this donor pool probably represents the potential population of combat casualties, this information is reassuring in assessing the risks associated with blood transfusion in combat situations.