Department of Hematology, Aerospace Center Hospital, No. 15 Yu Quan Road, Beijing, 100049, China.
Department of Laboratory, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China.
Int J Hematol. 2021 Apr;113(4):508-517. doi: 10.1007/s12185-020-03060-z. Epub 2021 Jan 2.
In this study, we aimed to improve understanding of the clinical manifestations, laboratory findings, and risk factors of Clostridium perfringens sepsis in patients with acute leukemia and to analyze treatment strategies for improving prognosis. We analyzed clinical manifestations, laboratory data, diagnosis, and treatment strategies in three cases of C. perfringens sepsis in patients with acute leukemia. We also reviewed and analyzed the relevant literature, incorporating our findings into the discussion. All three patients developed septic shock with neutropenia following chemotherapy. Analysis of blood samples confirmed the presence of C. perfringens, and two patients had fulminant intravascular hemolysis and developed multiple organ dysfunction syndrome. Two patients survived and one died despite timely and full-dose antibacterial treatments, blood purification, and noninvasive positive pressure ventilation. Overall, our findings showed that C. perfringens sepsis is rare in patients with acute leukemia but progresses rapidly. A high mortality rate was observed, and patients often experienced refractory shock and intravascular hemolysis. This demonstrates the importance of early detection and diagnosis. Multimodal treatments, including fluid resuscitation, antibiotics, organ support, and blood purification, are essential for success.
在这项研究中，我们旨在提高对急性白血病患者中产气荚膜梭菌败血症的临床表现、实验室发现和危险因素的认识，并分析改善预后的治疗策略。我们分析了三例急性白血病患者中产气荚膜梭菌败血症的临床表现、实验室数据、诊断和治疗策略。我们还回顾和分析了相关文献，并将我们的发现纳入讨论。所有三名患者在化疗后均出现中性粒细胞减少性感染性休克。血液样本分析证实存在产气荚膜梭菌，两名患者发生暴发性血管内溶血并出现多器官功能障碍综合征。尽管及时给予了充分剂量的抗菌治疗、血液净化和无创正压通气，但两名患者存活，一名患者死亡。总体而言，我们的研究结果表明，急性白血病患者中产气荚膜梭菌败血症很少见，但进展迅速。观察到死亡率较高，患者常出现难治性休克和血管内溶血。这表明早期检测和诊断的重要性。多模式治疗，包括液体复苏、抗生素、器官支持和血液净化，对于成功至关重要。
