Malignancy, mortality, and medicosurgical management of Clostridium septicum infection.

BACKGROUND: Necrotizing Clostridium septicum infections (CSI) have a strong association with malignancy or immunosuppression. To clarify this relationship and determine how it impacted mortality, the experience with CSI at a single institution was reviewed. METHODS: Records of all patients admitted to our hospital with culture proven clostridial infection from 1966 through 1993 were reviewed. RESULTS: Among patients presenting with clinical gas gangrene, 281 had culture proven clostridial infection and 32 (11.4%) had CSI. The mortality among CSI patients was 56%, whereas 26% of all patients with clostridial infections died (p = 0.001). An associated malignancy was found in 50% of patients with CSI, whereas this was seen in only 11% of patients with other clostridial infections (p = 0.0001 for CSI versus clostridial infection overall). The remaining patients with spontaneous CSI all had evidence of immunosuppression. CONCLUSIONS: The high mortality and likelihood of associated malignancy or hematologic disease underscore the importance of a high index of suspicion and the need to search for and treat associated conditions in all patients with CSI.

[A case of NIDDM with non-clostridial gas-producing infection in the lower limb--the effects of hyperbaric oxygen therapy].

A 36-year-old male was admitted because of swelling and pain in the lower left limb. He had been diagnosed as having non-insulin dependent diabetes mellitus 4 years previously and had been treated unsuccessfully with insulin. Since gas formation was radiographically demonstrated in the soft tissue of the left foot, we treated him with antibiotics and hyperbaric oxygen under the diagnosis of gas gangrene. Despite this therapy, the gangrenous lesions progressed. Amputation of the left foot was necessary. Peptstreptococcus was isolated from the gangrenous area and identified as such on the seven hospital day. Nine cases of diabetic patients with non-clostridial gas gangrene who were treated with hyperbaric oxygen therapy have been reported in Japan. The results indicated that hyperbaric oxygen therapy is ineffective in the treatment of non-clostridial gas gangrene in diabetic patients.

Clostridial gas gangrene associated with congenital generalized lipodystrophy: report of a case.

Congenital generalized lipodystrophy (CGL) is a rare disease, the main symptoms of which are a reduction of systemic subcutaneous fat, characteristic facial features, hypertrichosis, and insulin-resistant diabetes. We report herein the unusual case of a 25-year-old man with CGL in whom gas gangrene developed, an association which has never before been encountered.

Necrotizing anorectal and perineal infections.

Sixteen cases of spontaneous necrotizing infection of the anorectum and perineum are described. Thirteen patients had clostridial infections and three had infections with nonclostridial organisms. Six patients were diabetic and two had leukemia. All 16 patients presented with pain, tenderness, swelling, and crepitation. Four had an ominous black spot on the scrotum or posterior labia. Shortly after initial recognition by the patient, all infections rapidly disseminated to include all surrounding areas such as the external genitalia, the anterior abdominal wall, and thighs. Treatment consisted of radical debridement and antibiotics; hyperbaric oxygen was used in the clostridial cases. Ten of the 16 patients survived. Delayed diagnosis and delayed treatment were the primary factors responsible for death.

Treatment of gas gangrene. Interest of hyperbaric oxygen therapy.

We report 27 cases of gas gangrene treated at the University Hospital of Liège since the Anesthesiology Department has been using a caisson for hyperbaric oxygen therapy. Frequency of gas gangrene does not appear to have decreased during recent years. The etiologies now encountered are mainly of post-traumatic and post-operative origin (especially surgery on the digestive tract); arterial insufficiency is a predisposing factor. The prognosis depends on the speed with which an effectual treatment is started; the latter consists in intensive hyperbaric oxygen therapy, antibiotic therapy and resuscitation. Surgery should be as conservative as possible and is undertaken only when progress of the disease has been checked by hyperbaric oxygen therapy. The association of these various modes of treatment proves effectual despite a still significant mortality.

Clostridium perfringens infection complicating chemotherapy for choriocarcinoma.

A case of Clostridium perfringens sepsis and gas gangrene complicating chemotherapy for gestational choriocarcinoma is reported. The infection was eradicated using antibiotics, surgery, and hyperbaric oxygen therapy. The pathophysiology, diagnosis, and treatment of this unusual but often lethal complication are reviewed.