Diffuse spreading Clostridium septicum infection, malignant disease and immune suppression.

Nineteen patients have been treated with gas gangrene infection proved on cultures to be caused by Clostridium septicum. Infection occurred after trauma in three patients and occurred spontaneously in 16, including six patients with peritonitis. None of the instances occurred as a postoperative infection. Ten of the patients had an associated malignant disease including carcinoma of the colon and rectum in six, hematologic malignant conditions in three and carcinoma of the gallbladder in one. Of the remaining six patients, four had evidence of immune suppression (two had leukopenia, one was preleukemic and one had undergone a postcadaver renal transplant), one had diabetes and one had overwhelming sepsis due to a perforated gallbladder with peritonitis. Only three of the 19 patients were otherwise healthy, and infection occurred after trauma in all of these patients. Four patients were moribund upon admission and died before initial therapy was completed. In the other 15 patients, treatment consisted of administration of penicillins and broad spectrum antibiotics and débridement, as well as hyperbaric oxygen in 13 patients. Thirteen of 19 patients died and eight of ten with malignant disease died. The data show a striking relationship between Clostridium septicum and both malignant disease and immune suppression.