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Sponge-like appearance of the liver parenchyma due to fatal intrauterine gas gangrene following mechanical abortion

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... Further studies of vaccines and chemotherapy are thus considered essential. In humans, a similar sponge-like appearance of the liver parenchyma was detected in a 23-year-old woman who died in Berlin in 1953 (Widulin et al. 2013). It was caused by fatal intrauterine gas gangrene following mechanical abortion (Widulin et al. 2013). ...
... In humans, a similar sponge-like appearance of the liver parenchyma was detected in a 23-year-old woman who died in Berlin in 1953 (Widulin et al. 2013). It was caused by fatal intrauterine gas gangrene following mechanical abortion (Widulin et al. 2013). Histologically, numerous empty cystic spaces, lined with abundant Gram-positive, rod-shaped bacteria corresponding to clostridiae, were the predominant findings (Widulin et al. 2013). ...
... It was caused by fatal intrauterine gas gangrene following mechanical abortion (Widulin et al. 2013). Histologically, numerous empty cystic spaces, lined with abundant Gram-positive, rod-shaped bacteria corresponding to clostridiae, were the predominant findings (Widulin et al. 2013). Unfortunately, no histological finding was described in other organs. ...
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A 33-month-old indoor sow showed a sudden loss of appetite and then died. Necropsy revealed a sponge-like appearance of the liver parenchyma, encephalomalacia, and dark red coloration of the heart. Histologically, extensive necrotic lesions were detected in the liver, brain and heart, and Grampositive rods were detected in these necrotic lesions. Immunohistochemically, the rods reacted with an antibody against Clostridium species. Anaerobic cultures yielded high numbers of Clostridium novyi (C. novyi) type B. These findings suggested that necrosis and encephalomalacia were associated with C. novyi type B. C. novyi type B infection was diagnosed as the cause of death, and this was a case of fatal C. novyi type B infection with gas gangrene in an indoor sow.
... As the human alimentary tract physiologically contains anaerobic bacteria gastrointestinal necrosis is particularly liable to developing gangrene. Nontraumatic abdominal gangrene is a well-recognized but rare complication of abdominal surgery, appendicitis, pancreatitis, hernial incarceration, malignant neoplasms, or even pregnancy [4][5][6]. Additionally, Byard and Gilbert [7] reported an autopsy case of intra-abdominal infection, where an ingested foreign body was complicated by a multilocular liver abscess. Lastly, abdominal necrotizing infection is a well-known delayed complication after penetrating abdominal trauma. ...
... The specimen is linked to autopsy number 217/1970 and is part of the non-public section of the forensic specimen collection of the Institute of Legal Medicine and Forensic Sciences in Berlin. Previous papers have described other interesting specimens held in this collection [1,2]. ...
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After thirty five years, Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 8th Edition is still the reference of choice for comprehensive, global guidance on diagnosing and treating the most challenging infectious diseases. Drs. John E. Bennett and Raphael Dolin along with new editorial team member Dr. Martin Blaser have meticulously updated this latest edition to save you time and to ensure you have the latest clinical and scientific knowledge at your fingertips. With new chapters, expanded and updated coverage, increased worldwide perspectives, and many new contributors, Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 8th Edition helps you identify and treat whatever infectious disease you see. I highly recommend Mandell, Douglas, and Bennetts Principles and Practice of Infectious Diseases, together with the included ExpertConsult, the on-line version of the book that is a searchable source and is available to a variety of platforms. It is updated twice each year and is an excellent solution for health-care professionals to keep informed of the latest knowledge Reviewed by: Graefes Archive for Clinical and Experimental Ophthalmology, March 2015
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Life-threatening soft tissue infections caused by Clostridium species have been described in the medical literature for hundreds of years largely because of their fulminant nature, distinctive clinical presentations and complex management issues. The Clostridium species perfringens, septicum and histolyticum are the principal causes of trauma-associated gas gangrene and their incidence increases dramatically in times of war, hurricanes, earthquakes and other mass casualty conditions. Recently, there has also been an increased incidence of spontaneous gas gangrene caused by Clostridium septicum in association with gastrointestinal abnormalities and neutropenia. Similarly, over the last 15 years there has been increased recognition of a toxic shock-like syndrome associated with Clostridium sordellii in individuals skin-popping black tar heroin, in women undergoing childbirth or other gynecologic procedures including medically-induced abortion. Like their cousins Clostridium tetanus and Clostridium botulinum, the pathogenesis of these clostridial infections is largely the consequence of potent exotoxin production. Strategies to inhibit toxin production, neutralize circulating toxins and prevent their interaction with cells of the innate immune response are sorely needed. Recent studies have elucidated novel targets that may hold promise for newer therapeutic modalities.
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In der Geburtshilfe sind anaerobe Infektionen mit Clostridium perfringens (CP) eine Rarität, allerdings mit einer hohen maternalen Mortalität. Wir berichten über eine Patientin, bei der sich postpartal ein uterines Gas-Gangrän entwickelt hat und diskutieren das Management. Bei der 28-jährigen GII, PII mit Status nach Sectio in 2002 wurde wegen akutem Abdomen 48 h nach Vakuumextraktion eine Laparotomie bei Verdacht auf gedeckte Uterusruptur durchgeführt. Intraoperativ zeigte sich bei intakter Uterotomienarbe ein parametraner Riss, der übernäht werden konnte. 36 h später verschlechterte sich der Allgemeinzustand schlagartig. Bei Verdacht auf Cellulitis und nach Erhalt der Abstrichresultate (CP positiv) aus Uterus und Hämatom wurde die resistenzgerechte Antibiose (Tazobactam) mit Clindamycin kombiniert. Trotzdem konnte ein sich rasant entwickelndes Gas-Gangrän beobachtet werden, mit einseitiger Ausbreitung über das Abdomen bis in die linke Flanke von der Axilla und zum Oberschenkel reichend. Entscheidend für das Überleben der Patientin war, trotz hoch dosierter Antibiose, ein aggressives Management mit Hysterektomie, Nekroseausräumung und Faszienspaltung, gefolgt von mehrmaligem Débridement und offener Behandlung, um die anaeroben Bedingungen zu unterbrechen. Die Patientin konnte nach 21 Tagen entlassen werden. Sie entwickelte jedoch ein posttraumatisches Syndrom mit schweren depressiven Episoden. Clostridium perfringens ist ubiquitär, in 1 - 10 % auch vaginal bei gesunden Frauen zu finden. Sein Nachweis hat noch keine pathologische Bedeutung. Die Infektion aber, die sich in geeignetem Milieu entwickelt, von Endometritis bis zur Sepsis reichend, kann fulminant laufen. Eine Früherkennung und ein bewusstes interdisziplinäres Management sind von zentraler Bedeutung. Die aggressive chirurgische Behandlung mit Hysterektomie ist, kombiniert mit der entsprechenden Antibiotikatherapie, lebensrettend.
Gasbrandsepsis mit ungewöhnlicher Streuquelle
  • H Gujer
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Gujer H, Hartmann HP, Wiesmann E. Gasbrandsepsis mit ungewöhnlicher Streuquelle. Beitr Gerichtl Med. 1970;27:284-7.
Uteriner Gasbrand mit Clostridium Perfringens Sepsis nach intrapartaler gedeckter Uterusruptur
  • C Montavon
  • E Krause
  • W Holzgreve
  • I Hösli
Montavon C, Krause E, Holzgreve W, Hösli I. Uteriner Gasbrand mit Clostridium Perfringens Sepsis nach intrapartaler gedeckter Uterusruptur. Z Geburtsh Neonatol. 2005;209:167-72.
Gas gangrene and other Clostridium-associated diseases Mandell, Douglas and Bennett's principles and practice of infectious diseases
  • B Lorber
  • Gl Mandell
  • Je Bennett
  • R Dolin
Lorber B. Gas gangrene and other Clostridium-associated diseases. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas and Bennett's principles and practice of infectious diseases, vol 2. Part III. Infectious diseases and their etiologic agents, 4th ed. New York, Edinburgh, London: Churchill Livingstone; 1995. pp. 2182– 2195.
3 The restored museum specimen 129 CBF: sponge-like appearance of the liver parenchyma due to fatal intrauterine gas gangrene
  • Fig
Fig. 3 The restored museum specimen 129 CBF: sponge-like appearance of the liver parenchyma due to fatal intrauterine gas gangrene
Part III. Infectious diseases and their etiologic agents
  • B Lorber
Lorber B. Gas gangrene and other Clostridium-associated diseases. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas and Bennett's principles and practice of infectious diseases, vol 2. Part III. Infectious diseases and their etiologic agents, 4th ed. New York, Edinburgh, London: Churchill Livingstone; 1995. pp. 2182-2195.