Nanjappa Sowmya, Shah Sweta, Pabbathi Smitha
Department of Internal Hospital Medicine, H. Lee Moffitt Cancer Center, Tampa, FL 33612-9416, USA; USF College of Medicine, 12902 Magnolia Drive, Tampa, FL 33612-9416, USA.
Internal Medicine Residency Program, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, FL 33612-9416, USA.
Case Rep Infect Dis. 2015;2015:694247. doi: 10.1155/2015/694247. Epub 2015 Dec 17.
The Clostridia species are responsible for some of the deadliest diseases including gas gangrene, tetanus, and botulism. Clostridium septicum is a rare subgroup known to cause atraumatic myonecrosis and is associated with colonic malignancy or immunosuppression. It is a Gram-positive, anaerobic, spore-forming bacillus found in the gastrointestinal tract and can lead to direct, spontaneous infections of the bowel and peritoneal cavity. The anaerobic glycolysis of the tumor produces an acidic, hypoxic environment favoring germination of clostridial spores. Tumor-induced mucosal ulceration allows for translocation of sporulated bacteria from the bowel into the bloodstream, leading to fulminant sepsis. C. septicum bacteremia can have a variable presentation and is associated with greater than 60% mortality rate. The majority of deaths occur within the first 24 hours if diagnosis and appropriate treatment measures are not promptly started. We report a case of abdominal myonecrosis in a patient with newly diagnosed colon cancer. The aim of this study is to stress the importance of maintaining a high suspicion of C. septicum infection in patients with underlying colonic malignancy.
梭菌属细菌可引发一些最为致命的疾病，包括气性坏疽、破伤风和肉毒中毒。败血梭菌是一种罕见的亚群，已知可导致非创伤性肌坏死，且与结肠恶性肿瘤或免疫抑制有关。它是一种革兰氏阳性、厌氧、产芽孢杆菌，存在于胃肠道中，可导致肠道和腹膜腔的直接、自发性感染。肿瘤的无氧糖酵解产生酸性、缺氧环境，有利于梭菌芽孢的萌发。肿瘤引起的黏膜溃疡使芽孢化细菌从肠道转移到血液中，导致暴发性败血症。败血梭菌菌血症的表现可能各异，死亡率超过60%。如果不及时开始诊断和采取适当的治疗措施，大多数死亡发生在最初24小时内。我们报告一例新诊断为结肠癌患者发生腹部肌坏死的病例。本研究的目的是强调对患有潜在结肠恶性肿瘤的患者保持高度怀疑败血梭菌感染的重要性。
