unanuviieay AVSUAIALA Clostridium perfringens dou Muisuas * uss sasuyas** Tannirandorn Y, Dhamabutra N. Abortion complicated by Clostridium per- fringens infection. Chula Med J 1986 Sep; 30 (9) : 827-837 Septic abortions from Clostridium perfringens are still an important health problem in Thailand because of the high mortality rate. Clostridium perfringens produces many exotoxins which are responsible for the clinical manifestations of clostridial septicemia such as hemolysis, hemoglobinemia, hemoglobinuria, hyperbilirubinemia, acute renal failure, hyperkalemia and dis- seminated intravascular coagulation. The fullblown syndrome is easily diagnosed from the above manifestations, the presence of gas in the pelvic organs, foul smelling pus and positive gram stain for clostridium. High dose penicillin followed soon by curettage provides effective therapy with prompt recovery in less severe cases. Close observation is also necessary. The presence of hemo- lysis, hemoglobinemia, hemoglobinuria, hypotension, soft tissue gas in the pelvis, acute renal failure or septicemia are indications for total abdominal hysterectomy and bilateral salpingo-oophorectomy. Good supportive care is essential. Acute renal failure may indicate hemodialysis. The use of antitoxin and hyperbaric oxygen may be beneficial in some cases. * mefingimaed-uiovinn aucuwnuman’ ymeans clu tnerdts metngadyinn aucunnomised giasnscluninn dy828 ow diisiiny wax usm senanje Juuazinenemsyiuiatauenquams waswgfiousedonadadhunranetiviiangwany Sskunragnnourirurtslansénrsanra q Tosa wulvatuusciuaung tifiamsutstnde indy drazssnaltifinnneunsmfouss 4 qaanannany avsuttafindadiinan Cl. perfrin- gens dunvizuninfaundanariuistiqa- sdunnindomannmenits desonorany mafiadequurswurigndetteléwvae Surrada Aimeinginans-wovinn bes wouragmsanstt luszwhell we, 2500-2528 wuansmidediavinmsuvsaiada 3310 vn Jwnansorfaetationia 18 swdadquu maniinnaaiifinvimun 80,146 710 Fsludawa Swuflarnaiiqaludtatufioninda Cl. per- fringens 1 10 lusraisnsaivarizunandow inmsrhurtaatnys unnbdgqualalaiintis mmedondralusseetiaurn WlkmrinsAlal oansan daliipaudediebusseeamdurads sollumaidadunncurtstagofiinan Cl. perfringens “\diousluscexiiaucsndautiuns Wastnnfiomnesaatiavturaett alt sraninaaduar uacwadarimunslal' 2) 1 dagMine (Morphology) uaznamnia Ticinityvoa Cl. perfringens!) Cl. perfringens #30 Cl. welchii iy Seuefatinuouoloud unsunnithagulyn surisess ‘mnie 0. .0 “alesis ‘indouln 13x 34 (non motile) Sumuga@outau taidaowy ailafidatowend as seszseiniihonSoeinns wosdaunomrduador qt ucltudss ‘worwrrfices du Ellner medium yw suasqutaifiusiomlng 4 sw (oval subter- minal endospore) vwiavassuatin 7 Tu vegetative cell vilWhinunrwosvasieand grraanasinrvans Cl. perfringens Saaylungunasiaint fivinliifin gas gangrene \itoseina nian ‘Wrhrswifiafonunsuavidadodys q Walt Winornusames gas gangrene lunw Writ ‘anguiuanann Cl. perfringens u&atad Cl. novyi, Cl. septicum, Cl. histolyticum, Cl. fallax \Wee Cl. haemolyticum'4) Cl. perfringens & smuvnatianiie wantnad (exotoxin) nawrdafidrdyd 7 saint) (iurt 1. @ toxin siqnéurnaniinfonuns usernitifiadio@amuawnesas (necrotizing) 2 Bp toxin dqnfluvaliiiadadio muaweaay uaciiuiiwiatsssm (neurotoxic) 3. © toxin Signs luraliiadiodia moaawiesiay usvifhufiveodszenn 4.6 toxin fignélurhaniafonues uaciiabhifindlagamunawnza an 5. K toxin sqnfliioudededitin collagen 6 4 toxin Siqné'tliow hyaluronic acid 1. toxin figné'lurhnew DNA wes Ymudadaavn anarwarwraluntsad sarTAe wan candinari vinlwSruun Cl. perfringens oan ‘Willy 6 vila (types) “Murnfa A, B,C, D, E uae Fl) sinvifiudunavaslanluent wuvee duriniia A unssfiny Cl. perfringens & Teutly Sneiimuldmuuntadandsludyiden ls aeuuotnsdumufaatuarmuiudnlss) 2. auiimaal maurtstiogafiiiaain Cl. perfringens aianwaulaniauwuusssim 1 ly 307 fa4 ed Ti s0 alti o iiuuww 2520 1 ly 761 swvosnrsuvfaratul®) Baton) wy 14s 60 sxvesnnauvisfinda 3. MatfialsA (Pathogenesis)("2*7) Cl. perfringens wunaoriiiialsalu aulousiornmamion iu edoylwsoungn Smaunssason lousamaAado#quuss Vfietinnvnmadiedonuns uss lwantimw ls amuquussvostsaninmséindde Cl. per- Sringens Suny 1. Savasswwus, (strains) Butler) fawanfigwt Cl. perfrin- gens asinawarwug wiseawwugaslt snafivuoniaaddns q fudonsina squad Yabiiiamsfedoyuussaedunuganuttalgn Yewlavwyaumansurirew (phagocytosis) 2. siovoseaiwuonsad mwrudfimansantseriynanisnd aia a asvalivfiamsfadoquuss waving onsrnwuitusfanay 5 tudauau 640 sould ues Cl. perfringens’? €. amnefifimsan oxidative reduction potential asain Cl. perfringens uuon- uoladeunusdunciutaued Awulsernwunaly aruvatnaeéuvugantdendia daiumstiva Wihinlsalaesfinnniismacwiagowrsosrs Arhbistnietiinrsui saucers mauleté Tow nivinliifia oxidative reduction potential dhas) ammedendvattun mftiiedona Gonuidivs mafifldsudandaonsauitusins shawitlade matiedori 4 midasutill until viomaidimareigtulevastine uowuolsudeiedus ada) Holtz wa: Mauch(®) tésqusawans sho q fidududawfunrsifia Gas gangrene wad mreuMaAarto Clostridium perfringens 820 ‘vosuagrldur a. wouualsuddfesgmiaanmonant ‘Whusagn Teorsutiumentivias via rimmatasnaantlé a, dosmutitodotinw davzd aadalt drstiilads 6. odofinwt tosejmuluungnitia castmmunofieerialiauettisimauada a. iladavasuagniigniinawde sins aiuialavar student oiianesia > sansa eviction ‘Whdusuagnauiiuaaas tin anaerobic glyco- lysis Waliiiniaa314 lactic acid Ssazvialt pH aamsuncifin oxidative-reduction potential doas valtuouuolsudsonoonvinaves sha mast qiulauasmaudistaiin 1. perfringens wolatfianrsfiagoquusy fsmwla fudlodofgniewainnwofesi ifn mmewataunad untangle vosuenualrudit ungrlwunedaersA luunsnrétoe wuts fumiefiiensndusios uaeiimvrmniaiie dudawauann no distansinataun('®) n. mrautsdingatiiamumdsnstiarsias dna itu ahaa) waster lysol a. madairunfortushitlundmde uagnlusuaunrsviaurs a. mauvstnsufiianstiads wat Godafignina infos sogannlulwasuagn a. mafintanewlunssA idodarswiadenfimancaudansra Cl. perfringens fazfavsuistauasUnaus aie uonsasoonn maadiwarrisuonaadieos Woonssanm 24-48 Solus aniiyuonaad donde uihanadotratesyialtuowuelrudt830 dow sinisias uae wins sysuyns & qnawaindy otinedwutilenstasionns fiwuonsadodrannldun suas uae to Cl. perfringens auwiaatweaiye uanwadnaruriadandy aAvuanssd onthilesrltiinawms uazarmsusasshs 4 vasnnzifaniiusis (septicemia) Tarik uinifangniinernifia hemoglobinemia, hemo- globinuria, hyperbilirubinemia, \fa'leamdou ndu dlwunaviuurts waciinfowdumaly waaaifonuwinseai (disseminated intra vascular coagulation) aaranw uilwda(47112) mivfiainifanunsgnvinane iilunaan arvftyuonmatetin a Gahran (enzyme) lecithinase vzuvrarrtsventianfanuns amauansosidiefonuns Ssazrilitl he- moglobin daizlutanfesnri yoliihuntes Sigiiraractulls (portwine colored serum) hemoglobin Sa7ziezgndueonmsiagan in hemoglobinuria YWiaanetadiamady matfiaanelarnwduundu araifiean Amare AwuanTAA lu Munsaalalaass wSoaratfiagn acute tubular necrosis Ald mafia acute tubular necrosis iihnaevnnns fi hemoglobin datz lugaduralwlania Mommas aunavinmsfdmaiet anvintammituduauninudayialtifianny dufondafta msifinlnunsuiuauitongs vfavinms fin foaunsgmiameudaiinmiodlmunaden aamnifiuduraann Iwunsiduasauaumonsina ‘hisrunreduthwoanmslelaiiosnnfiametere Tau maifiatousumelunaoeifoauninss aw invinmsfiudinonuasgnyiiarnudausouans fag thromboplastin sana Ss9elunizda grnaemeiinsea nalnnrudsdrwosfoalandiunr extrinsic clotting pathway wieeradhwasinmfianiiy woniaaéludqné lavarssionttadnuluvomaaa von dsaztinsedunelnmaudadavesation Touriums intrinsic clotting pathway woneinisisfisuanaadvay Cl. per- fringens Cwuannsunindanlistuuaciiaes Wi shbiifiaine deer iiifinditosnrouunry (crepitation) duluidada voliiindludne ne \aynvuos gas gangrene unsrausiw("3) uth Cl. perfringens srunsasdsarsAyuensaseiie neurotoxin uaz myotoxin ‘law neurotoxin az'urinew aeuunheam dsowrligihandeielamely 24 Salus Tanamediluviamoquiases mh muquatisfideguestisme a4 myotoxin aziiitinnmsaaioonsiue unre uacifiaane hypersensitivity ‘l made Cl. perfringens ‘wamgn sowinn Minainmavhuts udursaisearaifianinosuits (or mautshinwy nasoafienumntonat thidurousunssAMla'®) wu Cl. per- Sringens \iusrvnafivaiiianrsutatndots Foun: 8-27( Mahal) wuiiaravaurtan saliifianstadasinlsnddwunndigatdun masenmunsauisarisititllulnrwagn wutouse 64 nvdanrurvedweiitvlulyss uagn nufauas 20 saufinfariesinnaly Aandu 9 ditululwssuagn sowisimsdinseu vouvsmuunnlussinelneldun asdevos inaacdilsowagnlandtamsauensfivonrinn dhnuagnidudswutstouay 67.519) Folin Aafionsfadonnlsadtasw 4. dpa mandvin Mufiamadiaa Cl. perfringens lawAW 20 atid o fiwuruu 2529 fithuitas ommvciinmaly 24-48 alus waar mavinuvts Fonudedauay 65(9) aaulurwh Wuannazmuarmamely 24 Falusl®) daunsads nawudiornrafaanmvazanes 6 Saluandterhuta ata) aimaidausn fo Sifonaannrstes anon therios iene Stimundul? 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Duin ondadoAdssMinfogsatuuinm dood moaned virmidotoratia ‘Wfunon8 eueritiutug sfiaretis hydrogen peroxide 4u vtasain Clostridium ‘hitler Yindaufveaaw hydrogen peroxide ¥114 hydrogen peroxide ‘hlaanqnéduiismaaiq Viulewes Clostridium wactubansad arity wonusndty Fodovosnnlgoondiuaniniudugs fife iannzeondimmiuiwdalonté volt diannstnuaswolanyauduls daquluanmfiAsoond uanadwti quorelddaufums Mew gfoucuasdoutuns Yaeinolé usidurssworn?) wudnt dandiawnrnantadugslilanalksarroaew (survival rate) vosifuauitara 7.8 msinwuuuseriuszAed maine uuulseMuuszaasdy 9 Muti mibithinfanaunuliiuswe maliifonuss osfusznouresifiomnaunn mainsrmeitien idunsa mauffluanwlisaqadvesnfoud mal heparin lunatasranetoudanols waononuwiniyswiudsliufoutuit Tnuviatu@) dauluswfifianns'tanmudans ‘yn peritoneal dialysis(?5) va hemodialysis analy 24 fa 48 Falwsl@”) onsinusnnaitin uremia ussiWavioaldunadomuacvasite dhaq muludromaan waneiniisd eta aiiAuanupad uaz hemoglobin Saizaen