Clostridial intra-abdominal and pelvic infections

[PussyCat]

Clostridia, primarily Clostridium perfringens, are common in mixed intra-abdominal infections due to a ruptured viscus or pelvic inflammatory disease. Symptoms of abdominal infection may include fever, pain, and tenderness; symptoms of pelvic infection may include a foul-smelling discharge. Diagnosis is by Gram stain and culture. Treatment is with penicillin and surgical debridement.
(See also Overview of Anaerobic Bacteria and Overview of Clostridial Infections.)
Clostridial infections of the abdomen and pelvis are serious and sometimes fatal.
Clostridium species are common residents of the gastrointestinal tract and are present in many abdominal infections, generally mixed with other enteric organisms. Clostridia are often the primary agents in the following:

Emphysematous cholecystitis
Gas gangrene of the uterus (which may occur after delivery and was previously common in patients who had a septic abortion)
Certain other female genital tract infections (tubo-ovarian, pelvic, and uterine abscesses)
Infection after perforation in colon carcinoma

The primary organisms are C. perfringens and, in the case of colon carcinoma, C. septicum. The organism produces exotoxins (lecithinases, hemolysins, collagenases, proteases, lipases) that can cause necrosis. Gas formation is common. Clostridial septicemia may cause hemolytic anemia because lecithinase (alpha-toxin) disrupts red blood cell membranes. With severe hemolysis, muscle necrosis, and coexisting toxicity, acute renal failure can occur.