Temple Ana-Maria M, Thomas Neal J
Department of Pediatrics, Penn State Children's Hospital, Hershey, PA 17033, USA.
Pediatr Emerg Care. 2004 Jul;20(7):457-9. doi: 10.1097/01.pec.0000132218.42729.97.
To report 2 cases of severe gas gangrene secondary to Clostridium perfringens in pediatric oncology patients.
We describe 2 children with acute presentations of gas gangrene secondary to C. perfringens. Both children were initially seen and treated in a community hospital emergency department and subsequently were cared for in a pediatric intensive care unit in a tertiary care, university-based children's hospital.
Both children demonstrated severe and unrelenting decompensation and required operative intervention within the first hospital day, which included amputation of the infected limb. One child survived and one child expired despite heroic measures.
Gas gangrene secondary to C. perfringens is an uncommon but life-threatening and limb-threatening condition in pediatric cancer patients. A high index of suspicion in a immunocompromised child with cancer who presents with extremity pain in combination with neutropenia is the key to early diagnosis and may lead to improved survival. This disease requires prompt recognition and aggressive treatment to allow any hope of recovery. Emergency medicine physicians who treat these children should be aware of this severe and potentially fatal infectious process and should not delay treatment or prompt orthopedic surgery consultation.
报告2例儿科肿瘤患者继发于产气荚膜梭菌的严重气性坏疽病例。
我们描述了2例继发于产气荚膜梭菌的急性气性坏疽患儿。两名患儿最初在社区医院急诊科就诊并接受治疗，随后在一家大学附属医院的儿科重症监护病房接受护理。
两名患儿均表现出严重且持续的失代偿，在入院第一天内均需要手术干预，包括截肢感染肢体。尽管采取了积极措施，一名患儿存活，一名患儿死亡。
产气荚膜梭菌继发的气性坏疽在儿科癌症患者中并不常见，但会危及生命和肢体。对于免疫功能低下且患有癌症的儿童，出现肢体疼痛并伴有中性粒细胞减少时，高度怀疑是早期诊断的关键，可能会提高生存率。这种疾病需要及时识别和积极治疗，才有恢复的希望。治疗这些患儿的急诊医学医生应意识到这种严重且可能致命的感染过程，不应延迟治疗或及时咨询骨科手术。
