Pathology of fatal traumatic and nontraumatic clostridial gas gangrene: a histopathological, immunohistochemical, and ultrastructural study of six autopsy cases.
We prospectively investigated six fatal cases of clostridial gas gangrene using autopsy, histology, immunohistochemistry, microbiology, and scanning electron microscopy. The causative pathogen was Clostridium perfringens in four cases, C. sordellii in one case, and a mixed infection with both C. perfringens and C. sordellii in one case. According to the previous medical history and autopsy findings, clostridial infection was related to trauma in three cases. Characterized by extensive tissue necrosis and total absence of an accompanying leukocyte infiltration and tissue inflammatory response, the histopathological picture of clostridial gas gangrene is distinctly different from other bacterial infections. In medicolegal casework, the proof of the source of infection and the portal of entry of the responsible pathogen is not always an easy task, especially in the absence of trauma.
Tsokos
Michael
M
Institute of Legal Medicine and Forensic Sciences, Charité-Universitätsmedizin Berlin, Turmstr. 21 (Haus L), 10559, Berlin, Germany. mtsokos@web.de
Schalinski
Sarah
S
Paulsen
Friedrich
F
Sperhake
Jan P
JP
Püschel
Klaus
K
Sobottka
Ingo
I
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000150:complications; D001921:Brain / Q000382:microbiology / Q000473:pathology; D003013:Clostridium / Q000302:isolation & purification* / Q000648:ultrastructure; D005260:Female; D049429:Forensic Pathology; D005738:Gas Gangrene / Q000473:pathology*; D006470:Hemorrhage / Q000382:microbiology / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D007668:Kidney / Q000382:microbiology / Q000473:pathology; D008099:Liver / Q000382:microbiology / Q000473:pathology; D008168:Lung / Q000382:microbiology / Q000473:pathology; D008297:Male; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology; D009336:Necrosis / Q000382:microbiology / Q000473:pathology; D010195:Pancreatitis / Q000150:complications; D011446:Prospective Studies; D012872:Skin Diseases, Vesiculobullous / Q000382:microbiology / Q000473:pathology; D013154:Spleen / Q000382:microbiology / Q000473:pathology; D014947:Wounds and Injuries / Q000150:complications