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Peng J, Zhai Q, Li J, Chen X, Wu H, Zhong T, Tang G, Yu D, He L, Li J. Clostridium perfringens Liver Abscess Disguised as Biliary Disease: A Report of Two Cases and a Review of the Literature. Infect Drug Resist 2023; 16:5209-5222. [PMID: 37589015 PMCID: PMC10426438 DOI: 10.2147/idr.s415347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/26/2023] [Indexed: 08/18/2023] Open
Abstract
Liver abscesses caused by Clostridium perfringens are rare but rapidly fatal. In only a few days, patients progress from liver abscess to sepsis, intravascular hemolysis, multiple organ failure, and even death. These abscesses often occur in patients after trauma or surgery or in those with immunodeficiency. Because patients only show non-specific symptoms such as fever and abdominal pain in the early stage, they can easily be misdiagnosed and miss the therapeutic window, resulting in a poor prognosis. The diagnosis of Clostridium perfringens liver abscess mainly depends on computed tomography (CT), needle aspiration, and/or blood culture. After diagnosis, treatments such as antibiotic therapy, surgical abscess drainage, blood transfusion as needed, and correction of metabolic disturbances must be immediately administered to prevent severe complications. Here, we present two cases of liver abscess due to Clostridium perfringens infection. Both patients initially presented only with fever, abdominal pain, and jaundice, symptoms that were easily confused with cholangitis caused by cholelithiasis. The patients then progressed rapidly and, despite receiving antimicrobial and multimodal sepsis treatment, both eventually died of multiple organ dysfunction syndrome. Clinicians should be on high alert for Clostridium perfringens liver abscesses disguised as biliary disease. Early diagnosis and treatment with the appropriate antibiotics and surgery are fundamental for the survival of the affected patients.
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Affiliation(s)
- Jialun Peng
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - Qilong Zhai
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - Jinzheng Li
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - Xingyu Chen
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - Hongyu Wu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - Tao Zhong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - Gangyi Tang
- Department of General Surgery, Wushan County People’s Hospital of Chongqing, Chongqing, 404700, People’s Republic of China
| | - Dajun Yu
- Department of General Surgery, Wushan County People’s Hospital of Chongqing, Chongqing, 404700, People’s Republic of China
| | - Lixian He
- Department of General Surgery, Wushan County People’s Hospital of Chongqing, Chongqing, 404700, People’s Republic of China
| | - Jinxu Li
- Department of General Surgery, Wushan County People’s Hospital of Chongqing, Chongqing, 404700, People’s Republic of China
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Li Z, Yan C, Gong X, Wang J. Severe Intravascular Hemolysis from Clostridium perfringens Septicemia in a Neonate with Necrotizing Enterocolitis in China: A Case Report. Infect Drug Resist 2022; 15:1461-1465. [PMID: 35401007 PMCID: PMC8986761 DOI: 10.2147/idr.s355621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/21/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Zhiqi Li
- Department of Neonatology, ChangNing Maternity and Infant Health Institute, Shanghai, 200051, People’s Republic of China
| | - Chongbing Yan
- Department of Neonatology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, 200062, People’s Republic of China
| | - Xiaohui Gong
- Department of Neonatology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, 200062, People’s Republic of China
| | - Junfang Wang
- Department of Neonatology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, 200062, People’s Republic of China
- Correspondence: Junfang Wang, Department of Neonatology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, 200062, People’s Republic of China, Tel +86 21 52976179, Email
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Liu F, Xue S, Zhang Y, Yang J, Hu J, Li D, Ma X, Wang J. Clostridium perfringens sepsis in three patients with acute leukemia and review of the literature. Int J Hematol 2021; 113:508-517. [PMID: 33387294 PMCID: PMC7776304 DOI: 10.1007/s12185-020-03060-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 11/22/2022]
Abstract
In this study, we aimed to improve understanding of the clinical manifestations, laboratory findings, and risk factors of Clostridium perfringens sepsis in patients with acute leukemia and to analyze treatment strategies for improving prognosis. We analyzed clinical manifestations, laboratory data, diagnosis, and treatment strategies in three cases of C. perfringens sepsis in patients with acute leukemia. We also reviewed and analyzed the relevant literature, incorporating our findings into the discussion. All three patients developed septic shock with neutropenia following chemotherapy. Analysis of blood samples confirmed the presence of C. perfringens, and two patients had fulminant intravascular hemolysis and developed multiple organ dysfunction syndrome. Two patients survived and one died despite timely and full-dose antibacterial treatments, blood purification, and noninvasive positive pressure ventilation. Overall, our findings showed that C. perfringens sepsis is rare in patients with acute leukemia but progresses rapidly. A high mortality rate was observed, and patients often experienced refractory shock and intravascular hemolysis. This demonstrates the importance of early detection and diagnosis. Multimodal treatments, including fluid resuscitation, antibiotics, organ support, and blood purification, are essential for success.
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Affiliation(s)
- Fuhong Liu
- Department of Hematology, Aerospace Center Hospital, No. 15 Yu Quan Road, Beijing, 100049, China
| | - Song Xue
- Department of Hematology, Aerospace Center Hospital, No. 15 Yu Quan Road, Beijing, 100049, China
| | - Yongping Zhang
- Department of Hematology, Aerospace Center Hospital, No. 15 Yu Quan Road, Beijing, 100049, China
| | - Jingxian Yang
- Department of Laboratory, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Jiajun Hu
- Department of Hematology, Aerospace Center Hospital, No. 15 Yu Quan Road, Beijing, 100049, China
| | - Di Li
- Department of Hematology, Aerospace Center Hospital, No. 15 Yu Quan Road, Beijing, 100049, China
| | - Xiaojun Ma
- Department of Infectious Diseases, Peking Union Medical College Hospital, No. 1 Shuai Fu Yuan, Beijing, 100005, China.
| | - Jingbo Wang
- Department of Hematology, Aerospace Center Hospital, No. 15 Yu Quan Road, Beijing, 100049, China.
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Chinen K. Sudden death caused by Clostridium perfringens sepsis presenting as massive intravascular hemolysis. AUTOPSY AND CASE REPORTS 2020; 10:e2020185. [PMID: 33344302 PMCID: PMC7703123 DOI: 10.4322/acr.2020.185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
An 80-year-old Japanese woman with diabetes mellitus was admitted with gastrointestinal symptoms and pyrexia. At presentation, liver abscesses and severe hemolytic anemia were noted. Before detailed diagnostic evaluation and adequate treatment, she suddenly died 2.5 hours after admission. The autopsy and bacteriological examinations revealed liver abscesses and massive intravascular hemolysis caused by Clostridium perfringens as well as other miscellaneous critical pathological findings, including acute renal tubular necrosis, lung edema, and pulmonary fat embolism. In this article, the detailed autopsy results are described and clinicopathologic characteristics on Clostridium perfringens-related sudden death are discussed with a review of the literature.
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Affiliation(s)
- Katsuya Chinen
- Nerima General Hospital, Department of Pathology. Nerima, Tokyo, Japan
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Landi G, Gualtieri G, Bello IS, Kirsch D. A case of fatal Clostridium perfringens bacteremia and sepsis following CT-guided liver biopsy of a rare neuroendocrine hepatic tumor. Forensic Sci Med Pathol 2017; 13:78-81. [PMID: 28093692 DOI: 10.1007/s12024-016-9823-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Gianluca Landi
- Section of Legal Medicine, University of Siena, Siena, Italy.
| | | | | | - Daniel Kirsch
- The Office of Chief Medical Examiner, New York City, NY, USA
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Lim AG, Rudd KE, Halliday M, Hess JR. Hepatic abscess-associated Clostridial bacteraemia presenting with intravascular haemolysis and severe hypertension. BMJ Case Rep 2016; 2016:bcr-2015-213253. [PMID: 26823354 DOI: 10.1136/bcr-2015-213253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Clostridium perfringens bacteraemia is a potentially fatal condition, and its early identification is paramount to maximise chances of survival. Prompt recognition of intravascular haemolysis, a known complication of C. perfringens bacteraemia, can help guide clinical decision-making before microbiology data becomes available. We present a novel finding of severe hypertension in a fatal case of Clostridial bacteraemia with massive haemolysis. A 58-year-old man with no known medical history presented to the emergency department with malaise, fever and hypertension. He developed abdominal pain and a hepatic abscess was identified on CT imaging. Within 4 h of presentation, he developed massive intravascular haemolysis, extreme hypertension, pulmonary oedema and respiratory failure. He died less than 8 h after presentation. His blood cultures subsequently grew C. perfringens. This case underscores the importance of early recognition of intravascular haemolysis complicating C. perfringens bacteraemia, and discusses the rare complication of hypertensive emergency in this setting.
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Affiliation(s)
- Andrew George Lim
- Division of Emergency Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Kristina Elizabeth Rudd
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Melissa Halliday
- Division of Emergency Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - John Rider Hess
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
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Acute Hemolysis with Renal Failure due to ClostridiumBacteremia in a Patient with AML. Case Rep Infect Dis 2016; 2016:6549268. [PMID: 27774325 PMCID: PMC5059580 DOI: 10.1155/2016/6549268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/07/2016] [Indexed: 11/17/2022] Open
Abstract
We present a case of acute hemolytic anemia, renal failure, and Clostridium perfringens bacteremia in a patient with acute myelogenous leukemia. The high fatality of C. perfringens bacteremia requires that clinicians recognize and rapidly treat patients at risk for this infection. Although other hemolytic processes are in the differential diagnosis of these events, the presence of high fever, chills, and rapidly positive blood cultures may help narrow the diagnosis. Most cases of C. perfringens bacteremia have a concomitant coinfection, which makes broad spectrum empiric therapy essential. There is a high mortality rate of C. perfringens infections associated with leukemia.
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Simon TG, Bradley J, Jones A, Carino G. Massive intravascular hemolysis from Clostridium perfringens septicemia: a review. J Intensive Care Med 2013; 29:327-33. [PMID: 24019300 DOI: 10.1177/0885066613498043] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We describe the case of a patient with hemolysis-associated Clostridium perfringens septicemia and review all similar cases published in the literature since 1990, with specific focus on the relationship between treatment strategy and survival. We searched PubMed for all published cases of C. perfringens-associated hemolysis, using the medical subject terms "clostridia," "clostridial sepsis," and/or "hemolysis." All case reports, case series, review articles, and other relevant references published in the English literature since 1990 were included in this study. There were no exclusion criteria. Each case was examined with respect to presenting features of illness, antibiotic regimen, time-to-antibiotic therapy, additional interventions, complications, and patient survival. These variables were entered into a data set and then systematically analyzed with the aid of a statistician, using serial t tests and chi-square analyses. Since 1990, 50 patients of C. perfringens septicemia with hemolysis have been reported. Median age was 61 years (range 31-84), and 58% were male. Mortality was 74%, with a median time to death of 9.7 hours (range 0-96 hours). Of the patients, 35 (70%) were treated medically, while 15 (30%) received antibiotics and surgery. Surgical intervention was associated with significantly improved survival (risk ratio [RR] 0.23, 95% confidence interval [CI] 0.10, 0.53) as was the use of a combination of penicillin and clindamycin (RR of death 0.46, 95% CI 0.25, 0.83). Four patients utilizing hyperbaric oxygen therapy (HBOT) have been reported, and all patients survived. In cases of clostridial sepsis with hemolysis, strong predictors of survival include early initiation of appropriate antibiotics as well as surgical removal of infected foci. The HBOT may also be associated with survival. The disease often progresses rapidly to death, so rapid recognition is critical for the patient survival.
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Affiliation(s)
- Tracey G Simon
- Brigham and Women's Hospital, Harvard University, Cambridge, MA, USA
| | - Joanna Bradley
- The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RL, USA
| | - Adisa Jones
- The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RL, USA
| | - Gerardo Carino
- The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RL, USA
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Yang CC, Hsu PC, Chang HJ, Cheng CW, Lee MH. Clinical significance and outcomes of Clostridium perfringens bacteremia--a 10-year experience at a tertiary care hospital. Int J Infect Dis 2013; 17:e955-60. [PMID: 23578849 DOI: 10.1016/j.ijid.2013.03.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 02/19/2013] [Accepted: 03/19/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The mortality rate of patients with Clostridium perfringens bacteremia is 27-44%. Typically, the clinical characteristics of this infection are non-specific, which leads to considerable difficulty with the diagnosis and early initiation of appropriate therapy. METHODS A retrospective cohort study of patients who were hospitalized between August 2002 and July 2011 with C. perfringens bacteremia was conducted within a 3715-bed teaching hospital in northern Taiwan. The patients identified in this search were included when they had fever or other clinical features suggestive of systemic infection. Multiple logistic regression analysis was applied to determine the independent risk factors of 30-day mortality. RESULTS A total of 93 patients were identified. Elderly patients with comorbid illnesses, especially renal insufficiency or malignancy, were at risk of developing C. perfringens bacteremia, and 23 patients (24.7%) had nosocomial bacteremia. The 30-day and attributed mortalities were 26.9% (25/93) and 8.6% (8/93), respectively. Nosocomial infection was a significant predictor for mortality within 30 days (odds ratio 19.378, 95% confidence interval 2.12-176.99; p=0.009), independent of other disease parameters. Other independent risk factors included the Charlson weighted index of comorbidity, length of hospitalization, and stay in the intensive care unit. CONCLUSIONS Early recognition of this critical infection and early initiation of appropriate antibiotic treatment by surgical intervention or drainage is essential.
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Affiliation(s)
- Chien-Chang Yang
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Shin Street, Gueishan, Taoyuan 333, Taiwan
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Clostridium perfringens Septicemia. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2012. [DOI: 10.1097/ipc.0b013e318234c3bf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Maroto F, Jara I, Barrero A. [Severe hemolytic crisis and multiorgan failure secondary to Clostridium perfringens infection]. Med Intensiva 2011; 36:240-2. [PMID: 21903298 DOI: 10.1016/j.medin.2011.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 05/26/2011] [Accepted: 06/04/2011] [Indexed: 11/19/2022]
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España Fuente L, Soto Mesa D, Fernández Díez A. [Emphysematous cholecystitis due to Clostridium perfringens]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2011; 58:129-131. [PMID: 21427832 DOI: 10.1016/s0034-9356(11)70014-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Rajendran G, Bothma P, Brodbeck A. Intravascular haemolysis and septicaemia due to Clostridium perfringens liver abscess. Anaesth Intensive Care 2010; 38:942-5. [PMID: 20865884 DOI: 10.1177/0310057x1003800522] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Intravascular haemolysis is a rare but serious complication of Clostridium perfringens sepsis. The outcome is usually fatal unless treatment is started early. We describe a case of survival after haemolysis and multiple organ failure in the setting of a ruptured liver abscess and sepsis caused by C. perfringens in an immunocompetent 58-year-old male.
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Affiliation(s)
- G Rajendran
- Department of Anaesthesia and Intensive Care, James Paget University Hospital, Great Yarmouth, United Kingdom.
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Pita Zapata E, Sarmiento Penide A, Bautista Guillén A, González Cabano M, Agulla Budiño JA, Camba Rodríguez MA. [Massive intravascular hemolysis secondary to sepsis due to Clostridium perfringens]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2010; 57:314-316. [PMID: 20527348 DOI: 10.1016/s0034-9356(10)70234-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Massive hemolysis secondary to sepsis caused by Clostridium perfringens is a rare entity but appears fairly often in the literature. In nearly all published reports, the clinical course is rapid and fatal. We describe the case of a 75-year-old woman with diabetes who was admitted with symptoms consistent with acute cholecystitis. Deteriorating hemodynamics and laboratory findings were consistent with intravascular hemolysis, coagulation disorder, and renal failure. Gram-positive bacilli of the Clostridium species were detected in blood along with worsening indicators of hemolysis. In spite of antibiotic and surgical treatment, hemodynamic support and infusion of blood products, the patient continued to decline and died in the postoperative recovery unit 14 hours after admission. Mortality ranges from 70% to 100% in sepsis due to Clostridium perfringens, and risk of death is greater if massive hemolysis is present, as in the case we report. Only a high degree of clinical suspicion leading to early diagnosis and treatment can improve the prognosis. This bacterium should therefore be considered whenever severe sepsis and hemolysis coincide.
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Affiliation(s)
- E Pita Zapata
- Servicio de Anestesiología y Reanimación, Hospital Arquitecto Marcide, Area Sanitaria de Ferrol, A Coruña.
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Uppal A, Hymes K, Schwartz DR. A 61-Year-Old-Man With Massive Intravascular Hemolysis. Chest 2009; 136:1424-1427. [DOI: 10.1378/chest.09-0950] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Macías I, de Zayas RS, Zoila L, Dólera C. Hemólisis intravascular masiva por Clostridium perfringens en paciente inmunocompetente. Enferm Infecc Microbiol Clin 2009; 27:548-9. [DOI: 10.1016/j.eimc.2008.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2008] [Revised: 10/19/2008] [Accepted: 11/10/2008] [Indexed: 10/20/2022]
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