Didbaridze N, Lomidze N, Abuladze T, Qiliptari G, Didbaridze T, Gvasalia I, Mkervalishvili Z, Gogokhia N
Tbilisi State Medical University; The First University Clinic, Georgia.
Georgian Med News. 2016 Sep(258):73-76.
Anaerobic clostridial infection is the most severe form of paraproctitis. The incubation period is very short, from 3 to 6 hours, sometimes lasting for 1-2 days. Clostridial infection spreads rapidly and induces gas gangrene, causes destruction of cells and other intermediate substances, and impedes blood circulation. This paper presents a case study of an extremely severe form of anaerobic infection with spontaneous gas gangrene, cellulitis, fasciomyositic necrosis, severe intoxication and septic shock on the abdominal front and lateral surfaces. This patient presented as infected with Clostridium septicum, a rare and highly toxic Gram-positive, spore-forming, obligate anaerobic bacillus that progresses and migrates rapidly, affecting all soft tissues (muscle, fascia), and produces four toxins which cause gas gangrene, intravascular hemolysis, tissue necrosis, and septic shock. The mortality rate is typically 80%. In this case study, a positive clinical outcome was achieved by aggressive identification of the microbe, appropriate and immediate therapy, and vigorous surgical intervention. Specifically, immediate surgery was conducted to ensure a wide excision of damaged tissues, necrectomy, curettage, wide drainage, readjustment, oxygenation through drainages, further additional surgical corrections through CT control with wide bandages in the operating area. Further, the diagnostic workup was thorough, identifying the microbe through a properly constructed diagnostic algorithm, ultrasound and CT studies, infectious agent assessments, and bacteriological monitoring carried out on the 1st-2nd-5th-7th-12th-15th-21st-25th days. Rational antibiotic therapy with permanent susceptibility testing informed the selection of an appropriate agent. Finally, markers for the evaluation of severity (Apache scale) were assessed, as they were for stage of infection (prokalcitonin), inflammation (CRP) and other indicators.
厌氧梭菌感染是直肠旁炎最严重的形式。潜伏期很短，为3至6小时，有时持续1至2天。梭菌感染迅速蔓延，引发气性坏疽，导致细胞及其他中间物质破坏，并阻碍血液循环。本文介绍了一例极其严重的厌氧感染病例，患者腹部前侧和外侧出现自发性气性坏疽、蜂窝织炎、筋膜肌坏死、严重中毒和感染性休克。该患者感染了败血梭菌，这是一种罕见且毒性极强的革兰氏阳性、产芽孢、专性厌氧杆菌，其病情进展和扩散迅速，会影响所有软组织（肌肉、筋膜），并产生四种毒素，可导致气性坏疽、血管内溶血、组织坏死和感染性休克。死亡率通常为80%。在本病例研究中，通过积极识别微生物、进行恰当及时的治疗以及有力的手术干预，取得了良好的临床效果。具体而言，立即进行手术以确保广泛切除受损组织、清创、刮除、广泛引流、调整，通过引流进行充氧，在手术区域用宽带子进行CT控制下进一步进行额外的手术矫正。此外，诊断检查全面，通过合理构建的诊断算法、超声和CT检查、感染源评估以及在第1、2、5、7、12、15、21、25天进行的细菌学监测来识别微生物。通过持续的药敏试验进行合理的抗生素治疗，从而选择合适的药物。最后，评估了用于评估严重程度的指标（Apache评分）以及感染阶段（降钙素原）、炎症（CRP）等其他指标。
