Insidious, Largely Undetected, Fatal Clostridium perfringens Sepsis Resulting in Unbridled Vascular Hemolysis: Concepts Regarding Pathogenesis

© 2012 Elsevier 0196-4399/00 (see frontmatter) 47 Introduction Clostridium perfringens is a grampositive, encapsulated, nonmotile, anaerobic, spore-forming bacillus that is widely distributed in nature and the alimentary tracts of animals and humans (1). When cultured on 5% sheep blood agar, it produces a distinct zone of beta hemolysis surrounded by a secondary, less-intense hemolytic zone. The hemolytic zones on blood agar are attributable to several hemolysins, including the very potent alpha-lecithinase (phospholipase C) toxin. Under ideal growth conditions, C. perfringens has a doubling time of 7 min (2) and, therefore, in a short time span can produce and secrete large amounts of toxins, which can account for most of the clinical manifestations of infections caused by the bacterium. C. perfringens is well known as a virulent pathogen in gas gangrene infections and in food poisoning, as exemplified by enteritis necroticans (pigbel), a necrotizing infection of the jejunum and ileum accompanied by bloody diarrhea (3,4). Other devastating manifestations of C. perfringens invasion include postabortal and postpartum infections, leading to intravascular hemolysis in patients who have undergone abortion (5) or who have sustained trauma. In addition, spontaneous, nontraumatic gas gangrene can occur in Corresponding Author: Steve Xie, M.D., Ph.D., Department of Pathology, Westchester Medical Center, New York Medical College, 100 Woods Rd., Valhalla, NY 10595. Tel.: 914-493-7433. Fax: 914493-1145. E-mail: xies@wcmc.com Case Report