| streptococcus anginosus was recently identified as a distinct species from the other members of streptococcus milleri group (streptococcus constellatus, streptococcus intermedius). We report a rare case of nonclostridial gas gangrene caused by S. anginosus. A 62-year-old diabetic woman was admitted with gas gangrene of the perineal area. She had been taking her oral hypoglycemia medication regularly for 10 years, but the diabetes was inadequately controlled. She was treated with surgical debridement of the necrotic tissue, insulin injection, and antibiotic therapy, and had a satisfactory clinical course. ( info) |
| Three cases of emphysematous cholecystitis are presented. The role of hyperbaric oxygenation as excellent adjuvant therapy to urgent surgical as well as intensive conservative treatment is emphasized. ( info) |
3/189. Nontraumatic clostridial myonecrosis. We describe three cases of nontraumatic clostridial myonecrosis seen at the Victorian Institute of forensic medicine. Nontraumatic clostridial myonecrosis is an uncommon and often fatal condition that requires immediate institution of appropriate medical and surgical therapy. It is most commonly caused by clostridium perfringens and clostridium septicum and is associated with gastrointestinal and hematologic malignancies, diabetes mellitus, and peripheral vascular disease. The clinical features include a rapidly evolving acute illness with severe pain, marked tachycardia, and brawny discoloration of the skin with bullae formation and crepitus, followed by hypotension and acute renal failure. Features at autopsy include reddish brown skin discoloration with bullae formation and necrotic skeletal muscle. Radiographs may be of use prior to the postmortem in detecting gas within the soft tissues. Gram stain and microbiologic culture are important in establishing a definitive diagnosis; although the major factors in suggesting the diagnosis are the recognition of the typical clinical history and macroscopic autopsy findings. ( info) |
| Clostridium meningitis is a rare complication of elective surgery, but the presence of pneumocephalus on CT in the absence of penetrating injuries, should raise the possibility of anaerobic infections. We report a case of fatal clostridium perfringens meningitis which occurred 4 months after a craniotomy for glioblastoma multiforme. The diagnosis was suspected based on the CT findings. The literature of this rare condition is reviewed. ( info) |
5/189. gas gangrene in a patient with severe haemophilia A. The haemophilia patient tends to live a more protected life than his normal counterpart, this is particularly so in underdeveloped and developing countries where due to poor health infrastructure, financial constraints and nonavailability of factor concentrates, patients quickly learn that they need to live a protected life. Under such circumstances, gas gangrene seems to be a very unusual infection for this group of patients. We report here a 25-year-old male with severe haemophilia who developed gas gangrene due to inadequate medical management following a road traffic accident. Subsequently, his affected limb was salvaged by conservative therapy. A literature search failed to reveal any reports of similar patients in the English literature. ( info) |
6/189. Clostridial infection in total hip joint replacement: a report of two cases. Two cases of clostridial cellulitis are presented in patients who had Charnley total hip joint replacement for severe osteoarthritis. Early deep infection can be a major problem in this operation, and is usually due to staphylococcus aureus. ( info) |
7/189. Traumatic retroperitoneal rupture of the duodenum. A report of six cases of retroperitoneal rupture of the duodenum is presented. A high index of suspicion is necessary to enable early diagnosis to be made and appropriate treatment carried out. Early treatment will prevent the extremely rare, but at present uniformly fatal complication of gas gangrene. Plain X-ray and Gastrografin studies may help to elucidate the situation in particular cases, but are no substitute for repeated careful abdominal examination. It is suggested that large doses of penicillin be employed where possible in the management of these cases, in addition to such antibiotic therapy as may be expected to be effective against the usual Gram-negative bowel flora. ( info) |
| Six autopsy cases of non-traumatic gas gangrene in the abdomen are reported. Five of the six were caused by clostridia, as identified by culture or histology. There were associated underlying diseases, such as alcoholism, liver cirrhosis, diabetes mellitus, and malignant disease. Three of the six patients had gas gangrene in the liver. Bacterial proliferation and gas accumulation were found in the sinusoids of the liver, and congestion and edema with extensive gas embolism were found in the lungs. Pulmonary gas embolism was considered to be the direct cause of death in these three patients. The other three patients had intestinal clostridial gas gangrene, with alcoholism as an underlying condition. None of the six patients was clinically diagnosed as having gas gangrene. We suggest that gas gangrene should be considered in any patient with abdominal infection. A review of 19 autopsy cases of gas gangrene in the abdomen reported in the Japanese literature is also presented. ( info) |
9/189. Clostridial sepsis: is death avoidable? Massive intravascular hemolysis is a rare yet often fatal complication of clostridial sepsis. The only chance for survival is an early diagnosis and prompt initiation of treatment. We report a rapidly fatal case who developed electrocardiographic changes of acute myocardial injury. autopsy showed gas-filled bubbles and cysts in the myocardium partially filled with sporulating bacilli with the morphology of clostridia. Gas filled bubbles were also present in the lungs, liver, kidneys and spleen. The gastric mucosa showed hemorrhagic and necrotizing changes, the probable site of entry of the infection. ( info) |
| A case of fatal spontaneous gas gangrene due to clostridium septicum septicaemia associated with an occult rectal malignancy is presented. This condition has a rapid progression and a high mortality even with prompt treatment. It is important that the radiologist considers this diagnosis in an appropriate clinical setting to allow rapid instigation of appropriate therapy. ( info) |