Zusammenfassung
Es werden zwei konsekutive Fälle von lebensbedrohendenClostridium-perfringens-Infektionen bei intravenösen Drogenabhängigen in Wien berichtet. Myonekrose ist eine Infektion, die besonders das Muskelgewebe betrifft. Zumeist ist der verursachende ErregerClostridium perfringens, aber andere Clostridien wieC. novyi, C. septicum, C. histolyticum, C. fallax oderC. bifermentans können auch Auslöser der Erkrankung sein. Das klassische Gas-Gangrän präsentiert sich als akute Erkrankung mit fulminantem Verlauf. Daher ist jede Verzögerung in der Diagnose und Therapie fatal. Der operative Situs zeigt betroffene Muskelgruppen dunkel rot, wobei die Muskeln zu keiner Kontraktion fähig sind und nur wenig bluten. Ein Krepitus, obwohl nicht unbedingt prominent, kann gelegentlich beobachtet werden. Es gelang, Sporen, die morphologisch nicht von Sporen vonClostridium perfringens zu unterscheiden waren, aus einer Heroin/Kokain-Probe des zweiten Falles zu identifizieren. Allgemein- und Notfallmediziner sollten die Möglichkeit einerClostridium perfringens-Infektion bei i.v. Drogenabhängigen in Betracht ziehen, insbesondere, wenn Drogen in Weichteilgewebe appliziert worden sind.
Summary
We describe two cases of severe myonecrotic infections caused byClostridium perfringens in injecting drug users (IDUs) in Vienna, Austria. Clostridial myonecrosis, or gas gangrene, is a clostridial infection primarily of muscle tissue.C. perfringens is isolated in 90% of these infections. Other clostridial species isolated areC. novyi, C. septicum, C. histolyticum, C. fallax, andC. bifermentans. Classically, clostridial myonecrosis has an acute presentation and a fulminant clinical course. It is diagnosed mainly on a clinical basis. The infection may be so rapidly progressive that any delay in recognition or treatment may be fatal. The onset is sudden, often within 4 to 6 hours after an injury. An early clinical finding is sudden severe pain in the area of infection. Swelling and edema in the area of infection is pronounced. At surgery, the infected muscle is dark-red to black, is noncontractile, and does not bleed when cut. Crepitus, although not prominent, is sometimes detected. We were able to demonstrate spores that were morphologically indistinguishable from spores ofC. perfringens in a drug sample obtained from case 2. General practitioners and accident and emergency staff should be aware of the possibility ofC. perfringens infection in IDUs, especially if injection into soft tissue is suspected.
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Assadian, O., Assadian, A., Senekowitsch, C. et al. Gas gangrene due toClostridium perfringens in two injecting drug users in Vienna, Austria. Wien Klin Wochenschr 116, 264–267 (2004). https://doi.org/10.1007/BF03041058
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DOI: https://doi.org/10.1007/BF03041058