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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An autopsy case of clostridial gas gangrene occurring in a 54-year-old man with colon adenocarcinoma, liver cirrhosis, and diabetes mellitus is reported. The patient died 4 days after the onset of symptoms with episodes of vomiting and abdominal pain. Gangrene of both hips and perineum, hemolysis, renal failure, and disseminated intravascular coagulation were the dominant clinical features. Clostridium septicum was isolated from the subcutaneous tissue fluid. Adenocarcinoma of the ascending colon with ulceration found at autopsy was supposed to be an entry of the organism. Histologically, lesions of subcutaneous tissue and muscles were characterized by the absence of inflammatory infiltrates in spite of extensive necrosis. A summary of 35 cases of gas gangrene hospitalized to the Osaka University Hospital for the past 16 years indicates that clostridial gas gangrene patients with underlying diseases such as malignant neoplasm, diabetes, liver cirrhosis or immunodeficiency have a relatively poor prognosis.
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PMID:A case of nontraumatic clostridial gas gangrene occurring in a patient with colon adenocarcinoma, liver cirrhosis, and diabetes mellitus. 373 9

We report a case of synchronous gas gangrene and spontaneous bacterial peritonitis associated with liver cirrhosis. The patient was a 52-year-old man who was being followed for decompensated liver cirrhosis. He experienced sudden onset lower abdominal pain with distension and pain in the left leg. A bullous lesion, with crepitation, later appeared in the thigh and showed air-bubbles on X-ray. Eschericia coli was cultured from ascites and the bullous lesions; there was associated gas gangrene. The patient died of bacteremia with disseminated intravascular coagulopathy 26 h after admission, despite receiving intensive care. We discuss the route of bacteria causing the spontaneous bacterial peritonitis and simultaneous gas gangrene.
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PMID:Liver cirrhosis with synchronous gas gangrene and spontaneous bacterial peritonitis due to E. coli. 908 80

Six autopsy cases of non-traumatic gas gangrene in the abdomen are reported. Five of the six were caused by clostridia, as identified by culture or histology. There were associated underlying diseases, such as alcoholism, liver cirrhosis, diabetes mellitus, and malignant disease. Three of the six patients had gas gangrene in the liver. Bacterial proliferation and gas accumulation were found in the sinusoids of the liver, and congestion and edema with extensive gas embolism were found in the lungs. Pulmonary gas embolism was considered to be the direct cause of death in these three patients. The other three patients had intestinal clostridial gas gangrene, with alcoholism as an underlying condition. None of the six patients was clinically diagnosed as having gas gangrene. We suggest that gas gangrene should be considered in any patient with abdominal infection. A review of 19 autopsy cases of gas gangrene in the abdomen reported in the Japanese literature is also presented.
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PMID:Non-traumatic gas gangrene in the abdomen: report of six autopsy cases. 1083 75

Bacteremic episodes caused by anaerobes are unusual and the clinical importance of Clostridium bacteremia remains unclear. This retrospective case study examined the risk factors among a group of patients who developed Clostridium bacteremia. Medical records from 73 episodes of clostridial bacteremia in 73 patients treated in a medical center during an 11-year period were reviewed. Of all episodes, 96% were community-acquired. Twelve percent of patients had polymicrobial bacteremia, with Escherichia coli being the most common accompanying bacterium. Diabetes mellitus (26%) and liver cirrhosis (25%) were the most common underlying diseases. The most common etiological organisms were Clostridium perfringens (77%), Clostridium bifermentans (9%), and Clostridium septicum (4%). Only one patient with C. septicum bacteremia had a histocytotoxic infection, which was a fatal gas gangrene. Univariate analysis of data from patients with monomicrobial Clostridium bacteremia revealed that younger age (age < 65 years), underlying liver cirrhosis, and presence of septic shock at initial presentation were associated with fatality; but only the latter two variables were independently associated with fatality in multivariate logistic regression analysis. Appropriate antimicrobial therapy for monomicrobial Clostridium bacteremia did not significantly affect clinical outcomes, which might suggest that Clostridium species in the bloodstream can be regarded as merely contaminants or transient bacteremia. This suggestion was not supported by the finding that seven of 13 cirrhotic patients with monomicrobial Clostridium bacteremia died of sepsis, of whom six had not receive appropriate antimicrobial therapy. Therefore, the clinical importance of Clostridium bacteremia should be interpreted with caution because of its high risk of mortality in susceptible hosts, particularly cirrhotic patients, who do not receive appropriate therapy timely.
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PMID:Clostridium bacteremia: emphasis on the poor prognosis in cirrhotic patients. 1145 56

We experienced two patients having Aeromonas species infection with severe clinical manifestations. The one patient was a 15-year-old high school girl student, who had been healthy in her school life, was admitted to the hospital with a sudden onset of left thigh muscle pain and swelling. She subsequently went into septic shock and died one day after admission. Pathological examination on autopsy revealed massive gas formation, skin bullas and ulcers, and extensive severe soft tissue damage throughout the body. Also, all the specimens, including brain, liver, spleen, thigh muscle, and blood in cardiac cavity, were positive for A. veronii biovar sobria. The other patient was 35-year-old man, who suffered from multiple bone fractures during the work in the harbor. One day after admission, he became febrile and went into septic shock. With the presumptive diagnosis of sepsis and gas gangrene, amputation of left thigh was performed. The exudate and aspirate of the amputated portion were repeatedly positive for A. hydrophila. Through the surveillance in Okinawa, Kagoshima, Miyazaki, and Kumamoto Prefectures, a total of 426 isolates from blood cultures were collected in the period from August, 1999 to February, 2000. Of these, 14 isolates (3.3%) were the species of Aeromonas. Of 14 isolates of Aeromonas, 13 were reported from Okinawa and the remaining one was from Kumamoto. Most patients had underlying diseases, particularly liver diseases including liver cirrhosis. The mortality rate was extremely high at 62.5%, and the patients died in short terms after blood culture became positive. With these, Aeromonas species infection is unique to Okinawa, and positive blood culture for Aeromonas species potentially indicates a high-risk, particularly among the patients with underlying diseases.
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PMID:[Aeromonas species infection with severe clinical manifestation in okinawa, Japan -association with gas gangrene-]. 2679 Apr 86

The risk of bacteremia in patients with cirrhosis increases with more advanced Child classification. Escherichia coli is the most frequently implicated organism in these bacteremic episodes. Unusually, E. coli can produce a bullous cellulitis or myonecrosis. Two previous cases of E. coli-associated myonecrosis in patients with cirrhosis have been reported. We describe a third case in a cirrhotic patient with E. coli-associated bilateral lower extremity gas gangrene and review the existing literature. In the three patients with cirrhosis and E. coli myonecrosis, no obvious gastrointestinal perforation was found as the source of bacteremia. Intestinal edema due to portal hypertension is thought to have facilitated mucosal microperforations and bacteremia. Awareness of this unusual presentation may facilitate earlier diagnosis.
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PMID:Escherichia coli myonecrosis in alcoholic cirrhosis. 1270 91