Bonnecaze Alex K, Stephens Sarah Ellen Elza, Miller Peter John
Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
BMJ Case Rep. 2016 Aug 3;2016:bcr2016215240. doi: 10.1136/bcr-2016-215240.
Clostridium sordellii is a spore-forming anaerobic Gram-positive rod that has rarely been reported to cause disease in humans. Resultant mortality from infection is estimated at nearly 70% and is most often correlated with gynaecological procedures, intravenous drug abuse or trauma. C. sordellii infection often presents similarly to toxic shock syndrome (TSS); notable features of infection include refractory hypotension, haemoconcentration and marked leucocytosis. Although clinically similar to TSS, a notable difference is C. sordellii infections rarely involve fever. The organism's major toxins include haemorrhagic (TcsH) and lethal factor (TcsL), which function to disrupt cytoskeletal integrity. Current literature suggests treating C. sordelli infection with a broad-spectrum penicillin, metronidazole and clindamycin. We present a case of C. sordellii bacteraemia and septic shock in an immunocompromised patient who was recently diagnosed with pleomorphic gluteal sarcoma. Despite presenting in critical condition, the patient improved after aggressive hemodynamic resuscitation, source control and intravenous antibiotic therapy.
索氏梭菌是一种形成芽孢的厌氧革兰氏阳性杆菌，很少有报道称其可导致人类疾病。据估计，感染导致的死亡率接近70%，且最常与妇科手术、静脉药物滥用或创伤相关。索氏梭菌感染的表现通常与中毒性休克综合征（TSS）相似；感染的显著特征包括难治性低血压、血液浓缩和明显的白细胞增多。虽然在临床上与TSS相似，但一个显著的区别是索氏梭菌感染很少伴有发热。该生物体的主要毒素包括出血毒素（TcsH）和致死因子（TcsL），它们的作用是破坏细胞骨架的完整性。目前的文献表明，可用广谱青霉素、甲硝唑和克林霉素治疗索氏梭菌感染。我们报告一例免疫功能低下患者发生索氏梭菌菌血症和感染性休克的病例，该患者最近被诊断为多形性臀肉瘤。尽管患者病情危急，但在积极的血流动力学复苏、源头控制和静脉抗生素治疗后病情有所改善。
