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Massive intravascular hemolysis is an important factor in Clostridium perfringens-induced bacteremia

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Abstract

Clostridium perfringens bacteremia is rare but often fatal. In particular, once bacteremia with massive intravascular hemolysis (MIH) occurs, the mortality rate is extremely high. However, because of its rarity, the detailed pathophysiology of this fulminant form of bacteremia is unclear. To elucidate the detailed pathogenesis of MIH, we retrospectively reviewed the data of all patients with C. perfringens bacteremia from two university hospitals from 2000 to 2014. The medical records and laboratory data of 60 patients with bacteremia, including 6 patients with MIH and 54 patients without MIH, were analyzed. Patients with MIH had higher rates of intense pain at onset, impaired consciousness, shock at presentation, hematuria, metabolic acidosis, and gas formation than patients without MIH. The antibiotic susceptibility of the clinical isolates was not significantly different between the two groups. All patients with MIH, although treated with appropriate antimicrobial agents, died within 26 h of admission due to rapidly progressive acute lung injury or acute respiratory distress syndrome, and the median time from arrival at the hospital to death was only 4 h and 20 min. When clinicians observe intravascular hemolysis in blood samples from patients with characteristic symptoms of MIH, they should prepare for a severe disease outcome. The underlying pathophysiology of fulminant cases must be investigated.

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Acknowledgements

The authors would like to thank Professor Yoshitaka Kaneita, Division of Public Health, Department of Social Medicine, Nihon University School of Medicine for his guidance in the statistical analysis. We also thank Associate Professor Masaji Nagaishi, Department of Obstetrics and Gynecology, Nihon University School of Medicine, for providing detailed clinical data on a case of ovarian carcinosarcoma.

Funding

This study was supported by the Japan Society for the Promotion of Science KAKENHI (grant number JP17K10034).

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Authors and Affiliations

  1. Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi, Tokyo, 173-8610, Japan

    Ai Suzaki, Shihoko Komine-Aizawa & Satoshi Hayakawa

  2. Department of General Medicine, Nihon University Hospital, Tokyo, Japan

    Ai Suzaki

  3. Department of Clinical Laboratory, Nihon University Itabashi Hospital, Tokyo, Japan

    Hiroyuki Nishiyama

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  1. Ai Suzaki
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  4. Satoshi Hayakawa
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Contributions

The study conception, design, data collection and analysis were performed by Ai Suzaki. Hiroyuki Nishiyama contributed data collection. The first draft of the manuscript was written by Ai Suzaki, and Shihoko Komine-Aizawa and Satoshi Hayakawa commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ai Suzaki.

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Conflict of interest

All the authors declare that no conflict of interest exists (no relationship with industry or financial associations poses a conflict of interest in connection with the present study). No author received any financial support or other benefits from commercial sources for this work.

Ethics approval

The study was approved by the ethical committee of Nihon University School of Medicine on the 13th of June 2019.

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Suzaki, A., Komine-Aizawa, S., Nishiyama, H. et al. Massive intravascular hemolysis is an important factor in Clostridium perfringens-induced bacteremia. Intern Emerg Med 17, 1959–1967 (2022). https://doi.org/10.1007/s11739-022-03036-3

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