Clostridium perfringens-induced massive hemolysis treatment with blood purification to target toxins: a case report.

IF 1 Q4 UROLOGY & NEPHROLOGY
CEN Case Reports Pub Date : 2024-10-01 Epub Date: 2024-03-04 DOI:10.1007/s13730-024-00857-3
I Reffo, M Domini, M Cevolani, G Del Fabro, D Rufolo, S Venturini, L Pinciroli, D Tonin, M Avolio, M Crapis, G Basaglia, M Balbi, G Nadalin
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引用次数: 0

Abstract

Clostridium perfringens can rarely cause severe systemic infections, usually from an abdominal source, associated with massive hemolysis, which is usually fatal. Hemolytic anemia and acute renal injury resulting from toxin action are critical for the development of multiple organ dysfunction syndrome (MODs), making this condition a real emergency, requiring multispecialty skills and aggressive multimodal therapies. We herein describe a case of septic shock from acute cholecystitis with massive hemolysis caused by C. perfringens in a 55 year-old man that was successfully treated with early blood purification and continuous renal replacement therapy (CRRT) along with antibiotic therapy and surgery. The effect of the enormous amount of toxins produced by Clostridium which elicit a strong cytokine response and the damage caused by the hemolysis products are the main pathogenetic mechanisms of this rare but lethal clinical entity. The main goal of treatment is to remove toxins from plasma, block toxin action, and further production by achieving bacterial killing with antimicrobial agents and controlling the infectious focus, remove waste products and prevent or limit multiorgan damage. Blood purification techniques play an important role due to a strong pathophysiological rationale, as they can remove toxins and cytokines as well as cell-free products from plasma and also replace renal function. Although this condition is rare and robust data are lacking, blood purification techniques for C. perfringens-induced massive hemolysis are promising and should be further explored.

针对毒素的血液净化治疗产气荚膜梭菌诱发的大量溶血:一份病例报告。
产气荚膜梭菌在极少数情况下会引起严重的全身感染,通常来自腹腔,伴有大量溶血,通常是致命的。毒素作用导致的溶血性贫血和急性肾损伤是引发多器官功能障碍综合征(MODs)的关键,因此这种病症是一种真正的急症,需要多专科技能和积极的多模式疗法。我们在此描述了一例由产气荚膜杆菌引起的急性胆囊炎并伴有大量溶血的脓毒性休克病例,患者 55 岁,经过早期血液净化、持续肾脏替代疗法(CRRT)、抗生素治疗和手术治疗后成功治愈。梭状芽孢杆菌产生的大量毒素会引起强烈的细胞因子反应,溶血产物造成的损害是这种罕见但致命的临床疾病的主要发病机制。治疗的主要目标是清除血浆中的毒素,阻断毒素的作用,并通过使用抗菌剂杀灭细菌和控制感染灶来阻止毒素的进一步产生,清除废物,防止或限制多器官损伤。血液净化技术能清除血浆中的毒素、细胞因子和无细胞产物,还能替代肾功能,因此具有重要的病理生理学意义。虽然这种情况很少见,也缺乏可靠的数据,但针对产气荚膜杆菌诱发的大量溶血的血液净化技术前景广阔,应进一步加以探索。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CEN Case Reports
CEN Case Reports UROLOGY & NEPHROLOGY-
CiteScore
1.90
自引率
0.00%
发文量
80
期刊介绍: Clinical and Experimental Nephrology (CEN) Case Reports is a peer-reviewed online-only journal, officially published biannually by the Japanese Society of Nephrology (JSN).  The journal publishes original case reports in nephrology and related areas.  The purpose of CEN Case Reports is to provide clinicians and researchers with a forum in which to disseminate their personal experience to a wide readership and to review interesting cases encountered by colleagues all over the world, from whom contributions are welcomed.
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