1/20. Pseudomembranous enteritis after proctocolectomy: report of a case.Intestinal pseudomembrane formation, sometimes a manifestation of antibiotic-associated diarrheal illnesses, is typically limited to the colon but rarely may affect the small bowel. A 56-year-old female taking antibiotics, who had undergone proctocolectomy for idiopathic inflammatory bowel disease, presented with septic shock and hypotension. A partial small-bowel resection revealed extensive mucosal pseudomembranes, which were cultured positive for clostridium difficile. Intestinal drainage contents from an ileostomy were enzyme immunoassay positive for C. difficile toxin A. Gross and histopathologic features of the small-bowel resection specimen were similar to those characteristic of pseudomembranous colitis. The patient was treated successfully with metronidazole. These findings suggest a reservoir for C. difficile also exists in the small intestine and that conditions for enhanced mucosal susceptibility to C. difficile overgrowth may occur in the small-bowel environment of antibiotic-treated patients after colectomy. Pseudomembranous enteritis should be a consideration in those patients who present with purulent ostomy drainage, abdominal pain, fever, leukocytosis, or symptoms of septic shock.- - - - - - - - - - ranking = 1keywords = shock, septic shock (Clic here for more details about this article) |
2/20. Postpartum clostridium sordellii infection associated with fatal toxic shock syndrome.Clostridium bacteria are anaerobic Gram positive spore-form-ing bacilli, known to cause distinct clinical syndromes such as botulism, tetanus, pseudomembranous colitis and myonecrosis. The natural habitats of Clostridium species are soil, water and the gastrointestinal tract of animals and humans. In 5-10% of all women, Clostridium species are also found to be normal inhabitants in the microbial flora of the female genital tract. In case of a non-sexually transmitted genital tract infection, Clostridium species are isolated in 4-20%, and clostridium welchii seems to be the most common isolate. clostridium sordellii is rarely encountered in clinical specimens (1% of Clostridium species), but it has been described as a human pathogen with fatal potential. Two toxins, a lethal and a hemorrhagic (that antigenically and pathophysiologically appear similar to clostridium difficile toxins B and A, respectively) are responsible for this potential. Reviewing the obstetric literature, only six cases of postpartum endometritis caused by C. sordellii, are described - all being fatal. In addition, one lethal case of spontaneous endometritis resulting from C. sordellii is reported. The clinical aspects of these cases include: - sudden onset with influenza-like symptoms in previously healthy women - progressive refractory hypotension - local and spreading tissue edema - absence of fever Laboratory findings include: - marked leukocytosis - elevated hematocrit. This paper reports the seventh fatal postpartum C. sorlellii associated toxic shock syndrome - the first recognized in scandinavia.- - - - - - - - - - ranking = 12.632060758045keywords = toxic shock syndrome, toxic shock, shock syndrome, shock (Clic here for more details about this article) |
3/20. Acute necrotizing bacterial tonsillitis with clostridium perfringens.Bacterial infection with clostridium perfringens in children less than 2 years of age is frequently associated with meningitis, necrotizing gastrointestinal infection, and postoperative infections. However, a review of the literature reveals no reports of these bacteria infecting the tonsils. A 9-month old black female was found unresponsive at the baby-sitter's and was rushed to the hospital. Shortly after admission to the emergency department death was pronounced. An autopsy performed on this otherwise healthy infant revealed shock and acute necrotizing bacterial tonsillitis. The initial report of this infant's death was questionable sudden infant death syndrome and questionable smothering. Postmortem cerebrospinal fluid, blood, and lung cultures grew pure colonies of C. perfringens. The necrotizing tonsil revealed no significant gross lesions. Microscopically, large numbers of gram-positive rods were easily recognized and were compatible with C. perfringens. Because the oropharynx is a common portal of entry for infectious agents, it is essential to sample tissues of Waldeyer's ring and especially the tonsils to find infectious diseases that may become systemic.- - - - - - - - - - ranking = 0.27597153903075keywords = shock (Clic here for more details about this article) |
4/20. Toxic shock syndrome due to clostridium sordellii: a dramatic postpartum and postabortion disease.We describe a young woman who developed clostridium sordellii toxic shock syndrome after having had an abortion medically induced by mifepristone (RU-486; Mifeprex [Danco laboratories]) 7 days before admission to our hospital. Although the patient was aggressively treated, death occurred <3 days after admission. It is hoped that very early recognition of this disease will decrease the mortality associated with this rarely reported ailment that occurs among young, otherwise healthy women.- - - - - - - - - - ranking = 5.9346504385442keywords = toxic shock syndrome, toxic shock, shock syndrome, shock (Clic here for more details about this article) |
5/20. Recovery after prolonged anuria following septic abortion.After a criminal abortion, a 21-year-old woman developed clostridial sepsis, massive hemolysis, shock, and protracted renal failure. anuria was present for 3 weeks and hemodialysis was required for 35 days. Because of the prolonged anuria, the patient was thought to have irreversible renal cortical necrosis. A renal biopsy demonstrated tubular necrosis only. Shortly after the biopsy procedure, urinary volumes began to increase, and renal function gradually returned to normal levels. This case demonstrates that a protracted course of renal failure following clostridial infection is not necessarily due to cortical necrosis but may result from tubular necrosis, and renal function may return to normal.- - - - - - - - - - ranking = 0.27597153903075keywords = shock (Clic here for more details about this article) |
6/20. 31-year-old injection drug user with massive skin necrosis and shock.Massive tissue necrosis and septic shock have recently been reported in a series of injection drug users in scotland, england and ireland. We report the first case outside the UK meeting the criteria for this new entity (septic shock without fever in an injection drug user, local and systemic inflammation, rhabdomyolysis and tissue necrosis at the injection site). Following surgical treatment and antibiotic treatment, the patient was cured and is currently well.- - - - - - - - - - ranking = 2.103886156123keywords = shock, septic shock (Clic here for more details about this article) |
7/20. Clostridial sepsis with massive intravascular hemolysis: rapid diagnosis and successful treatment.A 61-year-old man developed a pyrescia accompanied by a massive intravascular hemolysis after abdominal surgery (Whipple's operation) of a pancreatic adenocarcinoma. Abdominal ultrasound and the abdominal CT-scan showed marked aerobilia and multiple liver abscesses. Laboratory tests demonstrated the presence of the Thomsen-Friedenreich cryptantigen (TCA) on the membranes of the patient's erythrocytes. The enzymatic cleavage of N-acetyl-neuraminic acid usually covering the TCA may lead to a life threatening intravascular hemolysis. Since Clostridial bacteriae typically synthesize neuraminidase, the presumptive diagnosis of Clostridial sepsis complicated by massive hemolysis was made. Immediate antibiotic therapy including penicillin g and metronidazole stopped hemolysis within a few hours and the patient servived. On the following day, microbiological examination identified clostridium perfringens in the patient's blood cultures. Clostrial sepsis should be suspected in patients with underlying infections and/or malignant diseases, particularly of the gastrointestinal or genitourinary tract, who present with septic shock and acute intravascular hemolysis. Whereas microbiological specification of the organism is time consuming, the relatively simple agglutination test with anti-TCA peanut lectin can provide a rapid presumptive diagnosis. The immediate onset of an appropriate antimicrobial therapy is of central importance and might be life-saving.- - - - - - - - - - ranking = 0.5keywords = shock, septic shock (Clic here for more details about this article) |
8/20. clostridium sordellii bacteremia: case report and review.clostridium sordellii is a gram-positive, anaerobic bacillus that has rarely been implicated as a human pathogen. It produces several exotoxins, which contribute to the progressive edema and refractory shock frequently seen with human infection. There have been eight prior reports of bacteremic C. sordellii infection and seven prior reports of nonbacteremic infections not due to myonecrosis of skeletal muscle. mortality was 50% in the bacteremic group and 71% in the nonbacteremic group. mortality correlated with both shock and leukemoid reaction at presentation. We present a case of C. sordellii sepsis in an asplenic patient with sickle beta thalassemia and inflammatory bowel disease, and we review the literature.- - - - - - - - - - ranking = 0.55194307806151keywords = shock (Clic here for more details about this article) |
9/20. clostridium perfringens pleuropulmonary infection and septic shock: case report and population-based laboratory surveillance study.We report a rare case of necrotizing pneumonia, empyema, and septic shock caused by clostridium perfringens. population-based laboratory surveillance was subsequently conducted that identified an annual incidence of invasive C. perfringens disease of 0.83 per 100,000 population with a striking age-related increased risk for acquisition.- - - - - - - - - - ranking = 2.5keywords = shock, septic shock (Clic here for more details about this article) |
10/20. A fatal case of clostridium sordellii septic shock syndrome associated with medical abortion.BACKGROUND: Clostridia bacteria are infrequent human pathogens. In the obstetric and gynecologic literature, clostridium sordellii infections have been very rarely reported. This is a case of infection following medical termination of early pregnancy with mifepristone and misoprostol. CASE: A 27-year-old woman presented for termination of pregnancy at 5.5 weeks from her last menstrual period. She received mifepristone 200 mg orally followed by 800 microg vaginal misoprostol. Three days after administration of misoprostol, she complained of dizziness, pelvic pain, and bleeding. The next day, she experienced worsening of symptoms and was hospitalized. She developed pulmonary edema, ascites, and heart failure. Despite supportive measures, antibiotics, and hysterectomy, she died 3 days later. The post mortem examinations indicated that death was caused by shock secondary to C sordellii infection. CONCLUSION: The frequency of infection following medical abortion is low. The rapid and fatal course of this infection is similar to other obstetric and gynecologic cases reported in the literature. Although providers should remain vigilant to the possibility of infection following medical abortion, the overall proven safety of medical abortion remains the same.- - - - - - - - - - ranking = 4.580323669843keywords = shock syndrome, shock, septic shock (Clic here for more details about this article) |
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