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Fulminating Gastroenterocolitis Caused By Staphylococci

1953; Elsevier BV; Volume: 24; Issue: 4 Linguagem: Inglês

10.1016/s0016-5085(53)80111-3

1528-0012

Kornel Terplan, John R. Paine, John Sheffer, Richard Egan, Herbert Lansby,

Clostridium difficile and Clostridium perfringens research

Summary Detailed anatomic reports are presented of 8 cases in which various major surgical operations were performed, accompanied by administration of several broad spectrum antibiotics, including terramycin, Syncrobin (penicillin and streptomycin), and aureomycin. Dosages, which were in general comparatively small, and the combinations of the antibiotics used in some individual cases are presented in Table I. The clinical picture was characterized by nausea, vomiting, and a few loose stools, commencing from the first to the fourth postoperative day and changing rapidly into massive diarrheas, leading to a severe shock-like state. Death occurred from the third to the eleventh postoperative day. The causative agent responsible for the acute inflammation of the gastrointestinal tract was presented by large masses of staphylococci within the desquamated or loosely adherent pseudomembranous exudate covering the mucous coat, particularly in the small intestine (see Fig. 2 to 4). The recent inflammatory reaction was in general restricted to mucosa and submucosa. In five cases, colonies of coagulase positive hemolytic staphylococci were recovered from the intestinal tract and/or from the lungs. The clinical course and pathologic-anatomic findings, based in particular on bacteria stains of the tissue sections from the gastrointestinal tract and including the recent degenerative changes in the adrenals and kidneys, point to a severely toxic state from massive staphylococcic infection of the gastrointestinal tract, but not to a septicemic process. The staphylococci grown on blood agar in the few instances tested were resistant against all the antibiotics used in these cases. In three recent observations, not reported in detail, the same clinicopathologic syndrome was present, with the same rapid fatal outcome and the same pathologic, histologic, bacterioscopic and cultural findings. The staphylococci grown from the intestinal tract and from the lungs in these cases were sensitive only to Erythromycin, but not to the antibiotics administered.