Miwa Kurasawa, Takashi Nishikido, Department of Internal Medicine, Nishi-agatsuma Welfare Hospital, Naganohara-machi, Agatsuma-gun, Gunma Prefecture 377-1308, Japan.
World J Diabetes. 2014 Apr 15;5(2):224-9. doi: 10.4239/wjd.v5.i2.224.
We experienced a case of liver abscess due to Clostridium perfringens (CP) complicated with massive hemolysis and rapid death in an adequately controlled type 2 diabetic patient. The patient died 6 h after his first visit to the hospital. CP was later detected in a blood culture. We searched for case reports of CP septicemia and found 124 cases. Fifty patients survived, and 74 died. Of the 30 patients with liver abscess, only 3 cases survived following treatment with emergency surgical drainage. For the early detection of CP infection, detection of Gram-positive rods in the blood or drainage fluid is important. Spherocytes and ghost cells indicate intravascular hemolysis. The prognosis is very poor once massive hemolysis occurs. The major causative organisms of gas-forming liver abscess in diabetic patients are Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli). Although CP is relatively rare, the survival rate is very poor compared with those of K. pneumoniae and E. coli. Therefore, for every case that presents with a gas-forming liver abscess, the possibility of CP should be considered, and immediate aspiration of the abscess and Gram staining are important.
我们遇到了一例因产气荚膜梭菌（CP）引起的肝脓肿病例，该患者为 2 型糖尿病得到充分控制的患者，伴有大量溶血和迅速死亡。患者在首次就诊后 6 小时死亡。后来在血培养中检测到 CP。我们搜索了 CP 败血症的病例报告，发现了 124 例。50 例患者存活，74 例死亡。30 例肝脓肿患者中，仅 3 例经紧急手术引流治疗后存活。为了早期发现 CP 感染，检测血液或引流液中的革兰阳性杆菌很重要。球形红细胞和鬼影细胞提示血管内溶血。一旦发生大量溶血，预后非常差。糖尿病患者气性肝脓肿的主要病原体是肺炎克雷伯菌（K. pneumoniae）和大肠杆菌（E. coli）。虽然 CP 相对较少见，但与 K. pneumoniae 和 E. coli 相比，其存活率非常低。因此，对于每例出现气性肝脓肿的患者，都应考虑 CP 的可能性，立即抽吸脓肿并进行革兰染色很重要。
